Intake / output Mod E: Ch. 26

Food intake studies / calorie counts p. 437 Dr. may order food intake study to evaluate nutritional status Documented on “Food documentation form” p.438 Usually start with BF and goes on for certain number of days You have to record after every meal, how much pt consumed of each item You need to document all snacks, drinks, foods brought from home, meals Dietician calculates protein, carbohydrates, fats etc. consumed Dr. may adjust diet and/or nutritional supplements for patient

Dysphagia. 437 Dysphagia: difficulty swallowing food and liquids May occur with certain medical conditions: After CVA or TIA Neurological disease CA of head, neck or esophagus After radiation therapy of head or neck Dementia Medication use that causes sedation or reduce saliva production

Dysphagia. 437 S/S of dysphagia: Taking a long time before beginning swallowing Swallowing 3-4 times for each bite of food Frequent throat clearing or coughing Lack of a gag reflex or weak cough Difficulty controlling liquids and secretions in mouth Wet, gurgling voice Refusing to eat, spitting food out, pocketing food in cheeks Unintentional weight loss Tightness in throat or chest Feeling as if food is sticking in esophagus or sternal area If you observe any of these, report to the nurse ASAP

Dysphagia. 437 Risks with dysphagia: Malnutrition Dehydration Aspiration PNE Treatment is ordered by speech language pathologist who also tests for it Swallowing exercises Alter consistency of food and drinks Goal is to keep look, taste and consistency as close as normal; may use more gravy or puree food Liquids are most difficult: use thickeners to slow movement Consistency ordered by MD: honey, nectar, pudding Add thickener right before serving drink, mix until consistency is right ALWAYS: have pt eat with HOB elevated or sitting up if possible to avoid aspiration

Fluid Balance p.439 Balance between liquid intake and liquid output 2/3 of body weight is water, so balance is important Measured in milliliters (mL) or cubic centimeters (cc) 1 ounce (oz) = 30 mL 1 pint = 500 mL 1 quart = 1,000 mL 2.2 lbs = 1 kilogram (kg) = 1,000 mL

Intake p.439 Most adults take in about 2.5 – 3 quarts (2,500-3,000 mL) of fluid/day Includes: Liquids as water, tea, soft drinks Foods like fruits and vegetables Artificial intake per IV Adult patients need 600-800 mL of fluid per 8hr shift Due to sleeping during night shift, more fluid must be provided during waking hours Edema = excessive fluid retention (swelling) Dehydration = lack of sufficient fluid in body tissues

Output p.440 Usually about 2.5 quarts (2,500mL) per day in form of Urine (1,500 mL) Perspiration Moisture from lungs (exhalation) Moisture from the bowel (BM) Excessive fluid loss results in dehydration, possible causes: Diarrhea Vomiting Diuresis (excessive urine output) Diaphoresis (excessive perspiration) Wound drainage Blood loss

Recording Intake and Output (I&O) p. 440 Accurate recording of fluid taken in and given off by the body Ordered by MD, especially when patients: Are dehydrated or at risk for dehydration Receive IV therapy Had recent surgery Have a urinary catheter Are diaphoretic or vomiting Have a specific diagnosis like: CHF ______________ or renal disease

Recording Intake and Output (I&O) p. 440 I&O is calculated by measuring and recording all the fluids that patients takes in AND all the fluids the patient excretes Intake: often have to estimate PO Know what the liquid container holds when it’s full (p. 440) ex. Coffee cup (8oz) 240mL, water pitcher 1,000mL, foam cup (8oz) 240 mL, Soup bowl (6oz) 180 mL, 1 jello 130mL etc Estimate how much is gone from the container ex. ½ cup of coffee = 120mL Convert everything to mL Includes all liquids like water, coffee, tea, milk, soup, soda, juices Includes foods that melt at RT like ice cream, sherbet, gelatin Intake: includes fluids through IV: know exactly what has been infused Gastric feeding tubes: know exactly what has been given

Recording Intake and Output (I&O) p. 440 Output: all fluids excreted from body are measured, including Urine Emesis (vomitus) Diarrhea Drainage from body cavities, ex. Gastric drainage Drainage from wounds Graduate: container marked in mL or cc used to measure amount of output See Figure 26-15 p. 441: Sample of I&O record

Changing Water p.441 Encourage patient to drink 6-8 glasses of fluids every 24/hrs unless patient is NPO or on fluid restrictions Push fluids/force fluids order by MD: encourage patient to drink each time you are in the room, help if needed Make sure patient has drink that he/she likes and is allowed to drink Fresh water is best Make sure the water pitcher is full; some patients like ice water, others don’t When getting ice, avoid contamination: Use only provided scoop, keep it covered when not in use Don’t touch scoop to water pitcher Don’t fill pitcher over ice chest – if ice falls out of pitcher into ice chest, everything’s contaminated Label water pitcher with patient name For patients in isolation room: can’t remove water pitcher, bring ice in plastic bag or disposable cup

Urinary output: emptying and recording urinary drainage bag p. 812 Procedure 104 p. 812 Initial procedure Supplies: gloves, graduate, paper towels Wash hands, put on gloves Put a paper towel on floor under drainage bag, place graduate on top of paper towel Remove drain from holder, open it, drain urine into graduate – DO NOT ALLOW TIP OF TUBING TO TOUCH SIDES OF GRADUATES Close drain and replace in holder Check position of drainage tube and drainage bag Set graduate on a second, level surface (on top another paper towel) and read at eye level Empty into toilet, rinse (into toilet), dry, store in dirty supply area Remove gloves, wash hands Ending procedures