09.01 Intake and Output (I&O)

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All right in this lesson we're going to take a look at intake and output.

As we first get started, I want you to understand that when we refer to I&O, were talking about intake and output. Is a really common nursing term, so I want you to be really familiar with it. When you hear I&O, your ears should totally perk up.

Intake and output are way medical providers can check fluid and electrolyte balances for patient. They’re literally measurements for patients in the form of volume intake and what they put out, whether that's a drain or weather they're eliminating it..

I&Os also identify a patient's risk for having extra fluid or not having enough fluid. This is really important for your kidney and your cardiac patients, because their organs aren't working at maximum capacity, so you may put extra work on the heart, or you may put extra stress on the kidneys.

One little pro-tip that you need to keep in mind is that when you're weighing your patients, one kilogram of body weight is equal to about a liter of fluid. So if your patient weighs three more kilograms and they did yesterday, they potentially could have about 3 liters of extra fluid on them. For cardiac and kidney patients this could be a really big deal, so just keep that little notation back in the back your mind. You also want to make sure that you're weighing your patients daily. That way you can keep a really solid track of their fluid status and see if you have any changes in their trends over time.

So let's get the nuts and bolts of intake and output.

This is where your intake and output is really going to be important.

For patients on fluid restriction, so your kidney and your cardiac patients, this is where you're going to have to be really precise in measuring what they take in and what they put out. This is going to be crucial to their overall fluid status, so be really mindful of that.

The other type of patient that you're going to really pay attention intake and output on, are your critical or your unstable patients. These patients are going to be really susceptible to fluid shifts, so any little bit of fluid in the wrong spot could make a huge difference in their outcomes so really pay attention to how much they're taking and how much they're putting out.

The other time you're going to want to think about intake and output is when you have a patient on IV fluids, or if they're on a diuretic. Remember with IV fluids or giving fluids directly in to their cardiovascular system, so they're really susceptible to those small changes. The important thing you need to focus on when were talking about diuretics is that you were promoting them to kick out more fluid. So if they just start jumping out a bunch of fluid, we need to be mindful of their fluid status and really pay attention to how much they're taking in and how much they're putting out.

So what exactly is in take?

We're talkin about fluids by mouth, so things like coffee, juice, soup, broth, ice cream, Etc. Foods have a general volume of fluid, but we really want to pay attention to those liquids. One of the things that you need to keep in mind is the measurements of the volume of intake. Coffee is usually going to be between 180 to 200 mL, juice is going to be about 120 ml. What you need to do is check the container that they're in to see what the actual volume is. This will help you to keep a better idea of how much fluids are actually taking in.

One quick tip about ice chips, is that you record the volume of half of what it is. So if you give your patient 8 oz of ice chips, the fluid that's going to be in there is 4 oz of water.

The other time you going to want to keep an eye on fluid intake are for patients with tube feedings. You always have a pump for your tube feedings, And you can always check for the total volume that your patient is getting in.

The other thing you're going to have to keep an eye on is their IV fluids. Always keep an eye on your patient’s fluid rate, and their fluid volume that they've gotten over your shift or any given time period. You want to make sure that your patient’s not getting too many fluids, make sure they're not getting them too fast, and make sure that they're always the right fluid for the order.

Sometimes your patients are going to have fluid restrictions. So for your cardiac and kidney patients, they may be on a fluid restriction, and a strict i&o. What a strict i&o is, is that you are absolutely monitoring every single milliliter that goes in and out of your patient. It's really standard for your ICU floors, but it's not standard on your med-surg floors. So if you have a fluid restriction, you can almost always anticipate having a strict i&o order. That just means measure everything in and everything out, and make sure that it's accounted for.

When we're talking about output, we're talking literally about all the fluids coming out of the patient. So whether that's something they're eliminating, something they're throwing up, or any drainage from any wounds, or if they have any particular drains, these are the things were talking about.

If your patient can eliminate on their own, be sure that your educating them on how to use whatever tool they're using. So they're using a bedpan, make sure that they're using it right and make sure that you measure all of the output With something like a graduated cylinder. This will help with accuracy. If they can get up and go toilet in restroom, make sure you have one of those urinal hats so that they can pee in it and you can measure it accurately. Also make sure to educate your patient not to pee around the hat and that they need to pee in the Hat. If they don't, you're missing out on what their actual output is, And you want to make sure that you're accounting for everything.

If you have a drain, you should be able to measure that in a measuring cup or graduated cylinder, and if you have a wound that's draining, what you can do is stick a disposable pad underneath the draining wound, and then when you need to change it, you can actually measure the weight of the pad, and you can get an idea of what the fluid volume is. So for instance if you have a wound that draining, and you measure it, and it weighs 500 grams, And that's after you took off the weight of the actual disposable pad, you can estimate that it would be about five hundred mL of fluid.

The big thing that you need to know here it is that you want to measure absolutely everything that comes out of your patient. If you got an NG tube to suction, you want to measure their stomach contents, if your patient is having liquid diarrhea, make sure you're measuring it. Some units require you to measure all stool, so just find out what your policy is on that. Sometimes strict I&Os are only about liquid diarrhea, but just check.

For nursing concepts for intake and output, we really focus on fluid and electrolyte balance, nutrition, and elimination aspect of our patients.
Alright so let's recap.

Measure absolutely everything. Everything needs to be accounted for, so that everything in and everything out.

When you're talking about intake, know your measurements. Always refer back to the little container that your patients are drinking from.

Make sure that you check all of your output on your patience. So that's all your drains, all of your containers, if you have an oozing wound, make sure you're measuring absolutely everything.

Educate your patient. If your patient is peeing outside of the Hat, it doesn't help you. Make sure they know where they need to be eliminating into.

Lastly strict I&Os don't only account for ICU patients. So if you have an order for it to make sure that you're paying attention to it and also make sure that your adhering to a strict fluid restriction orders from your provider.

So that's our lesson on intake and output.Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!
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