While the order or plan may extend into the nursing morning shift of the next day, the intake and output measurements end with the night shift. The nurse on duty calculates the cumulative total at the end of the shift. In order to know the fluid intake that you do every day, you better use the fluid intake charts. When the pack/bottle is finished in the middle of the shift, Night shift: 9.00 p.m. to 7.00 a.m. next day, to infuse fluids into two separate veins, or. There is a danger of losing the identity of the patient whose I-O is being charted. In children this amount is significant enough to be recorded. You should be careful to not confuse how much water you need with how much water you need to drink. It is only in situations where there is clear indication that the patient’s oral intake needs to be monitored and controlled that an I-O chart is indicated. Another normal means of output of water is through evaporation of water from the skin and mucous membranes (mouth, throat, respiratory tract) and also through sweating. At Hospital Selayang, Malaysia, I was Chairman of the Clinical Advisory Committee, the Clinical-IT Coordinator and Quality Coordinator, for close to 10 years. The amount of both the input and the output is totalled for every shift (sub-total) and for the 24 hr period (grand total) starting at 7.00 a.m. and ending at 6.59 a.m. the next day. via the intravenous route and also one of the enteral routes. If the patient has a fistula originating from the jejunum or ileum, the intestinal contents are collected into a jejunostomy or ileostomy bags. This order can easily be written as: “to give 2400 ml of enteral feeding formula via jejunostomy in 24 hours using infusion pump”. At the beginning, the nurse records the following data in the Intake Chart: The nurse needs to ensure that the type of fluid being insfused is the same as the one ordered. The type of fluid that is excreted or drained out is indicated by the headings on separate columns. Hence, the admixture may be done by the nurse in the ward or by pharmacists. Plan for IV Infusion if Only One Type of Fluid is to be Given. In this situation, it is better to use more than one chart. Coke, coffee, tea and other drinks can be included in the fluid intake category. Not only food intake needed by humans to stay alive. Charting Intake when Fluid Is Given by Both IV and also Enteral Route.
Sometimes, especially in children the amount of loss due to diarrhoea is estimated.

You should add 12 ounces of water to your daily total for every 30 minutes that you work out. There should be an order, a plan besides the recording of fluid intake and output. The period of infusion can be extended to the next day i.e. a second set is piggy backed to a line on the same vein, Continuous Infusion via an infusion set attached to the tube with the flow determined by gravity or using an infusion machine, When there is doubt regarding ability of the patient to take adequate amounts of fluid, Whenever the patient is given fluids orally in addition to IV fluids, Patients on trial of oral feeding after prolonged period of IV Therapy (e.g. Even though it is not necessary to know the amount left behind for purpose of calculation, it is good practice to make a note of the remainder left in the pack/bottle. While the doctor may order the total volume for a 24 hour period, the nurse need to take into consideration how the fluid is to be provided. In practice, KCl may be supplied by the pharmacy in gm per vial (usually 1 gm per vial equivalent to 13 mEq) or in meq per vial (usually 10 mEq per vial). ), Patients where intake needs to be limited (e.g. How the data is transferred from the order to the plan and then onto the chart will be discussed later.

However to avoid confusion, for recording of the Output only on one of the charts should be used (preferably the second one). The frequency of defecation also can provide an indication of bowel movement. The nurse needs only to calculate the rate. Consuming 4 litres of water in a day has a different effect on each person. The same form for ordering and planning as shown above may be used.
The regime is then reviewed taking into consideration the change in the patient’s condition. The shift total is made up by adding the total for each route/mode. In order to avoid physiological complications, Nasoduodenal, Nasojejunal and Jejunostomy feeds are best given via continuous infusion using infusion pumps. The workflow for starting and recording IV infusion is as shown below:

Usually, the intermittent bolus feeding method is used for this route. Patient who has a collection of fluid in a body cavity (like in pleural effusion or ascites) may have a drainage tube inserted into the cavity to drain the fluid. Fluid in ascites or pleural effusion usually had accumulated for some time and it is wise not to replace it volume for volume. All relevant particulars of the input and output data are charted in the appropriate time-interval (period) on the chart under the relevant the chart headings (column and row titles). The chart is for a 24 hour period but, for practical reasons, it does not follow the calendar day (i.e. This period varies with the time of admission of the patient. It is quite common for patients to be given intravenous fluid therapy. Because men and women have different activities, normal standards for fluid intake are also different. In a closed drainage system changing the whole drainage bag/bottle at every shift is not done. This is not a deficit because it is not an abnormal loss. Therefore the amount of intake compared to the output as per the I-O chart is not supposed to be balanced.

An example is when starting a trial of enteral feeding, the enteral feed is given at a slow rate e.g. Then, she/he needs to calculate the rate of infusion in ml/min and the equivalent drops per minute if a gravity driven drip set is used rather than an IV infusion pump. However, the clinician needs to be aware of circumstances where an abnormal amount of urine is excreted because of complications of disease for example. : It caters for the different site of administration by having two sections for intake as shown below: When providing and monitoring fluid intake and output, clinical care providers use two types of forms/charts, one for purposes of planning and the other for recording findings. This amounts to 1000-1500 ml per day in a normal adult.


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