FNP Week 3 4

1/28/2022 527- FUNDAMENTALS OF NURSING-LAB (SET 2) - https://usl-tuguegarao.neolms.com/student_lesson/show/3143336?
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527- FUNDAMENTALS OF NURSING-LAB (SET 2)

PRELIM WEEK 3-4
INTAKE AND OUTPUT MONITORING
I. LEARNING CONTENT
IMPORTANCE OF MONITORING INTAKE AND OUTPUT
Monitoring is an important clinical care process that provides the means to determine the progress of the disease and the beneficial as well as
detrimental effects of treatment.
Monitoring of Intake help nurses ensure that the patient has proper intake of fluid and other nutrients.
Monitoring of output helps determine whether there is adequate output of urine as well as normal defecation.
PURPOSE OF THE INTAKE-OUTPUT CHART
The intake and output chart is a tool used for the purpose of documenting and sharing information regarding the following:
Whatever is taken by the patient especially fluids either via the gastrointestinal tract (enterally) or through the intravenous route (parenterally)
Whatever is excreted or removed from the patient
THE PHYSIOLOGIC BASIS FOR THE INTAKE-OUTPUT CHART
The chart gives an idea of the status of the patient’s physiology including:
Gastro-intestinal function (ability to eat or drink, absorb food and defecate)

Fluid balance and the renal function (ability to pass urine in adequate amounts)
Occurrence of any abnormal losses
Bowel movement
The amount of fluid required by a person and the urine output varies with age, weight, activity and physical surrounding.
The water intake of a 50-90 kg adult person is about 2500 to 3000 ml per day or 2 ml/kg/hour. Normally, this is accomplished by:
Water consumed as drinks (usually about 2000 ml)
Water that is part of solid food
Water produced in the body as a product of metabolism
The greater part of this water is re-excreted as urine, the amount of which can be measured by various means. Urine output in an adult is
between 1000 to 1500 ml per day.
Another normal means of output of water is through evaporation of water from the skin and mucous membranes (mouth, throat,
respiratory tract) and also through sweating. The amount contributed by these two mechanisms is about 800-1200 ml (dependent on climate
and environment). In clinical practice, this amount is not measurable and is called the insensible loss
Some 300 ml of water is also excreted together with feces and is also not usually measured. The frequency of defecation is often only
recorded.
STRUCTURE OF INTAKE OUTPUT CHART
The Intake-Output chart is so named because on one side is the Intake and the other the Output. Measurements of volume are in ml.
The chart is for a 24 hour, it follows the nursing shift i.e. usually from 7 a.m. on the starting day to 7 a.m. the next day.
Institutionalized: depending on hospital chart protocol
MONITORING AND MEASURING OF INTAKE
Whatever is taken by the patient especially fluids either via the gastrointestinal tract (enterally) or through the intravenous route (parenterally)
1. ORAL INTAKE
For patients taking well orally and on a normal diet, an Intake-Output Chart is quite unnecessary
In most cases fluid intake is recorded
The nurse can provide graduated container to the patient (e.g. cup, glass or bowl) and use it for feeding. The nurse then records the amount
that the patient actually takes.
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1/28/2022 527- FUNDAMENTALS OF NURSING-LAB (SET 2) - https://usl-tuguegarao.neolms.com/student_lesson/show/3143336?lesson_id=14476012§i…
conversion of fluids:
2. FEEDING VIA NASOGASTRIC/ NASODUODENAL/JEJUNAL/ GASTROSTOMY TUBE
These tubes are alternative route for feeding of patient wherein oral (by mouth) cannot be done
Feedings can be given thru infusions, bolus, gavage
Most of the feeding using these routes are in liquid form and sometimes pre filled or premix
As a nurse, measure all the amount of fluids(feedings) given to the patient in ML
Use a graduated container in measuring all fluids (feedings given to the patient)
3. PARENTERAL INTAKE
When IV fluid is to be given, the recommended fluid intake is usually ordered by doctors.
The order for the type and amount of fluid to be infused is called the Fluid Regime
In the clinical setting, the type and amount of fluid whether given parenterally or enterally, needs to be measured. The type of fluid is
copied from the plan.
When fluid is given via intravenous (IV) infusion, the amount of intake is taken as the amount put up minus the amount left over.
When an infusion pump is used, the volume is calculated by the machine based on the flow rate set by the nurse.
IVF Flow Rate Formula:

Formula:
VOLUME= Volume of IVF in ML
FLOW RATE= VOLUME(ML)* DROP
DROP FACTOR= If using macro set = FACTOR
15gtts/ML
TIME(MINS)
If using micro set= 60ugtts/ML
Time= duration to be infused in minutes
Intravenous fluids:
Side drips/ piggy bank:
Total Parenteral Nutrition:
TPN is administered into a vein, generally through a PICC (peripherally inserted central catheter) line, but can also be
administered through a central line or port-a-cath. Patients may be on TPN for many weeks or months until their issues resolve.
https://www.youtube.com/watch?v=EOfWVQi9bl
Blood Transfusions:
MEASURING AND RECORDING OUTPUT
In the clinical setting, the normal output can be measured only partially. It is mainly a measure of the urine output.
Urine output in an adult is between 1000 to 1500 ml per day.
The loss from sweating and evaporation (insensible loss) is about 1000ml but it is not measured.
MONITORING/ MEASURING URINE OUTPUT
For fluid balance, the urine is collected and measured
In a patient who is alert and not on a urinary drainage catheter, the patient or care giver collects the urine in a urinal or bottle each time urine is
passed.
The amount is usually measured by a nurse or nursing aid using a measuring jug and recorded on the chart
Urine output may need to be measured at the end of a shift or more often (e.g. hourly).
Urine output is measured and documented in ML
OTHER LOSSES
Measuring Losses from Drainage Tube
drainage tube inserted into the cavity to drain the fluid

To measure the loss, one method is to read from markings on drainage bags / bottles.
Other method, reading is done and then the whole bag or bottle is emptied.
Another method to measure the output is by transferring the content into a measuring–container or aspirated with a syringe.
Procedure/ Steps in monitoring Intake and Output
Equipment needed:
non-sterile gloves
calibrated glass
calibrated container
bedpan
drainage bo le
urinal
urine bag
intravenous fluid
1. Wash hands.
2. Explain purpose of keeping I & O record to client. Explain that:
· All fluids taken orally must be recorded.
· Form for recording must be used.
· Client must void into bedpan or urinal, not into toilet.
· Toilet ssue should be disposed of in plas c-lined container, not in bedpan.
Oral Intake
3. Measure all oral fluids in accord with agency policy (e.g., cup = 150 ml, glass = 240 ml).
4. Record me and amount of all fluid intakes in the designated space on bedside form (oral, tube feedings, IV fluids).
5. Transfer 8-hour total fluid intake from bedside I&O record to graphic sheet or 24-hour I&O record on client’s chart.
6. Record all forms of intake, except blood and blood products, in the appropriate column of the 24-hour record.
7.
8. Complete 24-hour intake record by adding all 8-hour totals.
Output
9. Don non sterile gloves.
10. Empty urinal, bedpan, urine bag into a calibrated container.
11. Remove gloves, and wash hands.
12. Record me and amount of output (urine, drainage from nasogastric tube, drainage tube) on bedside I&O record.
13. Transfer 8-hour output totals in a 24-hour I&O record on the client’s chart.
14. Complete 24-hour output record by adding all 8-hour totals.
II. APPLICATION
ANWSER THE FOLLOWING:
IVF Flow Rate Formula:

Formula:
VOLUME= Volume of IVF in ML
FLOW RATE= VOLUME(ML)* DROP
DROP FACTOR= If using macro set = FACTOR
15gtts/ML
TIME(MINS)
If using micro set= 60ugtts/ML
Time= duration to be infused in minutes
I. Doctor Ramos ordered: 8:00 am -Start: IVF PNSS 1L; fast drip 300ml for 1 hour then consume remaining IVF for 6 hrs.
A. If you start the infusion at exactly 8:00 am, what time will the fast drip be consumed?
B. What is the flow rate of the fast drip infusion using macro set?
C. What time will the 1 liter PNSS be consumed?
D. What is the flowrate of the remaining PNSS using macro set
E. At 12:00 noon, how many ml of PNSS should be the intake of the patien
II. A hypo tensive client was ordered with IVF with side drip, order: 3pm: start IVF D5Water 1/2L to run for 24 hrs. + dopamine drip(250ml) to
run for 6 hours
A. What is the flowrate of the main IV line using macroset

B. What is the flowrate of the side drip using microset
C. At 8pm, how many ml of D5water was infused to the patient
D. At 5pm, how many ml of Dopamine was infused to the patient

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1/28/2022 527- FUNDAMENTALS OF NURSING-LAB (SET 2) - https://usl-tuguegarao.neolms.com/student_lesson/show/3143336?

527- FUNDAMENTALS OF NURSING-LAB (SET 2)

INTAKE AND OUTPUT MONITORING

IMPORTANCE OF MONITORING INTAKE AND OUTPUT

PURPOSE OF THE INTAKE-OUTPUT CHART

THE PHYSIOLOGIC BASIS FOR THE INTAKE-OUTPUT CHART

Gastro-intestinal function (ability to eat or drink, absorb food and defecate)

STRUCTURE OF INTAKE OUTPUT CHART

MONITORING AND MEASURING OF INTAKE

2. FEEDING VIA NASOGASTRIC/ NASODUODENAL/JEJUNAL/ GASTROSTOMY TUBE

IVF Flow Rate Formula:

Time= duration to be infused in minutes

Side drips/ piggy bank:

Total Parenteral Nutrition:

MEASURING AND RECORDING OUTPUT

MONITORING/ MEASURING URINE OUTPUT

Measuring Losses from Drainage Tube

drainage tube inserted into the cavity to drain the ﬂuid

Procedure/ Steps in monitoring Intake and Output

2. Explain purpose of keeping I & O record to client. Explain that:

· All ﬂuids taken orally must be recorded.

· Form for recording must be used.

· Toilet ssue should be disposed of in plas c-lined container, not in bedpan.

8. Complete 24-hour intake record by adding all 8-hour totals.

9. Don non sterile gloves.

10. Empty urinal, bedpan, urine bag into a calibrated container.

11. Remove gloves, and wash hands.

14. Complete 24-hour output record by adding all 8-hour totals.

ANWSER THE FOLLOWING:

IVF Flow Rate Formula:

Time= duration to be infused in minutes

A. What is the ﬂowrate of the main IV line using macroset

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