I/O in ER

Specialties Emergency

Published

Specializes in Cardiac.

So I went to the ER to pick up my CHF exac. pt and found the nurse toileting her without a hat to measure urine output. I figure this is common place for ER but in my opinion if there's anyone who needs strict I/O it's a CHF pt in fluid overload. Thoughts?

And for the love of God please don't give me a lecture on how I don't know the plight of an ER nurse yada yada yada. Not interested. I'm not attacking, just throwing out a thought for conversation

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Specializes in Med-Surg, Emergency, CEN.

You sound really frustrated. Did you really want answers or did you just want to vent?

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Specializes in Emergency, Telemetry, Transplant.

If the pt is crucially ill and needs strict I&Os, then they should have a Foley. Otherwise, what about when the pt urinated a large quantity right before coming to the ER? What about when she walked through the door and went right to the restroom rather than to triage? In other words, lots of the measurements in the first few hours of hospitalization is going to fall through the cracks. In theory, should the nurse have measured that urine? Yes. Not always practical though.

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Specializes in Cardiac.

I just think it's pretty important after a pt has their first dose of IVP lasix

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Specializes in Cardiac.
You sound really frustrated. Did you really want answers or did you just want to vent?

That's the *frustrating* thing about reading text, it's difficult to convey tone. The tone of what's read is completely up to the reader. :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Yes the I/O is measured in the ED however it is not always practical. Was this patient ambulated to the bathroom? Sometimes you give IV lasix and mean to get back to put a commode at the bedside but a trauma or a MI rolls in calling everyone's attention and you forget....they then call and have to go NOW! but the collection hat is across the unit. I know you don't want to hear about the ED nurses plight...The ED is far from perfect for a patient care environment and little things get missed in the effort to put out the fires....I/O is really not very high on the priority list if we are being honest here.

Technically the weight is more important measure.

ED nurses run around putting out small fires safely...some of the details however, get temporarily lost. IN the current environment when all nurses are being asked to do much more with less....it is what it is.

thread moved for best response.

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Specializes in Cardiac.
Yes the I/O is measured in the ED however it is not always practical. Was this patient ambulated to the bathroom? Sometimes you give IV lasix and mean to get back to put a commode at the bedside but a trauma or a MI rolls in calling everyone's attention and you forget....they then call and have to go NOW! but the collection hat is across the unit. I know you don't want to hear about the ED nurses plight...The ED is far from perfect for a patient care environment and little things get missed in the effort to put out the fires....I/O is really not very high on the priority list if we are being honest here.

Technically the weight is more important measure.

ED nurses run around putting out small fires safely...some of the details however, get temporarily lost. IN the current environment when all nurses are being asked to do much more with less....it is what it is.

thread moved for best response.

Good point about dly wt-it is more important. Lol

Idk how ER nurses do it. I like knowing EVERYTHING about my pts in CCU. Saw you had surgery same, hope you're recovering well

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Specializes in Emergency Room, Trauma ICU.
Good point about dly wt-it is more important. Lol

Idk how ER nurses do it. I like knowing EVERYTHING about my pts in CCU. Saw you had surgery same, hope you're recovering well

When I was in the ICU I was the same way. But it's completely different beast in the ER. And honestly I&Os isn't high on my priority list.

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Specializes in Emergency.

I/O gives you good information over time. ER patients should be somewhere else long before that information is very valuable. Sometimes we do collect I/O information, typically it's when we are admitting the patient, because then the nurse taking care of the patient after us will be able to use that information. On a fair number of patients our I/O are "bowels are flowing again doc, let's get 'em out of here before they give us another complaint!"

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

I can understand measuring I/O for critically ill patients, like those in septic shock that we are pouring the fluid into, but a woman or man who has received Lasix for CHF who are ambulatory? WHY???? You will know if it is working because they will get better or if it isn't working they won't. How about just daily weights and monitoring patient condition rather than doing something useless like measuring pee, as long as they are peeing who cares!! Maybe I just don't get it because I have never been a floor nurse so I don't get to see the value of that data?

HPRN

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Specializes in Med-Surg, Emergency, CEN.

They measure it because on the floor it is a constant vigilance method of measuring kidney functions and fluid/electrolyte balances.

They can also use it to spot possible diagnoses. If someone with no diagnosed medical history is putting out 4L a day and is always complaining about how hungry and thirsty they are and how itchy and painful it is to urinate, they may be able to catch the signs of diabetes.

If someone NPO for surgery has been vomiting and dizziness with standing, they can spot the signs of dehydration and turn it around.

I/Os are evidence based practice (I saw you roll your eyes!) to monitor and heal a patient. In fact, i found a great post about it here! http://nursingreviewbyozlek.blogspot.com/2010/07/intake-and-output.html

In emergency services, this doesn't help us much since we see a patient for such a short time. Our job is to stabilize, diagnose, and disposition a patient with a plan of care. The floor nurses implement the actual care to return the patient to full discharge status. (Long term care and primary care have it the hard too: the long term monitoring, teaching, and treatments of a patient for life!)

It's not about which specialty is better than the other, it's about working together to get people staying as independent as possible. We all get frustrated and need to let it out. That's one of the things AN is great for!!

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Specializes in ER/Emergency Behavioral Health....

I would weigh the patient upon coming to your unit. 1kg = 1L, correct?

We try to do our best in the ER. In my ER we often have holds and some of our patients are there for over 24 hours. In that case we do monitor I/O. We also often ask our docs for indwelling foley cath when there is a lot of lasix involved for accurate measurement.

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