WHY IS INTAKE AND OUTPUT IMPORTANT?.
1.For accurate measurements of critically ill patients.
2.Adequate record of incontinent patients.
3.Prevent infection in patients with pressure ulcers.
4.To monitor for renal patients.
4.Monitor intake and output of cardiology patients for example CHF( Congestive heart failure)
5.Monitor for urine concentration and consistency,urinary retention. Follow up with HOUDINl FOLEY CATHETER PROTOCOLS.
6.Compare intake with the output.
7.Hospice patients no urine output or very low output is an indication that death is imminent.
Documentation of accurate intake and output is very important. Without adequate documentation of intake and output the doctor will have difficulty in knowing if the patient is drinking,eating or not eating,urinating or not urinating. Even though laboratory is a good indicator but please document intake and output accurately.
Some nursing assistant will give a false intake and output because they have no records. Her record of patient vital signs were wrong and I &0 was equally wrong. Monitor it very well.Once in awhile you will work with the best CNA.If your CNA gives wrong intake and output and you (Registered nurse) document that,you will be in trouble not the CNA.At least eyeball the urinal or Foley catheter each time that you are in patient room. Record immediately after measurements so that you do not forget. Place the intake and output sheet in a designated area.
NB: As soon as the doctor orders that patient intake and output should be measured. The patient, the family members, nursing assistant and caregiver should be informed that anything that goes into the patient should be measured and anything that goes out of the patient should be measured.
If patient is on fluid restriction follow the guidelines. Because of inaccuracies in intake and output measurements, daily weight done at the same time every day will offer more authentic fluid balance status. Laboratory tests (complete blood count, serum electrolytes, patient urine pH,specific gravity,and arterial blood gas )will also help to determine whether there are electrolytes ,fluids and acid based balance.
Why is this important (in a nutshell)
1.Comparison of the intake and output because if what came out is much more than what patient takes in. Then patient is in trouble for FLUID VOLUME DEFICITS.
2. Urine concentration and Volume. Measure with the measuring tools of fluid losses ,all fluid taken in. urine, loss from skin,lungs, gastric,,blood loss.
High specific gravity with a low urine volume means fluid volume deficit.But a low urine volume and a low specific gravity means Renal disease. Diabetic patients will have high urine volume, also patients on high protein tube feedings and fever.Rapid changes in weight reflect on urine output.A rapid difference in weight will likely reflect on the body fluid volume.
3. Skin Turgor: Pinch the skin and release check for skin Turgor. In a patient with a volume deficits ,skin will take its time slowly to return. But if there is no volume deficits when you pinch and release the skin will quickly return to its normal level. Remember that there is reduced skin Turgor in people over 55years and up.Why?.This is due to reduced in skin elasticity.
NB: Severe malnourishment especially in infants can cause depressed skin Turgor even when there is no fluid depletion.
4.Dry mouth: One of the side effects of fluid volume deficits is dry mouth or breathing through the mouth. Dryness of where the gum and the check meet is indicative of fluid volume deficits. There are other factors such neuromuscular irritability ,neck veins and central venous pressure (CVP)
CASE SCENARIO NUMBER 1.
An eighty years old female with stage 111 coccyx pressure ulcer, she is incontinent alert and oriented ×2.Braden scale 11.This patient urine must be monitored .How do you monitor her urine ,you place the female urinal(PUREWICK)in her,and you measure every 4hours. Purewick is very good when done right and you connect to suction. (READ ABOUT FEMALE URINAL)You don’t need doctor orders for that.Your patient is clean and free from INFECTION because if the intake and output are not monitored, patient urine keep going into her wound can result in infection which leads to sudden Septic shock. If there is no output notify the doctor immediately.
CASE SCENARIO NUMBER 2.
You received a patient with Brain injury patient is alert and oriented × 2. He is recovering very slowly from head trauma due to fall . You received report from previous shift RN who told you that patient is voding well.You came in to check his vital signs. And patient said to you repeatedly I need to peep,you placed urinal and encouraged him to void.He kept saying the same thing again, I need to peep.You call the doctor. The doctor orders straight catheter now and every 6hours if patient did not void after the third straight catheter leave catheter in place. Bladder scan before each straight catheter if greater than 250ml straight cath. The nurse Bladder scanned, urine greater than 900ml ,straight catheter done over 1000cc of dark amber concentrated urine. Documented and the doctor notified .
CASE SCENARIO NUMBER 3.DIFFICULT PATIENT (Night shift)
You have a difficult patient that feels privileged and doesn’t want to be disturbed from 12midght till 7am.You came at midnight, he refused to talk to you, and refused his midnight vital sign. You asked him if he voided he lied and said yes,you asked how much ,he said 400cc.And at 4am you came and asked him if he voided,he lied again and said yes.
At 07:30am during report he told dayshift RN that he has not voided all night.Yes once in a while you will meet people like that. Don’t argue with patient, simply call and notify the doctor and get order for straight catheter and document your findings notify the day shift so that they can straight catheter the patient.I have refused to communicate with the nurses at night as a patient because I felt that they disturb too much whereas they were only during their job.I voided and recorded it in a piece of paper for them.The nurse did not like it because I am not supposed to get up. When I became a nurse I realized my self centered attitude. I just had a baby and I needed all my rest since I had nobody to help me after hospitalization at home. No allow nurses to do their job. Their jobs are not easy at all.