INTAKE AND OUTPUT WORKSHEET Intake and output (I & O) is the measurement of the fluids that enter the body and the fluids that leave the body. The metric system is used for fluid measurement. The measurements should be recorded in mls (milliliters). The average adult intake is 2500-3000 mls per day. The average adult output is 2500-3000 mls per day. Types of INTAKE: Oral fluids* IV fluids Hyperalimentation / TPN feedings Tube feedings (N/G tube, gastrostomy tube, etc.) Medications Types of OUTPUT: Urine* Vomit (emesis)* Bloody drainage Loose stool* N/G tube drainage Perspiration INTAKE & OUTPUT: Metric Conversions Using the basic volume conversions, convert the following equations to the metric system. Basic conversions: 1 ml = 1 cc 1 ounce (oz.) = 30 mls 1 cup = 8 oz. 1 L = 1000 mls 100 ml ice cubes = 50 ml water INTAKE & OUTPUT ASSIGNMENT (2 Parts) Part 1 Conversions: 1. 1 cc. = _______________ mls 2. 2 oz. = _______________ mls 3. ½ oz. = ______________ mls 4. 4 cc. = _______________mls 5. 8 oz. = _______________mls 6. 6 oz. = _______________mls 7. 4 oz. = _______________ mls 8. ½ cup = _______________oz. = __________________mls 9. 2 (8 oz.) cups of coffee = __________________ mls 10. 1 (6 oz.) bowl of broth = __________________ mls 11. 3 (8 oz.) glasses of water = _____________________ mls 12. 2 (4 oz.) glasses of ice chips = ___________________ mls 13. 2 (4 oz.) dishes of gelatin= __________________ mls 14. ½ pint of milk = _________________________ mls 15. 30 mls = __________oz. 16. 100% (6 oz.) bowl of soup = _____________mls 17. 75% (8 oz.) cup of coffee = ____________mls 18. 50% (4 oz.) cup of gelatin = _____________mls 19. 10% (6 oz.) bowl of soup = ____________mls 20. ¼ (4 oz.) cup of gelatin = _____________mls 21. ½ (6 oz.) bowl of soup = _____________mls 22. ¾ (8 oz.) cup of water = _____________mls Part 2 Directions: 1. Document the findings on the I & O chart below. 2. You will be recording 2 shifts of I & O. 3. First shift is 0700-1859 and the second shift is 1900-0659. 4. Document a 12 hour total for Intake and Output separately for each shift. 5. Document a 24 hour total for Intake and Output separately. 6. Determine the overall 24 hour balance. (Example: 24 hour total input = 2445 and the 24 total output = 1500; 2445 minus 1500 = + 945 ml. This patient is ‘positive (+)’ 945 mls) 7. Add rows to table as necessary. 8. Use these container measurements: Foam cup= 8 oz. Water carafe=480 ml Popsicle=90 ml Soup bowl= 180 ml Coffee mug= 6 oz. Sherbet=120 ml Gelatin=120 ml Juice=120 ml Soda=8 oz. 0700: Polly had abdominal surgery yesterday and has started a clear liquid diet today. She ate 1 Popsicle, ½ gelatin cup, and ½ of the carton of juice. She also had 100 ml in her urine bag that you emptied. 0800: Polly wasn‘t feeling well and vomited 100 ml of emesis. 1000: Feeling better, she ate ½ of a carton of sherbet. 1100: The RN discontinued Polly‘s IV and documented the 150 ml that infused. 1200: For lunch Polly had ½ bowl of low-fat broth, ½ mug of coffee, and 100% serving of gelatin. The urine bag was drained of 300 ml of urine and then the RN removed the catheter. 1300: The RN emptied Polly‘s abdominal Hemovac drain of 90 ml of bloody drainage. 1400: Polly was assisted to the bathroom where she voided 150 ml. of clear, yellow urine. 1700: The diet order has changed to a full liquid diet. Polly is helped to the bathroom where she voids 200 ml and returns to sit in the chair. Polly has ½ can of ginger ale, 1 bowl of soup, and ¾ of her sherbet. 1800: The RN gives her 15 ml of liquid medicine and ½ cup of water. 1900: Polly has a small emesis of 50 ml after taking a walk and became dizzy. 2100: Polly voids 260 ml of clear, yellow urine. 2200: The patient asks for fresh water in her pitcher and it is noted that 1/3 of the water carafe has been consumed by the patient. At this time, the RN empties the abdominal drain of 20 ml of bloody drainage. 0200: Polly turns on the call light and asks to use the bathroom. She voids 200 ml and returns to bed. She is thirsty and drinks 1/3 can of lemon-lime soda. 0600: Polly’s drain has 5 ml of drainage and she voids 900 ml. She drinks ½ mug of tea while waiting for the breakfast tray to arrive. Date Time Shift 1: 0700-1859 Intake & Output Record Intake Output Shift 1: 12-hour totals Shift 2: 1900-0659 Shift 2: 12-hour totals 24 Hour Totals Overall 24 Hour Balance Add Shift 1 Intake + Shift 2 Intake = Add Shift 1 Output + Shift 2 Output = 24 Hour Intake Total Minus 24 Hour Output Total = Based on your 24 Hour fluid balance is this patient in fluid balance overload, fluid balance deficit or equal fluid balance? Part 3: 1. List a nursing diagnosis appropriate for a patient in fluid balance overload and a patient with fluid balance deficit. 2. What are clinical signs and symptoms for a patient in fluid overload? What are clinical signs and symptoms for a patient in fluid deficit? 3. What are appropriate nursing interventions for a patient in fluid volume overload? Fluid volume deficit?
