Fluid Intake and Output (Nursing)

00:01 So fluid intake and output is a really important concept in pediatrics.

00:05 And there's a balance between the fluid that goes in, and the fluid that comes out.

00:11 When you're thinking about intake and water in, there are multiple different ways to have fluid come into the body.

00:19 Eating and drinking can be a way to have fluid come into the body.

00:23 And if your patient is hospitalized, medications, IV fluids, and other things can be a way that water and fluid can come into the body.

00:33 There are also multiple ways for your body to get rid of fluid.

00:38 One of these ways is sweating.

00:40 You can also lose fluid through breathing and talking, as we talked about in a previous presentation.

00:46 It is, the faster your respiratory rate, the more fluid you're going to lose with breathing.

00:52 And then, the one that we all think about urinating is a way that you're going to lose fluid in your body.

01:00 So how do we record this intake and output as a nurse? All intake and output as measured for hospitalized patients, and it's going to be recorded in the patient's chart.

01:11 And it is really important that we make this as accurate as possible.

01:16 So remember that intake is going to include IV and oral fluids.

01:20 It's going to include medications.

01:24 And might include anything else that is going into the body.

01:29 Output is going to be anything that you can record.

01:33 And you'll hear the term sensible and insensible losses.

01:37 So, sensible losses are the losses that we think about.

01:41 Like if your patient is urinating, that is a loss.

01:44 If your patient has a drain, that is a loss.

01:47 That's something that you can measure.

01:49 Insensible losses are those losses that it's just really difficult for us to measure.

01:54 I don't think you can imagine trying to measure sweat that's coming out of a patient or even measure the amount of fluid that you might lose while you're breathing.

02:03 We just really can't do that.

02:04 So, we do know that there's some losses happening, that we're not going to be able to measure.

02:11 When you are measuring that output, measuring urine output is a big part of that.

02:17 And there's several different ways that you can do this.

02:19 Your patient might have a Foley.

02:21 And you're recording what is being drained into that Foley bag.

02:25 Your a patient might be urinating into a urinal, or maybe they can make it to a bedside commode.

02:31 And they you might have what we call a hat in the toilet that can catch that urine.

02:37 And it's really important that we catch all of that that we can and that we record it.

02:44 Now for some patients who are infants or even older patients that might be incontinent, they're going to have diapers.

02:52 And so a big part of what you're going to be doing to measure output is measuring those diapers.

02:58 And occasionally, we're going to be needing to measure stool as well, especially in the case of infants.

03:06 And so you might be measuring the diaper with mixed output, meaning it has both urine and stool in it.

03:13 Or in the case of a patient that has a lot of diarrhea, they might even have a fecal management system, which is going to catch just the stool that is coming out.

03:24 So, a lot of different ways to measure output.

03:28 Now, one of the most important things that you can do, especially for infants that we are recording I's and O's, intake and output for, is to make sure that you have really accurate weights on the diaper.

03:41 So that is going to start with you zeroing the scale with a dry diaper.

03:45 Then you're going to place the wet diaper on the scale.

03:49 And the difference is going to represent the added volume of urine.

03:53 It's really important that we get only the urine and that you don't add in the weight of the diaper itself.

04:02 Don't forget about any drains.

04:03 We might have to.

04:04 That is also a source of output.

04:06 And sometimes it can be quite a lot of output.

04:09 Your patient might have JP drains.

04:11 They might have a device draining, the CSF.

04:16 They might have chest tubes that's draining fluid from the pleural space.

04:21 This can end up being quite a lot of volume.

04:23 And so we have to make sure that we're accounting for it.

04:27 You might be using an electronic medical record that looks something like this.

04:32 Where it's going to be really important that you're very precise in the measurements of the fluid that's going in and the fluid that's coming out for your patients.

04:44 So measuring total output is going to include diapers, and liquid stool, and emesis, nasal gastric tubes, drainage tubes, anything that might be coming out of your patient.

04:57 We think of urine output as being the major output for patients and often it is.

05:02 The goal for urine output is 1 to 2 milliliters per kilo per hour.

05:07 But we don't want you to forget these other sources of output for your patient.

05:12 The output that usually doesn't get included is those insensible losses.

05:18 So again, sweat, tears, sometimes mucus.

05:21 If your patient is being suctioned a lot and they have a lot of pulmonary secretions.

05:27 Those it's very difficult to measure.

05:32 Now, one of the things that you also want to do.

05:35 Remember, we're always assessing for dehydration in our patients as you're measuring that output.

05:40 And you're looking at the urine in the urinal or in the hat.

05:45 You want to assess the color, and make sure that it is on the lighter side and that we don't think our patient is getting dehydrated.

05:54 So it's really important for you to remember that medical decisions are going to be based on fluid balance.

06:00 So accuracy is really crucial.

06:03 And this can be especially important for patients that have heart failure, kidney disease, patients that are critically ill, and most hospitalized patients.

06:13 It's really crucial to have accurate numbers.