What is intake and output charts?
Monitoring provides the means to determine the progress of the disease, as well as the beneficial and detrimental effects of treatment.Monitoring of the patient's intake is important to ensure proper hydration.Monitoring the output helps determine if there is enough urine or normal defecation.
The intake and output chart is a tool used for documenting and sharing information.
Adding, subtracting and totaling can be done because the amount is measured in standard measuring units.
The amount of fluid required by a person varies with age, weight, activity and physical surrounding.
The water intake of an adult is 2500 to 3000 liters per day.This is usually accomplished by:
The amount of urine that can be measured is the greater part of the water.An adult's urine output is between 1000 and 1500 liters per day.It's normal for water to be produced through sweating, as well as from the skin, mouth, throat, and respiratory tract.The amount is dependent on climate and environment.The insensible loss is the amount that is not measured in clinical practice.
The normal intake is balanced by the amount that is excreted as urine.The amount of urine output is expected to be less if there is more loss due to higher temperature of the environment.
The water and faeces are not usually measured.Significant amount of fluid can be lost with the stool.Defecation can give an indication of bowel movement.
Clinical care providers use two types of forms, one for planning and the other for recording findings, when providing and monitoring fluid intake and output.Each type has different components.
Sometimes it is the nature of the fluid output.The passage of stool by the patient may be noted.The nature of the stool may be indicated.
As part of the treatment plan, the order is written in the continuation sheet.
Normally, nurses copy the orders into another sheet and use it as a guide to administer the infusion.It would be better if the doctor could write the plan and brief the nurse about it, rather than just placing an order.It is easier for the doctor to just order enteral feeds because of the methods involved.
The nursing observation chart is clipped on to a clip-board or a file separate from the medical record when the plan is attached to it.The information is put into the chart.The paper-based I-O chart is very concise and provides a lot of required information on a single chart.
The transfer of the data from the order to the plan will be discussed later.
Doctors usually order IV fluids to meet the needs of a 24 hour period.Doctors should order IV fluids for the duration they need them.The period required to achieve stabilization is when fluid is ordered.The regime is reviewed after a change in the patient's condition.If there is an order for the transfusion of blood or the administering of drugs in a large amount of IV fluid, a review is done.
The doctor is usually guided by the requirements of the day.The time of admission affects this period.IV infusion can be started at any time of the day and may be extended beyond the 24 hour nursing shift.IV infusion is meant to be continuous.The nurse may write a plan that extends to the next working day, but it's probably better to have a separate plan for the shifts of current nursing work day and another for shifts that follow.
There is a need for more clarity when ordering fluid therapy.Some methods can lead to confusion.
The nurse would divide the rate by 24 hours to arrive at 2500.She is most likely to give all 1500 liters of Dextrose 5% first.The doctor probably wanted to start with Normal saline and the alternate with 5%.The assumption is that the nurse knows she should only add 1gm of KCL per 500ml of fluid.It's still incorrect to order as below.
IV fluid orders indicate the type of fluid to be given, the starting time, and the period it will be administered.It acts as the plan when written properly.It is important that the doctor prescribes the type of fluid to be given, the amount of each type, and the total amount for the period.The order and plan are both written on the same form.The rate needs to be calculated by the nurse.This arrangement is subject to the policies of the hospital.
A single peripheral or central vein is used to give fluid.If you want to provide the normal requirements for water, it's a good idea to order 1/6 Normal saline in Dextrose 5 % at a rate that will give you the volume and sodium you need.It is possible to give total parenteral nutrition fluid from one bag.The rate is calculated and the total volume is determined.
The nurse needs to consider how the fluid is to be provided when ordering the total volume from the doctor.She/he will have to plan the amount, duration and when the bottles/bags need to be changed.If a gravity driven drip set is used instead of an IV, the equivalent drops per minute.
If additions are made, the amount to be added and the bottle/bag needs to been indicated.
The next day can be extended as well.When the intake is measured and totaled, it would be for the three nursing shifts.
Different types of fluids are usually given through a single vein.They may include blood, blood substitute, and albumin.The sequence and duration of each pack/bottle of fluid needs to be clearly stated by the doctor.The doctor writes the plan.The rate can be calculated by the nurse.
The doctor wants to give the patient 2500 liters of fluid in 24 hours.He/she would like to make sure that the patient gets 154 and 39 meq of Na and K+.He ordered 1000 liters of 0.9% Sodium Chloride.He/she said that 1gm of KCl would be added to 3 of the solutions ordered.
It is possible for the pharmacy to provide KCl in grams or meq per vial.It's a dangerous drug and should be ordered with care.
If fluid is to be given using more than one method, the order should be documented on a slightly different type of form.
The situation is similar when two IV sets are set up to run through one vein to give a different type of fluid.Diluted medication.The chart should be designed for the purpose.
For this purpose, the type of chart chart used has separate sections for different sites so that the specific site is specified.To keep it patent, fluid may be given via an arterial line.This amount is significant enough to be recorded in children.If there are more than one line attached to a vein, then the line needs to be named.In the example below, the doctor provides a total of 3000 liters of IV fluid consisting of 2000 liter of Total Parenteral Nutrition Solution in one bag, and 1000 liter in two bags of Normal saline with 2gm of potassium added in each bag.
The form can be used to order and plan for a different set.
Sometimes fluid can be given via more than one mode.One of the enteral routes is via the IV route.The same form can be used for ordering and planning.There is a separate section on the site for the type and amount of fluid to be given.
Data from the plan needs to be accurately transferred to the chart.It's a good idea to have the plan and chart in the same place.There is a clip-board or a file.
The amount and type of fluid need to be measured in a clinical setting.The plan has the type of fluid copied.The amount put up minus the amount left over is taken when fluid is given via IV.The volume is calculated by the machine based on the nurse's flow rate.When given through the enteral route, how fluid is measured depends on whether it is given by intermittent bolus feeding or a continuous infusion.
The Intake and the Output are on the same side of the chart.Volume is measured in liters.The chart does not follow the calendar day because it is for a 24 hour period.It's not from midnight to 12 midnight the next day.It follows the nursing shift.The next day is usually from 7 a.m.
The order or plan may be extended into the nursing morning shift of the next day, but the intake and output measurement end with the night shift.A new form is used to chart.When fluid is given by the enteral routes, a common Intake-Output Chart is used.The same chart is used to enter and view data.The rows divide the chart into time intervals.The columns say something.
The structure of the Intake Output Chart for a computerized Clinical Information System is discussed in another paper.
The data is entered in ink when the empty chart is pre-printed.The main medical record is usually separated from the charts.There is a clip board.The patient's identity is at risk if the I-O is being charted.The name of the patient, the registration number and the starting date are important.The charts should be deleted from the Medical record at the end of the patient's stay.All relevant particulars of the input and output data are plotted on the chart under the relevant chart headings.The input and output are totalled for every shift and for a 24 hour period starting at 7.00 a.m.
The chart was designed to follow the process of giving an injection.The nurse gets the first IV fluid pack/bottle of the specified type from the pharmacy or floor stock after receiving the doctor's orders.Policy can affect the source of the fluid solution.Large amounts of IV drips are used in acute care wards so it's convenient to keep them as part of the ward stock.When drugs such as inotropes, heparin, and antibiotics need to be added, there are issues.The nurse in the ward can do the admixture.Many hospitals give the responsibility of mixing common substances to nurses.The aseptic technique is followed and the nurses are trained on how to ensure the right concentration is given.The need for mixing to the correct concentration and asepsis is also applicable.Less people need to be trained is the advantage.The supply may be delayed.The pharmacy's staff may not be able to cope with the increased workload.Most hospitals only allow pharmacists to mix items such as parenteral nutrition and cytotoxic drugs.The chart below shows the process for starting and recording an IV.
The nurse enters the actual time that she starts the injection rather than the time planned.The time is recorded in rows on the extreme left.The same column is used for all activities.The time when the urine is collected.The time fluid is put up needs to be recorded.The finish time doesn't need to be recorded if the next one is put up immediately after the last one.
The nurse needs to make sure the type of fluid is the same as what was ordered.The particulars on the label are used to confirm this.The type of fluid being used.It is recorded if there is Normal saline, Dextrose 5%, or parenteral nutrition solution.It may be necessary to use abbreviations because the columns may not be wide enough.If a set with a chamber is used, the fluid put up is the amount in the pack/bottle or chamber.The maximum size of the chamber is usually 100 liters.If a pump is used, the amount set up is usually 50 or 100 liters.She/he needs to make a note on the existing label if there is an addition.The fluid intake plan may be used to decide the rate of infusion.An extra label stuck to the pack/bottle is a good way to indicate the additions, rate and period.The 500 liter bottle is to be finished at 12 noon.
The amount of fluid left in the pack/bottle is recorded by the nurse when the IV is started again.If the pack is finished in the middle of the shift, the replacement pack's volume is recorded as the amount set up.
If the fluid flow is by gravity and the flow rate is controlled by a flow regulator, then the infused amount is calculated as amount set up minus the amount left in the pack.At these instances, the amount that has gone needs to be recorded.
The amount went in at the end of the shift is calculated by subtracting the amount set up or remaining in the bag from the beginning.The nurse of the next shift will benefit from the amount of remainder fluid noted in the chart.The amount given on the machine is read from if an infused pump is used.It is not necessary to know the amount left behind for calculation, but it is a good idea to make a note of the rest.If a change is made, the new fluid and amount must be recorded.
The data must be written at the time it is calculated or read.Not on the same row as the time it is put up.
Patients are often given IV fluid therapy.IV fluids can be given via a single vein.The paper-based IV fluid intake chart is used for this purpose.
A certain amount is planned for.The nurse must make sure the rate of flow is set so that the intended amount is infused.If the time is delayed or brought forward for any reason, then the rate needs to be increased or decreased so as to make sure the amount is transfused.The nurse needs to observe the rate of flow and the rest of the pack.If the line is blocked or the rate is too fast, the right amount is not given.In emergency situations when fluid is quickly given, the nurse makes sure that the amount ordered is given at the correct speed.The amount should be recorded every hour in the column.
It is logical that the chart is divided into sections according to nursing shifts since the recording of the intake and output is the duty of nurses.
The cumulative total is calculated by the nurse at the end of the shift.The remainder or amount left-over of any IV fluid or enteral fluid in the container is noted to be carried forward to the next shift.The nurse in charge will record the rest at the next shift.This is being carried over.
Two separate charts may be used for each line to record the intake.Adding the total for each line makes up the shift total.The Output should only be recorded on one of the charts to avoid confusion.
When two sets of infusion system are used, a different Intake Chart with two sections can be used.:
It caters for the different site of administration by having two sections for intake.
abbreviations may be used in this chart because the width of the column is compromised.It's not possible to have charts with columns for more than two sites.It is better to use more than one chart.
The total for each section is added to give the shift total when two separate charts are used.A supplementary section at the bottom of one of the charts is where this is recorded.
The feeding regime may be ordered by the doctor or nurse.The amount and type of liquid food may be recommended by the dietitian.The nurse will usually plan the amount of each feed.There are two ways in which enteral tube feeds can be given.
An Intake-Output Chart is not necessary for patients taking well on a normal diet.In situations where there is clear indication that the patient's oral intake needs to be monitored and controlled, an I-O chart is indicated.There are indications.
Depending on the situation, the doctor or nurse may decide how much fluid to give.The nurse gives the patient the desired amount in a container.The amount supplied should be recorded as a cup, glass or bowl.The amount that the patient actually takes is recorded.There are situations where the amount needs to be controlled.
Intermittent feeding can be used for feeds via nasogastric tube or gastrostomy.The nurse shouldpirate the stomach contents before the next feed to determine if the feeds have been passed on and not retained.She would have to subtract the retained amount from the introduced amount and record it as the amount given.If most of the feed is not passed on or retained, this means there is a problem with absorption.A different type of formula or feeding may be abandoned if the route of administration is reduced.
Bolus feeding can cause problems of inadequate digestion.There is a better chance of absorption if you give feeds in small amounts.The incidence of the disease is reduced.The setting up, calculation of rate of infusion and recording amount gone in and left over is similar to IV infusion.
A patient can be fed via a nasogastric tube if they can't swallow.The creation of a gastrostomy is better for feeding for longer periods.The intermittent feeding method is usually used for this route.
In cases of inability to swallow, obstruction or injury to the aesophagus, a gastrostomy can be done.Food of any type can be given if the rest of the gastrointestinal tract is healthy.Milk and other formulas may be given where the rest of the bowel has limitations.The intermittent feeding method works well.
A feeding tube can be placed so that it ends in the duodenum or jejunum.It is indicated when there is a risk of aspiration as well as acute pancreatitis and hyperemesis.Feeds are administered by a pump.Parenteral nutrition is combined with the initial rate of administration to achieve the necessary calories.The type of feed is similar to jejunostomy feeding.
Depending on the ability of the jejunum and ileum to pass on and absorb liquid food, three types of liquid formulations may be given.
The amount and type of feed needs to be specified by the doctor.The nurse can decide how often to feed.
The feeds need to be given continuously.The amount and type of feed should be specified in the order.The nurses plan the periods of delivery and rest.
To give 2400 liters of enteral feeding formula via jejunostomy in 24 hours can easily be written as this order.
The intermittent bolus method is used for feeding via the nasogastric tubes.Milk formulas are the best for nasogastric feeding.porridge or soups can be given as the tubes are much bigger.It is not necessary to indicate the period since the time of feed is to be given.Patients can move around if they are able to, because the tube is closed in between feeds.The plan is an order to the unit supplying the feeds.The kitchen.There is a plan for gastronomy feeds.
Continuous infusion is the best way to give Nasoduodenal, NasOjejunal and Jejunostomy feeds.It is a good idea to have a break and stop for a while.From time to time, it is a good idea to clear the tubes with water.There is a side connection for this.
Doctors or dietitians can write the plan.It might be better to leave it to the nurses because they have more experience with the techniques.They would like to know the periods of feeding rest and clearance of the tubes.
Enteral feed formulas are usually sterile solutions in bottles.Two and a half bottles may be required to meet the daily fluid and calories requirements of adults.The plan may be extended to the next working day to finish the third bottle.The remainder in the container is used for the next shift.There is a plan for continuous tube feeding.
When fluid is given via the enteral route, the Intake-Output Chart should be used.
Since the feed is only given for a short time, the period needs to be recorded.Recording the intake of fluids.
The chart of fluid intake is given by continuous enteral feeding.The use of nasojejunal, jejuostomy tubes is quite similar to that of an IV.
There are two charts that can be used for each route.Adding the total for each route/mode makes up the shift total.The Output should only be recorded on one of the charts to avoid confusion.
When two routes/modes are used, the Intake Chart with two sections can be used.When starting a trial of enteral feeding, the feed is given at a slow rate.The rest of the fluid is given by the IV.When fluid is given by both IV and Enteral Route, it is necessary to chart intake.
The total for each section is added when two main sections are used.There is a supplementary section at the bottom of the chart.
Normal output can only be measured in the clinical setting.A measure of the urine output is what it is.In a normal adult, this amounts to 1000-1500 liters per day.The amount of loss due to diarrhoea can be estimated.Thesible loss is not measured.This is a lot.The input is more than the output in a normal person.This isn't a deficit because it's not an abnormal loss.Abnormal losses occur when there is a patient.
The urine is collected when there is a need to chart the patient's fluid balance.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 using a measuring jug and recorded on the chart.It is possible for patients to measure the urine and record it on a slip of paper.The amount is copied onto the chart by the nurse.At the end of a shift, urine output may need to be measured.hourlyThe urinary catheter is attached to a plastic.The amount can be read from the markings or emptied into a measuring jug at the end of the shift or day.
If it is desirable to let the urine accumulate for the whole day, the nurse will record the amount from the bag and time in the I-O chart.She can indicate the level at which the last measurement was made with a marker or tape on the bag.She can subtract the reading from the previous level at the time of the current reading.The amount was passed between the times of the readings.The amount of urine is recorded if the bag is full.The standard I-O chart may not be suitable if urine output is to be measured hourly.The total for a shift can be recorded on a separate chart and put into the main chart.
A patient with a collection of fluid in a body cavity may have a drainage tube inserted to drain it.Drains can be inserted into the abdominal or thoracic cavity to facilitate drainage after surgery.One way to measure the loss is to look at the markings on the bags and bottles.After reading the loss for the current period, she may use an ink marker or tape to indicate on the bag or bottle the level when it was last read.The amount at the end of a shift is calculated by subtracting the amount of the previous reading from the accumulated amount.
The whole bag or bottle is emptied in the second method.Changing the whole drainage bag/bottle at every shift is not done in a closed drainage system.If the bag or bottle is full, it's indicated.
If the jejunum or ileum is the source of the fistula, the contents are collected into bags.The content of the output can be measured by transferring it into a container or injecting it with a needle.
The type of fluid is indicated by the headings on separate columns.These include:
The time of measurement for each output is written on a separate row if it coincides with the time when the input was recorded.The time of intake and output should be recorded on the chart.Each type of output has its own title.As space is limited, total volume of all types of output of each shift needs to be added and written at the bottom of the chart.Entering data for output.
The excretion of products of metabolism is a normal mechanism for the production of urine.The most common reason for too much urine being produced is that more fluid has been given to the patient.The intake needs to be reduced.Increasing the intake to catch up with the urine output is a common mistake.The clinician needs to be aware of situations where an abnormal amount of urine is removed because of a disease.
The doctor needs to determine if the drainage is an active loss or drainage of accumulated fluid for which the body has been compensated.It is wise not to replace the fluid volume for volume because it has accumulated for a long time.If there is re-accumulation after the initial drainage, it may have to be replaced.
The Nasogastric volume will rise if the obstruction fluid is up into the stomach.Replacing volume with IV Normal-saline is quite common.Most of theAccumulation is in the small intestine.Replacing the Nasogastric aspirate is not enough.Judgement on the fluid need should be based on diminishing urine output, increased pulse rate and drop in blood pressure.