Allied Health & Medicine
**Begin Class by reading
Ch. 21:5 in Red Book
To maintain health,
the body must take in a certain
amount of fluid each day
Generally, a healthy person needs to take in from 64 to
96 ounces of fluid per day
Fluid Balance
 Fluid balance is maintaining equal input and output
-- taking in and eliminating equal amounts of fluids
Fluid volume excess
 a surplus, an amount greater than that which is normal
or that which is required
Fluid volume deficit
 a reduction in body fluids – “dehydration”
Intake (Input)
 Liquids a person drinks
 Semi-liquid foods
 Gelatin
 Soup
 Ice cream
 Pudding
 Yogurt
 (Nurses also figure IV solutions, medications, blood, etc.)
Output
 Urine
 Feces (including diarrhea)
 Vomitus
 (Nurses also figure blood loss, chest tube output,
drainage tubes, etc.)
Input -Measurement
 Know the sizes of the containers your facility uses
 Convert all measurements to milliliters (ml)
Output - Measurement
 Always remember to protect yourself with the proper
PPE
 Keep container level on a flat surface while measuring
 Prevent splashing or spilling
 If splashing is a risk: mask,goggles,& gown
 After emptying contents into the toilet,
rinse container and put it away
 Remove gloves and wash hands
The diaper/adult brief trick
 Weight of 1 US Gallon of water = approx. 8.35 lb (about 3.79
kg)
 One ounce of water weighs approx. one ounce.
Common Conversions
 15 drops = 1 ml = 1 cc
 1 teaspoon = 5ml = 5 cc
 1 tablespoon = 15 ml = 15 cc
 2 tablespoons = 1 oz = 30 ml = 30 cc
 1 cup = 8 oz = 240 ml = 240 cc
 1 pint = 16 oz = 500 ml = 500 cc
 1 quart = 32 oz = 1000 ml = 1000 cc
 Specimen Hat
 Urinal
 Graduate
 Traditional bed pan
 Fracture bed pan
Intake
 By Mouth: all fluids and foods that are liquid at room
temp.
 Tube Feeding:
 Recorded as oral intake or a special column.
 Used for patients who are unable to swallow, the
unconscious or comatose.
 Solution contains all nutrients required by the body and
is more nourishing than IV feedings
 Given through NG (nasogastric) or G (gastrostomy)
tube
 Patient will be in a mid fowlers position during feeding
and for 30-60 min following.
 Make sure there are no kinks in tubing, caution is used
when turning or positioning a patient, give frequent oral
hygiene, notify nurse if alarm sounds…solution is not
flowing…solution is low or empty
 IV (Intravenous)
 Fluids given into a vein
 Includes blood units, plasma, and other solutions
 Irrigation
 -fluids placed into tubes that have been inserted into the
body.
 Any fluid removed after irrigation is not intake
 If nasogastric tube is irrigated with 80 mL of solution and
exact amount is drawn back out, this is not recorded as
intake.
 However, if 60 mL is drawn back out, 20 mL is recorded as
irrigation intake
Measurement Is Responsibility of Nurse or other legally
authorized team member. (IV, Irrigation, tube feeding)
Output
 -refers to all fluids eliminated by patient
 Bowel Movement (BM)
 Liquid BM measured and recorded
 Solid or formed BM is usually noted in remarks column
or described under feces.
 Nurse assistant may measure/record
 Emesis
 Material vomited is measured and recorded
 Color, type, and other facts are noted in remarks
 Nurse assistant may measure/record
 Urine
 All urine voided is measured and recorded
 Urine drained by catheter is measured and recorded
 Nurse assistant may measure/record
 Urine output of less than 30 mL per hour must be
reported
 Irrigation
 Irrigation or suction drainage is measured and recorded
 Drainage included from NG tube, chest tube, other
tubes
 Type, color, and other facts are noted in remarks column
 Excess is recorded as output.
Records must be accurate
 All amounts are measured in graduates
 Container made of plastic or stainless steel
 Has calibrations for milliliters/cubic centimeters and/or
ounces on the side
 Similar to a measuring cup
 Graduate should be held at eye level or placed on solid
surface and viewed at eye level to accurately record
amounts
 Be careful adding or totaling
 Totals are for 8-hr and 24-hr
Recording I’s & O’s
 Some agencies keep record at bedside
 Team members note I and O of patient
 Record measurements on I and O record
 At times, patients are taught to record I and O
 Other agencies keep record in patient chart
 Measurements are noted on a sheet of paper and
reported.
 Nurse, unit sec., or authorized team member records
info on Is and Os.
 Give careful instructions for I’s and O’s
 Patient must inform healthcare worker when they
drink fluids
 Can recorded glasses of water or quantity remaining in
a filled pitcher.
 Assistants must think about fluid intake every time a
glass, cup , or water pitcher is removed from the room.
 Amounts must be recorded if a guest brings in fluids.
 Females: used a bed pan or specimen hat
 Males: use a urinal
 Patients must not place toilet tissue or expel BMs into
bedpan or urine collector
 If patients are given correct instructions, they can
cooperate so accurate records can be maintained.
Standard Precautions
 Includes Urine, emesis, liquid bowel movements, and
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drainage.
Gloves must be worn when fluids are measured and
discarded.
Hands must be washed frequently and immediately after
removal of gloves
If splashing or spraying of fluids is possible, a mask, eye
protection, and a gown must be worn
Graduate must be used for one patient only, and discarded
or sterilized when output is no longer measured.
Areas contaminated by body fluids must be wiped with a
disinfectant
Basic principles for completing
I and O records
 Use a blue or black ink pen
 Find correct time
 Find correct column (oral intake, urine output)
 Record correct amount
 Recheck all entries
 Enter observations: color, types
 All information for an 8-hr time period is recorded,
total each column separately to calculate the 8 hr total
 When all 8-hr time periods have been totaled, add the
3 8-hr totals for each separate column
 This gives a 24 hr total
 Some charts are 24-hr without 8-hr increments
 Recheck all addition
 Error: draw one red line through error, initial in red
 Final check:
 All entries correct, comments are noted in remarks
column, addition is accurate, entries are neat and
legible.