intake and output

Definition: Measuring intake and output (I&O) helps to determine the fluid status of the client.
References:
- Clinical Nursing Skills & Techniques 2nd Edition, Chapter 8: Health Assessment (Section Procedural Guideline 8.1 for Measuring Intake & Output)
- Canadian Fundamentals of Nursing, Chapter 41, pgs. 1016-1018 (Fluid Output Regulation and Fluid Intake Regulation, Table 41-1: Healthy Adult Average Fluid Intake and Output).

Definition: An electrolyte imbalance occurs when there is either an excess or deficiency of certain minerals in the body, which could indicate issues such as kidney disease.
Electrolytes:
- Minerals (such as sodium, potassium, calcium, etc.) that carry an electrical charge when dissolved in fluids like blood and urine.
- Produced by the body and obtained from foods, drinks, and supplements.
- Critical roles include balancing body fluids, regulating heart rhythm, and supporting nerve and muscle function.

I&O measurement is crucial when there are significant electrolyte losses due to:
- Vomiting and diarrhea
- Gastrointestinal drainage
- Extensive open wounds (e.g., burns)

I&O can be:
- An independent nursing intervention
- A dependent nursing intervention (requires physician's orders)
Accurate measurement and recording of I&O are vital for renal patients and those with congestive heart failure (CHF).

Patients may need reminders to measure & record I&O (keeping a tally may be useful).
Family cooperation is critical for accurate I&O measurements, especially for severely ill or disoriented patients who may need assistance.
Instruct clients and family to call for assistance when they need to empty urinal/bedpan, commode, or “hat” (calibrated receptacle for urine collection).

Includes:
- All liquids taken by mouth (ice cream, soup, juice, water, popsicles, sherbert, jelly, ice chips).
- Anything that becomes liquid at room temperature.
- Liquids via nasogastric or jejunostomy feeding tubes.
- Intravenous therapy.
- Blood transfusions and blood components.
- Medications administered via nasogastric tube.
Ice Chips: Recorded as 50% of measured volume (e.g., 100 mL of ice chips = 50 mL of water).
Some clients may require hourly urine outputs and may have a foley catheter with a urine meter; urine is measured in the meter before being emptied into a drainage bag.
Important: Report urine output of less than 30 mL/hr (as noted in the Clinical Nursing Skills book).

Feeding tubes implanted directly into the gastrointestinal tract for patients unable to tolerate nasoenteric feeding tubes or requiring long-term enteral nutrition.
Common Types:
- Gastrostomy tube (G-tube)
- Jejunostomy tube
Gastrostomy tubes are often referred to as percutaneous endoscopic gastrostomy (PEG) tubes.

Includes:
- Urine
- Diarrhea
- Vomitus
- Large amounts of bleeding (from surgery or trauma)
- Gastric suction
- Drainage from post-surgical wounds (e.g., Jackson Pratt or Hemovac).

Should Intake = Output?
- Daily intake should equal daily output plus an additional 500 mL for insensible fluid losses (evaporated water through skin and respiration).

For clients on fluid restrictions, proper recording of I&O is necessary.
Example: If a client has a fluid restriction of 1000 mL a day, half should be administered during the day (0700-1500) and the remaining half in the evening (1500-2300).

Watch videos on I&O measurement and utilize I&O sheets for accurate measurements.
Discuss equipment such as drainage bags, measuring containers (graduate cylinders, small cups) used to obtain small quantities of output.

Also Known As: Dehydration
Definition: Loss of fluid and electrolytes, resulting in output greater than intake.
Causes:
- Gastrointestinal losses (vomiting, diarrhea)
- Drainage from tubes
- Blood or plasma loss (e.g., burns)
- Excessive perspiration
- Fever
- Decreased oral intake of fluids
- Use of diuretics
- Confusion or depression.

Also Known As: Over-hydration
Definition: Excess of fluid and electrolytes, resulting in intake greater than output.
Causes:
- Congestive heart failure (CHF)
- Renal failure
- Cirrhosis of the liver
- Excessive sodium intake or administration (IV)
- Excessive fluid intake
- Elevated levels of steroids.

Measuring I&O is essential for assessing fluid and electrolyte balance.
Accuracy: Critical for effective monitoring, requiring patient and family cooperation.
Monitor I&O for:
- Patients with fever or edema
- Urinary catheterized patients
- Patients receiving diuretics or IV therapy
- Patients on restricted fluids (per employer policy or health care provider prescription).

Some aspects of I&O measurement can be delegated to unregulated care providers (UCP), while others cannot.
Nurse Responsibilities:
- Assess I&O totals at the end of each shift
- Compare 24-hour totals over days
- Monitor and document IV therapy, wound or chest drainage, and tube feedings.
UCP Responsibilities:
- Measure and record all sources of input and output.
- Report any changes in the patient’s condition, such as alterations in intake or characteristics of output.

Document I&O, indicating balance or imbalance.
Report any urine output less than 30 mL/hr or significant weight changes to the health care provider.
Use I&O forms or electronic health records (EHR) for documentation.

Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2020). Clinical Nursing Skills & Techniques. Elsevier.
Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A. M., Astle, B. J., & Duggleby, W. (Eds.). (2024). Canadian Fundamentals of Nursing (7th ed.). Elsevier.