Introduction
Monitoring and recording intake and output (I&O) is a fundamental nursing responsibility that plays a critical role in assessing a patient’s fluid balance, guiding treatment decisions, and preventing complications like dehydration, fluid overload, or electrolyte imbalances.
Purpose of I&O Monitoring
- Evaluate hydration status and renal function
- Detect early signs of fluid imbalance
- Guide IV fluid therapy and diuretic use
- Monitor response to medications (e.g., diuretics, vasopressors)
- Support care in critical conditions (e.g., heart failure, kidney injury, sepsis)
What to Include in Intake
| Source | Examples |
|---|---|
| Oral fluids | Water, juice, tea, coffee, soup, ice chips |
| Enteral intake | Tube feedings, flushes |
| Parenteral intake | IV fluids, medications, blood products |
| Other | Liquid medications, nutritional supplements |
- Tip: Ice chips are recorded as half their volume (e.g., 100 mL of ice = 50 mL fluid).
What to Include in Output
| Source | Examples |
|---|---|
| Urine | Measured via urinal, catheter, or collection bag |
| Emesis | Vomit collected in emesis basin |
| Stool | Especially if liquid or diarrhea |
| Wound drainage | From surgical drains or dressings |
| Other | Chest tube output, excessive perspiration (estimated) |
- Note: Insensible losses (e.g., sweat, respiration) are not directly measured but should be considered in clinical judgment.
Procedure for Accurate Monitoring
- Explain the process to the patient and involve them if possible.
- Use graduated containers for precise measurement.
- Record intake and output in milliliters (mL).
- Tally totals at the end of each shift and over 24 hours.
- Compare intake vs. output to assess fluid balance
Role of Nurse in Recording and Monitoring I/O
- Assess the physician’s order, patient’s health status, dietary and fluid intake, presence of IV fluids, infusions, presence of NG feeds/jejunostomy/TPN, drainage (surgical drains, intercostal, chest tube), NG aspiration, Foley’s/condom, and suprapubic drainage.
- Note the input volumes such as oral and parental administration, NG irrigation volume, output from urine, vomit, diarrhea, blood, and wound drains.
- Follow standard safety protocols in handling body fluids.
- Monitor for the need for fluids for patients with fever, with fluid loss, and on certain diuretics and corticosteroids drugs.
- Monitor for common signs of dehydration such as dry mouth, excessive thirst, sunken eyeballs, low urine output, and dark urine. For patients with fluid overload with electrolyte imbalanced, DKA, heart or kidney conditions, monitor for edema and ascites.
- Monitor every time the patient receives or loses fluids.
- Maintain an hourly I&O chart.
- Perform hand wash, don gloves, assess the total volume, transfer the fluid into the graduated measuring cup, and hold it at the eye level to ensure precise measurement.
- Subtract the volume in the graduate from the total volume of fluid served, doff gloves, practice hand hygiene, and document in the I&O chart.
- Document the date; time; changes in the volume by calculating fluid balance at the end of 24 hours [fluid balance = (total intake) – (total output)]; changes in the color, clarity, or odor of the output; observation related to excessive fluid loss (bleeding from the drain or increased abdominal girth); and fluid gain.
Note:
- Positive balance: Intake > output is normal.
- Negative balance: Output > intake is abnormal.
Special Consideration
- Use I&O charts or electronic records consistently.
- Collaborate with dietitians and physicians for fluid orders.
- Educate patients and families on the importance of tracking.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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