1. Intake / output
Mod E: Ch. 26

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 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

8. 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

9. 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

10. 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

11. 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 p. 441: Sample of I&O record

13. 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

14. 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