Component Task: Recording of Intake and Output

Introduction

Fluid balance is a term used to describe the balance of the input and output of fluids in the body to allow metabolic processes to function correctly (Welch, 2010). Fluid constitutes around 52% of total body weight in women and 60% in men. This consists of water and molecules containing, for example, sodium, chloride and potassium (Mooney, 2007). These compounds disassociate into particles which carry an electrical charge; these particles in solutions are called electrolytes. For example, sodium chloride (NaCl) dissolves in solution to form an equal number of positively charged sodium (Na+) ions, and negatively charged chlorine (C1-) ions (Waugh, 2007).

Plasma electrolytes are balanced as it is important to have the correct concentration of ions in the blood, especially sodium, potassium and magnesium. Too much or too little of these electrolytes can cause cardiac arrhythmias (Docherty, 2006). Fluid intake is obtained from diet i.e. from water and food, and is mostly lost through urine output. It is also lost through the skin as sweat, through the respiratory tract, and in faecal matter.

Conditions that call for fluid intake and output measurement

• Patients with kidney or renal failure. 
• Dehydrated patients either by vomiting or diarrhea.
• Patients with scalds or bums.
• Patients with cardiac failure.
• Some patients who have undergone surgery.
• Patients receiving diuretic and corticosteroids therapy.

Purposes of Intake and Output

• To help patients on drainage devices know how much fluid is lost or to be replaced.
• To evaluate fluids and electrolytes imbalance. An electrolyte is any substance which conducts electric impulses. Interstitial fluids are the fluids that the body cell nourishes.
•  To determine choices of fluids.
  

Requirement for recording Intake and Output

The following are requirements for measuring fluid intake and output;

• Measuring jugs.
• Chart for recording.
• Pen.
• Clock for time recording
• Gloves
• Urinal or bedpan
• Hand washing device

Intake Substances 

• Water, porridge, coconut water, light soup and all types of watery foods.
• Intravenous fluids such as dextrose, normal saline, ringers lactate, mannitol.

Output Substances

• Vomitus
• Watery stool/loose stool
• Urine
• Wound/surgical discharges
• Chest drainage thus accumulation of fluid in the lungs
• Gastric contents which may be due to increased interstitial secretion

Causes of errors in measuring fluid intake and output

Factors that lead to errors in measuring fluid intake and output includes;

• Guess work.
• Poor education given to patients on the need to measure intake and outputs.
• Poor communication between staffs regarding patients who are on fluid intake and output charts.
• Failure to record volumes at the right time.

Component Task

1. Explain procedure to patient and the importance of the procedure to gain his/her co­operation.
2. Get requirements eg. Measuring jugs for fluid intake and output, fluid chart and pen.
3. Record all measurements in milliters.
4. Record the amount of infusion or transfusions and other intakes at fluid intake column.
5. Record any output such as urine, watery stool, vomitus at output column.
6. Balancing the fluid intake and output chart, depends on the hospital protocol.
7. Find fluid balance by subtracting output from intake.
8. Inform the nurse in charged/doctor immediately if output is greater than intake or when there is low output.

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