Intake and output monitoring
You should monitor residents who have fluid imbalances or are at high risk of dehydration by calculating intake and output (I&O) each shift. Take I&O monitoring seriously. Set a realistic intake goal for each shift. Most fluid is consumed on the day shift, with the least consumed on nights. Thus, set a specific goal for each shift. Setting a goal will tell the nurse at a glance whether the resident has consumed enough fluid on his or her shift. If not, the CNA should encourage fluids before leaving for the day. When establishing goals for fluid intake, fluid is usually divided as follows:
- Day shift: 1/2 of total 24-hour fluid goal
- Second shift: 1/3 of total 24-hour fluid goal
- Third shift: 1/6 of total 24-hour fluid goal
For residents with a fluid restriction, total fluid allowance for each shift can be distributed in the same quantity listed above. Modify the amounts listed as necessary to personalize fluid intake to the resident’s individual needs.
Trainer’s tip: Residents who may require I&O monitoring
I&O monitoring is a simple procedure that does not require a physician’s order. Sadly, nurses sometimes do not take this important intervention seriously. Write the need for I&O monitoring, as well as any special approaches or resident preferences, on the care plan. If the resident is known to be at high risk of dehydration upon admission, begin a temporary care plan to address this risk.
Facility personnel should routinely monitor fluid balance (I&O) for the following:
- All residents receiving tube feedings
- Residents with catheters
- Residents with urinary tract infections
- Residents with physician orders for fluid restrictions or orders to force (encourage) fluids
- Residents with specific physician orders for additional liquid (fluid)
- Residents who are known to be dehydrated or who are at risk for dehydration
- Residents with certain heart and kidney conditions that are at high risk for fluid imbalance
- Residents receiving intravenous fluids or parenteral nutrition therapy
- Any resident who develops a fever, vomiting, diarrhea or a nonfebrile infection, unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of breath
This is an excerpt from HCPro’s book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.