INTAKE AND OUTPUT
One of the most basic methods of monitoring a client's health is measuring intake and output, commonly
called I and O. By monitoring the amount of fluids a client takes in and comparing this to the amount of fluid a
client puts out. The health care team can gain valuable insights into the client's general health as well as
monitor specific disease conditions.
INTAKE
- all those fluids entering the client's body such as water, ice chips, juice, milk, coffee and ice cream. Artificial
fluids include: parenteral, central lines, feeding tubes, irrigation and blood transfusion.
OUTPUT
- all fluid that leaves the client's body such as: urine, perspiration, exhalation, diarrhea, vomiting, drainage
from all tubes and bleeding.
An accurate record of a client's fluid balance is an important nursing function.
Equipments:
- I & O form at bedside
- I & O graphic record in chart
- Pencil and paper
- Calibrated drinking glass
- Bedside pan, commode or urinal
- Calibrated container to measure outputs
- Weighing scale
- Non-sterile gloves
- Sign at bedside stating patient is for I & O monitoring
Ideal Daily fluid Intake and Output
Source/ AMOUNT/ Route/ AMOUNT
H2O consumed as fluid/ 1500ml/ urine/ 1400-1500ml
H2O present in food/ 750ml / insensible losses/ 350-400ml
H2O produced by oxidation/ 350ml / lungs/ 350-400ml
skin / 100ml
sweat/ 100-200ml
feces /
TOTAL/ 2600ml/ TOTAL/ 2300-2600ml
Purpose:
- helps evaluate client's fluid and electrolyte balance
- suggests various diagnosis
- influence the choice of fluid therapy
- document the client's ability to tolerate oral fluids
- recognize significant fluid losses
Average daily water requirement by age and weight:
AGE/ ml/ BODY WEIGHT ml/kg
3 days/ 250-350ml/80-100
1 year/ 1150-1300ml/ 120-135
2 years/ 1350-1500ml/ 115-125
4 years/ 1600-1800ml/100-110
10 years/ 2000-2500ml/70-85
14 years/ 2200-2700ml/ 50-60
18 years/ 2200-2700ml/40-60
adult /2400-2600ml/ 20-30
Nursing Intervention:
Intervention/ Rationale
1. Ideally intake and output should be monitored/ To obtain an accurate record
2. In critical situations, intake and output should be monitored on an hourly basis/ Urine output less than
500ml in 24 hours or less than 30cc/hour indicates renal failure
3. Daily weights are often done/ Indicate fluid retention or loss
4. Identify if patient undergone surgery or with medical problem / May affect fluid loss
5. Make sure you know the total amount and fluid sources once you delegate this task/ To get an accurate
measurement
6. Record the type and amount of all fluids and describe the route at least every 8 hours
7. If irrigating a nasogastric or another tube or bladder, measure the amount instilled and subtract it from the
total output/ To get exact amount
8. Keep toilet paper out of client urine output/ For an accurate measurement
9. Measure drainage in a calibrated container and observe it at eye level.
A significant change in a client's weight or a significant difference in a client's total intake and output should be
reported immediately to the physician.
WEIGHT CHANGES
- mild dehydration- 2 to 5% loss
- moderate dehydration- 6 to 9% loss
- severe dehydration - 10 to 14% loss
- death- 20% loss
- mild volume overload- 2% gain
- moderate volume overload - 5% gain
- severe volume overload - 8% gain
Clinical Signs of Dehydration:
- dry skin and mucous membranes
- concentrated urine
- poor skin turger
- depressed periorbital space
- sunken fontanel
- dry conjunctiva
- cracked lips
- decreased saliva
- weak pulse
Client's signs of fluid excess:
- peripheral edema
- puffy eyelids
- sudden weight gain
- ascites
- rales in lungs
- blurred vision
- excessive salivation
- distended neck vein
