When the doctor orders "strict I's and O's" we have to measure and keep track of every drop that goes into or comes out of our client.
This generally happens only in the acute hospital setting, usually in the first few days after surgery. But, in congestive heart failure, we need to monitor closely to prevent fluid overload or dehydration.
We only count liquids or anything that becomes liquid at body temperature. Not room temperature, like 70 degrees, but body temperature, 98.6, so ice cream, pudding and jello count as liquid.
Of course all the usual suspects are included, coffee, milk, juice, etc. Don't forget the water pitcher at the bedside. Empty it and refill at the beginning of your shift so that you have an accurate reading. IV fluid, wound irrigation, g-tube feedings and flushes all must be included. You will need to get those amounts from the nurse.
All amounts must be in cc's. So if we have a 6 ounce cup of coffee, we multiply 6 times 30, and get 180 cc of coffee. Each ounce is equal to 30 cc.
As for output- we count urine, emesis (vomit), wound drainage, (when there is a proper drain like a jp drain in a surgical site). If there is wound irrigation, then there should be a suction set up to pull off the irrigation.
Bowel movements don't count unless it is watery diarrhea and you will need a container, a "hat," in the toilet to catch and measure. If not, at least estimate the amount. It must be reported, evan as an estimate, as our elderly clients especially can become dehydrated so quickly.
For your accuracy in documenting, keep a running list through your shift and label each item to prevent omissions and duplicates.
At the end of your shift, total both columns. They should be fairly close to the same amount. This is what is referred to as fluid balance.
Remember- to be healthy, the human body should take in and expel around 1,500 cc of fluid each 24 hour period.
With your totals- subtract the larger number from the smaller and record/report the difference. If the input is larger, then it is a positive fluid balance. If the output is more, then it is a negative fluid balance.
An example would be 2000cc of input, 800cc of output. Subtract 800 from 2000 and the difference is 1200+fluid balance. This client is on fluid overload.
If it was the other way around, 800cc intake and 2000cc of output, 1200- fluid balance, this client will get dehydrated very quickly.
It is up to you, the first line care giver, to monitor your client and record/report the results.
If you have questions on this or any other blog- feel free to email me through this site.