Unit 7: Fluid Intake & Output
7.1 Overview
Fluid intake and output is essential to understanding patient fluid balance. The total intake and output amounts are recorded at the end of each shift and also totaled for a 24-hour period. Oral intake includes fluids and solids that become liquid at body and room temperature, such as gelatin and popsicles; intake also includes water, broth, and juice. It does not include solids, such as bread, cereal, or meats. Liquid output refers to fluids that exit the body, such as diarrhea, emesis, gastric suction, and urine (Gray Morris & Brown, 2017, p. 93). It is important to have strong mathematical skills in conversion and units of measurement to be successful in calculating intake and output.
7.2 Learning Outcomes
After completing this unit, you will be able to
- add total volume of input amounts;
- add total volume of output amounts; and
- calculate the net fluid balance.
7.3 Learning Resources
The following resources will assist you in achieving the learning outcomes for this unit. If a resource link does not function, use a search engine to locate the current link or alternative websites.
Brashear, M. (n.d.). Urine output. Retrieved from https://www.atdove.org/article/urine-output
Buchholtz, S. (2016). Henke’s med-math: Dosage calculation, preparation, and administration (8th ed.). Philadelphia, PA: Wolters Kluwer.
College Registered Nurses of Alberta (2019). Entry-Level competencies for the practice of registered nurses. https://nurses.ab.ca/media/5ndpyfar/entry-level-competencies-for-the-practice-of-registered-nurses-mar-2019.pdf
Magoosh. (2017). Calculating intake and output on the NCLEX-RN. Retrieved from https://magoosh.com/nclexrn/calculating-intake-output-nclex-rn/
Gray Morris, D.C., & Brown, M. (2017). Calculate with confidence (1st Canadian ed.). Toronto, ON: Elsevier Canada.
Olsen, J.L., Giangrasso, A.P., & Shrimpton, D. (2016). Medical dosage calculations: A dimensional analysis approach (11th ed). New Jersey: Pearson Education.
Quizlet. (2018). Fluid balance: Intake and output. Retrieved from https://quizlet.com/231712800/fluid-balance-intake-and-output-flash-cards/
RegisteredNurseRN. (2018). Intake and output nursing calculation practice problems NCLEX (CNA,LPN, RN) I and O [Video File]. Retrieved from https://www.youtube.com/watch?v=a6ovyZIs9tg&index=17&list=PLQrdx7rRsKfUYdl0TZQ0Tc2-hLlXlHNXq&t=0s
Shepherd, A. (2011). Measuring and managing fluid balance. Nursing Times, 107(28), 12-16. Retrieved from https://docplayer.net/20796679-Measuring-and-managing-fluid-balance.html
7.4 Learning Activities
1. The nurse hangs a 1000 mL bag of D5W at 0700. Then at 1500 hours, she notices that 150 mL is left in the bag. The nurse records 850 mL was absorbed and indicates that 150 mL is left to be absorbed. The indwelling catheter bag was emptied for 480 mL. Find a input and output form online and share your form in Coffee room discussion.
2. Take this little Quizlet on Fluid balance intake and output: https://quizlet.com/231712800/fluid-balance-intake-and-output-flash-cards/
3. It is important to know your patient's hourly urine output. Fluid volume, when divided by the time in hours, will provide hourly output. Compute the average hourly urine output in each of the following situations. Round the answer to the nearest whole number.
500 mL in an 8 hour period
(500 mL/8 hr) = 62.5 mL/hr = 63 mL/hr
700 mL in an 8 hour period
(700 mL/8 hr) = 87.5 mL/hr = 88 mL/hr
640 mL in a 24 hour period
(640 mL/ 24hr) = 26.7 mL/hr = 27 mL/hr
7.5 Self-Evaluation Exam
1. Calculate this patient’s 8 hour (0700 - 1500) fluid intake.
IV NS fluid running at 50 cc/hr
50ml/hr x 8hr = 400 mL
Total parenteral nutrition running @ 55 cc/hr
55 mL/hr x 8 hr = 440 mL
Lipids running @ 10 cc/hr for 12 hours only (8 pm to 8 am)
10 mL/hr x 1 hr = 10 mL
2 units of packed red blood cells (PRBC) each unit = 250 mL
(1st unit given at 0730 and 2nd unit given 1330)
250 mL x 2 = 500 mL
Vancomycin 1500 mg in 250mL IV q 12 h (0800 and 2000)
250 mL
250mL of ice chips/8 hour shift (calculate ½ measure for ice chips)
250 mL x 0.5 = 125 mL
Total = (400 + 440 + 10 + 500 + 250 + 125) mL = 1725 mL
Answer: 1,725 mL
If you had problems finding the correct answers for questions 1, please take a few minutes to watch this teaching video.
2. The patient returns from having prostate surgery with a continuous bladder irrigation insitu. The irrigation fluid of normal saline is running at a rate of 150 mL/hr. After 8 hours the nurse must obtain a urine output. The drainage bag is emptied for 2,520 mL.
Of the total, ________mL is urine output.
1320 mL
Irrigation = 150mL/hr x 8 hrs = 1200 mL
Total emptied = 2520 mL
Urine output = 2520 mL – 1200 mL = 1320 mL
3a. Calculate your patient’s net balance (using Questions 1 and 2).
400 mL balance
3b. Does this patient have a positive or negative net balance?
Positive
Net balance = (1725 – 1320) mL = 405 mL
Watch this video to see an explanation.
4. Calculate how much IV fluid you would document on an Intake & Output flow sheet, as being absorbed from a 500 mL bag, if the following amounts are left in the bag.
5. Calculate the following items and give the total number of milliliters:
3 popsicles (3 oz each)
(30mL x 3) = 90mL
3 glasses of iced tea (6 oz glass)
(3 x 6 oz) x 30 mL = 540 mL
1½ glasses of water
(1.5 x 250 mL) = 375 mL
12 oz of diet cola
(12 oz x 30 mL) = 360 mL
Total: (90 + 540 + 375 + 360) mL = 1365 mL
Answer: 1365 mL
6. A patient’s output for the 1500 to 2300 shift was as follows:
- 325 mL of urine at 1600
- 75 mL of emesis at 1900
- 225 mL of urine at 2000
- 200 mL of nasogastric (NG) drainage at 2300
- 50 mL of wound drainage at 2300
What is the total output in mL?
875 mL
Total = (325 + 75 + 225 + 200 + 50) mL = 875 mL
7. The prescriber orders to replace NG loss 1:1 over 4 hours with Normal Saline (Use the patient referred to in Question 6).
How many mL of NS will you replace?
200 mL
What will you set your pump at in mL per hour to deliver the NG loss over 4 hours?
50mL/hr
200 mL/ 4 hrs = 50 mL/hr
7.6 Reflection
According to the Shepherd (2011) there only needs to be a 5% fluctuation in fluid volume to damage health. You are responsible for ensuring that fluid balance charts are recorded regularly and accurately. Reflect on this scope-of-practice statement from the College of Registered Nurses of Alberta (CRNA) (2013) that states that an entry level registered nurse will “analyze and interpret data obtained in client assessments to draw conclusions about client health status" (p. 14, competency 34).