Intake and Output, Specimens and Catheter Care

Measuring and Recording Fluid Intake and Output

Monitoring fluid balance is an essential daily responsibility of the nurse aide. Fluid intake includes liquids swallowed by mouth and foods counted as fluids, such as gelatin, ice cream, sherbet, and popsicles. For example, when a resident eats gelatin, ice cream, sherbet, popsicles, or clear broth during a meal, the aide must calculate these items as fluid intake. In addition, ice chips melt to approximately half their volume when calculated as fluid intake; an everyday example is a resident consuming a cup of ice chips, which is documented as half that container's volume of liquid. Fluid intake must be documented promptly after a resident finishes eating or drinking to maintain an up-to-date record.

Fluid output refers to bodily fluids eliminated from the body that can be measured. This includes measured urine, emesis, and liquid stool. If a resident has wound drainage, the nurse aide must report this to the nurse; the aide measures drainage from a collection device only if directed and permitted by facility policy. Accurate output tracking requires clear communication with the resident. Remind residents whose intake and output are being recorded not to empty their bedpans or urinals before staff measure and record the contents. Furthermore, toilet paper must never be placed into a urine collection container because it absorbs fluid and distorts output measurements.

To obtain an exact measurement of urine or other output, nurse aides use a calibrated container called a graduate. To read a graduate accurately, the aide must place it on a flat, level surface and read the measurement at eye level. Looking down from above or tilting the container creates an inaccurate reading. After obtaining the measurement, the aide must compare the volume against any guidelines provided by the supervisory staff. Promptly report urine output below a limit given by the nurse, or noticeably less urine than usual, so the nurse can evaluate the resident's status.