Why is intake and output monitored

It is very convenient for IV drip solutions to be kept as part of the ward stock, because large amounts are used especially in acute care wards.

However, issues arise when additions like electrolyte such as Potassium or drugs such as inotropes dopamine, dobutamine , heparin and antibiotics need to be added. Hence, the admixture may be done by the nurse in the ward or by pharmacists. The nurses are trained on how to ensure that the right concentration is given and the aseptic technique is followed. The need for mixing to the correct concentration and asepsis is also applicable if pharmacists are to make the additions. The advantage is less people need to be trained.

The trade-off is that the supply may be delayed. The workload of the pharmacy will be increased and the staff available may not be able to cope. However, most hospitals make it a rule that only pharmacists are allowed to mix items such as parenteral nutrition and cytotoxic drugs.

The instances when the nurse needs to enter write down data into the chart include:. The nurse enters the actual time that she starts the infusion rather than the time planned. The time is recorded on rows within the column on the extreme left. The same column is use for all activities and happenings including for the output e.

The time fluid is put up need to be recorded. The nurse needs to ensure that the type of fluid being infused is the same as the one ordered. The type of fluid being set up e.

Because the columns may not be wide enough, it may be necessary to use abbreviations. The chamber usually contains the maximum of ml. If a syringe is used with a pump, then the amount set up would be the amount drawn into the syringe usually 50 or ml. If the pack is finished in the middle of the shift, the volume in the replacement pack is recorded as the amount set up. The amount that has gone in need to be recorded at these instances:. The amount of the remainder fluid is noted in the chart for the benefit of the nurse of the next shift.

If an infusion pump is used, the amount given as indicated on the machine is read from it. Also, if a change is made, the new type of fluid and the amount put up must be recorded.

Since the amount that has gone in is for a period, the data must be written at the time it is calculated or read i. It is quite common for patients to be given intravenous fluid therapy. Frequently, IV fluids are given via a single vein using a single set.

When a certain amount is planned for a period, e. If the infusion time is delayed or brought forward for any reason, then the rate need to be increased or decreased accordingly so as to ensure the necessary amount is in fact transfused. Therefore, the nurse needs to observe by counting or otherwise the rate of flow and the remainder amount in the pack.

Often, the right amount is not given if the line is obstructed or the rate becomes too fast. In emergency situations when fluid is given rapidly, the nurse ensures that the actual amount required as ordered is given at the speed required.

Since, traditionally, the recording the intake and output is the duty of nurses, it is logical that the chart is segmented into sections according to nursing shifts. The nurse on duty calculates the cumulative total at the end of the shift. The remainder will be recorded again by the nurse in charge at the next shift as the starting amount.

To record the intake two separate charts may be used for the each of the line. The shift total is made up by adding the total for each line. However to avoid confusion, for recording of the Output only on one of the charts should be used preferably the second one. A different Intake Chart with two sections can be used when two sets of infusion system are used for e. It caters for the different site of administration by having two sections for intake as shown below: Chart with Sections for Two Sites of Administration for one shift.

In this chart, the width of the column is compromised and abbreviations may be used. It is quite impossible to have charts with columns for more than two sites or routes. In this situation, it is better to use more than one chart. When two separate charts or a chart with two sections are used, the total for each section is added to give the shift total. This is recorded at a supplementary section at the bottom of one of the charts preferably the one that comes later.

The doctor or nurse may order and plan the feeding regime or a dietitian is consulted. The dietitian may recommend the type and amount of liquid food formulation to use based on fluid and calorie requirements. Usually, the nurse will plan the frequency of feeds and the amount for each feed. Enteral tube feeds may be given in two ways:. For patients taking well orally and on a normal diet, an Intake-Output Chart is quite unnecessary.

Indications include:. For oral feeds, depending on circumstances, the doctor or nurse may decides on how much fluid to be given and how frequently. The nurse provides the desired amount to the patient in a container e. Situations where the amount needs to be controlled and measured carefully are:. Intermittent bolus feeding is suitable mainly for feeds via nasogastric tube or gastrostomy, even though it is also practiced for feeding via nasoduodenal or nasojejunal tubes.

If all or most of the feed is not passed on or retained, this will indicate that there is problem with gut motility or absorption. The route of administration may be reduced in amount, a different type of formula or feeding by this route is abandoned,. Bolus feeding may give rise to the problems of inadequate digestion and diarrhea.

By giving feeds in small amounts there is a better chance of absorption and less chance of food left undigested. The incidence of diarrhea is also reduced. The setting up, calculation of rate of infusion and recording amount gone in and left over is similar to that of IV infusion. Feeding can be given via a nasogastric tube as a temporary measure in the situation where a patient cannot swallow.

For feeding for longer periods, creating a gastrostomy for the purpose is better. Usually, the intermittent bolus feeding method is used for this route.

A gastrostomy is done to bypass the mouth and esophagus in cases of inability to swallow, obstruction or injury to the aesophagus. If the rest of the gastrointestinal tract is healthy, blended or homogenized food of any type can be given. Where the rest of the bowel has limitations in motility or absorption, then milk and other formulas may be given.

The intermittent bolus feeding method usually works well for gastrostomy feeding. A fine small diameter feeding tube can be placed so that it ends in the duodenum or jejunum using endoscopy or radiology imaging. It is indicated when there is gastric stasis or risk of aspiration as well as for acute pancreatitis and hyperemesis.

Feeds via these routes are administered continuously by infusion pump. Most people pee void 6 to 8 times every 24 hours. Each time you void, you should get to ml 1 to 2 cups of urine. Why do we measure intake and output? Category: healthy living nutrition. Identify whether your patient has undergone surgery or if he has a medical condition or takes medications that can affect fluid intake or loss.

How do you assess intake and output? Calculate Intake. Calculating a patient's daily intake will require you to record all fluids that go into the patient.

How do you record intake and output? Should fluid intake equal urine output? What is an intake and output chart? How do you measure urine output? How much water should a person with congestive heart failure drink a day? How do you calculate total fluid intake? Formulas Used:. For example, a number of seniors suffer from pressure ulcers each year, which can lead to septic shock. Those with circulation problems are at a higher risk as well. When hospitals are understaffed, nurses can be in such a rush that an assessment is never performed, or it can be quickly glossed over.

This is why patient advocate services like VBPA exist today. A major part of being a patient advocate is knowing how healthcare facilities are required to operate, being familiar with medical conditions and how to treat them, and knowing who to speak to regarding important matters.

Values Based Patient Advocate can provide you or a loved one with bedside monitoring, which is an invaluable service to have. You can change your ad preferences anytime. Intake and output chart. Upcoming SlideShare. Like this presentation? Why not share!

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