Understanding Intake and Output Calculations

This is Sarah with RegisteredNurseRN.com and in this video I'm going to go over how to calculate intake and output. What I'm going to be doing is I'm going to go over how to calculate intake, what specifically you include in that calculation versus output because I know sometimes it can get a little bit confusing on what you should include. Then I'm going to work a couple problems and show you how to do it and as always at the end of this YouTube video you can access the free quiz that will test you on how to do that. So let's get started. First let's start out talking about intake. Okay, what does this include? This includes fluids taken in the body. So this can be via the mouth, a tube, or an IV or central line. But first let's talk about liquids consumed, taken in by the mouth. Okay, this includes any liquids that are liquid at room temperature. That's what we're going to include in our calculation. So this will include things like juice, water. Ice chips and things you want to remember about ice chips is that they melt to half their volume. So if you give them eight ounces of ice chips, you're going to really record it as four ounces because it's going to melt down to four ounces. Any drinks like tea, coffee, soda you will include, gelatin desserts like Jell-O, milk, broths, ice cream, frozen treats like popsicles, sorbet, and nutrition supplements like Ensure or boost. Now what about pudding? Do you include that in the calculation or not? Unfortunately the consensus on this is not the same across the board. I will say no you don't include pudding. I've never included it as a nurse, wasn't taught to, and the latest NCLEX guide by Kaplan says that you don't include pudding in the calculation because it's a semi-liquid. However some students I've talked to They said that the professor told them to or their book told them to. So if you have any doubts or questions, always ask your professor before the exam and go by what they tell you. But for this video, we're not going to include pudding when we work or practice problems. Okay, some other miscellaneous things that's included in this intake calculation are tube feedings, like the tube feeding that you would feed them through their PEG tube, whatever type of tube they have. Also, don't forget the free water flushes that they'll receive as well. And any type of IV fluids, central line fluids, this can include TPN, lipids, blood products, any med infusions or flushes, and next, IV flushes, don't forget those, and any irrigants like... bladder irrigation things like that now let's talk about output okay this is anything that's taken out of the body that leaves the body and majority of your calculation for output will be urine and it also includes things like emesis vomit liquids stool like diarrhea or from an ostomy bag, especially in ileostomies since those stools tend to be a lot more liquid. Any wound drainage that you can measure that's like in a drain, like a wound bag, JP drain, a tube, chest tube, anything like that. Suction that you can suction from the respiratory system, gastric system, you'll want to include. Now, one thing that we don't include that you want to be aware of it as a nurse is the insensible loss, things we really can't. can't measure. This comes from the skin or the lungs. According to Moseby's medical dictionary, you can lose about 600 milliliters per day through these routes. Whenever you are assessing those I's and O's, you want to take that into consideration. Remember, if that intake is less than that output or the output is more than the intake, there is a risk of dehydration on your patient's part because they're losing so much fluid. more than they're taking in. Compared to if the intake was more than the output, or another way of saying it, the output's less than the intake, they're retaining fluid. They're at risk for fluid overload because they're just ingesting or receiving all this fluid, but they're not really urinating it out. So they're at risk for retaining it. Now let's solve a problem. Okay, this particular problem wants to know what's the patient's total intake during your 12-hour shift. So whenever you look at these problems, you've got to pay attention. attention to a couple things because they try to throw you off. Okay, number one, you have to make sure you're including the right thing in your intake calculation, which is why we went over that whole list of what's included. Number two, a lot of problems will give you the intake in ounces and you have to convert that to milliliters because we record intake and output in milliliters. It's really easy how you do that. You take all the ounces and you multiply that by 30. and that will equal your milliliters. Another thing is that you wanna... Make sure you pay attention whenever you are adding up those ounces and don't add in like 10 cc's to your ounce calculation until you have converted it because it can throw off your numbers. So let's see what our problem says. Okay, at 8 o'clock our patient had 8 ounces of orange juice, which we will include orange juice. They had 6 ounces of yogurt, we don't include that, and they had a 10 cc IV flush. Now cc's and milliliters are the same. same that equal one mil one cc equals one milliliter so we're going to include that so to help me keep them organized I'm going to have their own little columns which also equals milliliters so we had eight ounces of orange juice and we had a 10 cc flush okay at 10 o'clock they had eight ounces of coffee which will include with one ounce of cream liquid creamers we include so we'll include that so eight and one okay at 12 they had 12 ounces of soda which will include They had two 12 ounce popsicles. Don't let that mess you up because they had two of them. So what would it be? We're not going to record 12. We're going to record 24. So 24 ounces. They had three ounces of pudding, which we're not including. And then they had four ounces of broth, which we include. And then at 1300, they had six ounces of soda, which we include. and then at 1600 they had eight ounces of ice chips now what did we say about ice chips we only record it in half because it will melt down to that so we'll record that as four And then the last part it says from 1400 to 1900 they had IV fluids running at 50 cc's an hour, so 50 milliliters an hour. So they had this running for five hours, so 50 times 5 equals what? 250. Okay, now we're ready to add. Okay, so we're going to add up all of our ounces. So all that added together equals 67. But we're still in ounces and we got to get to milliliters. So we'll multiply 67 by 30 and that equals 2010. Okay, now we have to work this part over here. So 10 plus 250 equals 260. Okay, and then we add it all together. So, 2010 plus 260 equals 2,270 milliliters. And that was their total intake for your shift. Now let's calculate output. Okay, this problem may be something similar that you may see on an exam and it says a patient had a TURP and is receiving continuous bladder irrigation. During your 12-hour shift, the patient had a TURP and is receiving continuous bladder irrigation. patient's Foley collects 5320 milliliters the patient received 2500 milliliters of bladder irrigation what is the patient's urinary output and whenever you look at this at first it's like I don't know they had all this fluid of irrigation going to their bladder and it's mixed with their urine so what exactly is their true urinary output and it's so easy to solve so what you'll do is you'll take the whole amount that was collected in that Foley bag because remember in the Foley bag it has urine and irrigation solution in it so it was a total of 5320 and then you're gonna subtract how much a bladder irrigation was instilled in that bladder so subtract 2500 and what do you get you get 2820 milliliters so that is the patient's true urinary output okay so that wraps up how to calculate intake and output thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos.

Okay, what does this include? This includes fluids taken in the body. So this can be via the mouth, a tube, or an IV or central line. But first let's talk about liquids consumed, taken in by the mouth.

Okay, this includes any liquids that are liquid at room temperature. That's what we're going to include in our calculation. So this will include things like juice, water.

Ice chips and things you want to remember about ice chips is that they melt to half their volume. So if you give them eight ounces of ice chips, you're going to really record it as four ounces because it's going to melt down to four ounces. Any drinks like tea, coffee, soda you will include, gelatin desserts like Jell-O, milk, broths, ice cream, frozen treats like popsicles, sorbet, and nutrition supplements like Ensure or boost.

Now what about pudding? Do you include that in the calculation or not? Unfortunately the consensus on this is not the same across the board. I will say no you don't include pudding. I've never included it as a nurse, wasn't taught to, and the latest NCLEX guide by Kaplan says that you don't include pudding in the calculation because it's a semi-liquid.

However some students I've talked to They said that the professor told them to or their book told them to. So if you have any doubts or questions, always ask your professor before the exam and go by what they tell you. But for this video, we're not going to include pudding when we work or practice problems. Okay, some other miscellaneous things that's included in this intake calculation are tube feedings, like the tube feeding that you would feed them through their PEG tube, whatever type of tube they have.

Also, don't forget the free water flushes that they'll receive as well. And any type of IV fluids, central line fluids, this can include TPN, lipids, blood products, any med infusions or flushes, and next, IV flushes, don't forget those, and any irrigants like... bladder irrigation things like that now let's talk about output okay this is anything that's taken out of the body that leaves the body and majority of your calculation for output will be urine and it also includes things like emesis vomit liquids stool like diarrhea or from an ostomy bag, especially in ileostomies since those stools tend to be a lot more liquid. Any wound drainage that you can measure that's like in a drain, like a wound bag, JP drain, a tube, chest tube, anything like that.

Suction that you can suction from the respiratory system, gastric system, you'll want to include. Now, one thing that we don't include that you want to be aware of it as a nurse is the insensible loss, things we really can't. can't measure. This comes from the skin or the lungs. According to Moseby's medical dictionary, you can lose about 600 milliliters per day through these routes.

Whenever you are assessing those I's and O's, you want to take that into consideration. Remember, if that intake is less than that output or the output is more than the intake, there is a risk of dehydration on your patient's part because they're losing so much fluid. more than they're taking in. Compared to if the intake was more than the output, or another way of saying it, the output's less than the intake, they're retaining fluid. They're at risk for fluid overload because they're just ingesting or receiving all this fluid, but they're not really urinating it out.

So they're at risk for retaining it. Now let's solve a problem. Okay, this particular problem wants to know what's the patient's total intake during your 12-hour shift. So whenever you look at these problems, you've got to pay attention.

attention to a couple things because they try to throw you off. Okay, number one, you have to make sure you're including the right thing in your intake calculation, which is why we went over that whole list of what's included. Number two, a lot of problems will give you the intake in ounces and you have to convert that to milliliters because we record intake and output in milliliters.

It's really easy how you do that. You take all the ounces and you multiply that by 30. and that will equal your milliliters. Another thing is that you wanna...

Make sure you pay attention whenever you are adding up those ounces and don't add in like 10 cc's to your ounce calculation until you have converted it because it can throw off your numbers. So let's see what our problem says. Okay, at 8 o'clock our patient had 8 ounces of orange juice, which we will include orange juice. They had 6 ounces of yogurt, we don't include that, and they had a 10 cc IV flush.

Now cc's and milliliters are the same. same that equal one mil one cc equals one milliliter so we're going to include that so to help me keep them organized I'm going to have their own little columns which also equals milliliters so we had eight ounces of orange juice and we had a 10 cc flush okay at 10 o'clock they had eight ounces of coffee which will include with one ounce of cream liquid creamers we include so we'll include that so eight and one okay at 12 they had 12 ounces of soda which will include They had two 12 ounce popsicles. Don't let that mess you up because they had two of them. So what would it be? We're not going to record 12. We're going to record 24. So 24 ounces.

They had three ounces of pudding, which we're not including. And then they had four ounces of broth, which we include. And then at 1300, they had six ounces of soda, which we include.

and then at 1600 they had eight ounces of ice chips now what did we say about ice chips we only record it in half because it will melt down to that so we'll record that as four And then the last part it says from 1400 to 1900 they had IV fluids running at 50 cc's an hour, so 50 milliliters an hour. So they had this running for five hours, so 50 times 5 equals what? 250. Okay, now we're ready to add.

Okay, so we're going to add up all of our ounces. So all that added together equals 67. But we're still in ounces and we got to get to milliliters. So we'll multiply 67 by 30 and that equals 2010. Okay, now we have to work this part over here. So 10 plus 250 equals 260. Okay, and then we add it all together. So, 2010 plus 260 equals 2,270 milliliters.

And that was their total intake for your shift. Now let's calculate output. Okay, this problem may be something similar that you may see on an exam and it says a patient had a TURP and is receiving continuous bladder irrigation. During your 12-hour shift, the patient had a TURP and is receiving continuous bladder irrigation.

patient's Foley collects 5320 milliliters the patient received 2500 milliliters of bladder irrigation what is the patient's urinary output and whenever you look at this at first it's like I don't know they had all this fluid of irrigation going to their bladder and it's mixed with their urine so what exactly is their true urinary output and it's so easy to solve so what you'll do is you'll take the whole amount that was collected in that Foley bag because remember in the Foley bag it has urine and irrigation solution in it so it was a total of 5320 and then you're gonna subtract how much a bladder irrigation was instilled in that bladder so subtract 2500 and what do you get you get 2820 milliliters so that is the patient's true urinary output okay so that wraps up how to calculate intake and output thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos.

Transcript for:Understanding Intake and Output Calculations

Transcript for:
Understanding Intake and Output Calculations