Intake and Output

[dreamerachiever]

Need some help with intake and output problem!

-The patient is receiving an iv of d5w infusing at 100 ml/hr at the start of the shift (0700). He gets an IVPB of Pecid 20 mg in 50 ml NS Q 8H. For breakfast the patient took 4 oz of apple juice and 6 oz chicken broth. At 1000 the patient drank 1 cup of water. For lunch the patient took 1 glass of milk and 1 Tbsp of jello. The patient has an indwelling foley catheter. The CNA emptied 1250 ml of urine from foley catheter. The patient vomited 150 ml at 1500. Calculate the patient's Intake and Output at 0700 and ending at 1500.

**I'm getting 1795 mL for intake; the answer key has 1535 mL

[ThePsychWhisperer, BSN, MSN, APRN, NP]

In my drug calc class, we were taught a Glass is a standard 6oz, or 180mL. If you use that, along with other numbers given in these comments, you will get 1535mL for intake.

ETA: the answer of 1535 does not include the IVPB at all. It's 800+120+180+240+180+15

I have never heard of a "glass" being 180ml, and this is after 5 years as a nurse and 12 as a pharmacy tech. However, if we use this measurement (without PB), you get the following:

800 + 120 +180 + 180 + 180 + 15 = 1475

After looking at it again, what it looks like they're doing is taking the 750 from the IV fluids, 50ml from one IV PB, the 120ml from the apple juice, 180ml from the chicken broth, 180ml for a "cup" of water, and 240ml from a "glass" of milk.

This leaves 750 + 50 + 120 + 180 + 180 + 240 + 15 = 1535. Why in the world they are differentiating between a "cup" and a "glass," I have no idea. It's no wonder other medical professionals giggle at nurses; no standardization anywhere. *SIGH*

However, this does give you the appropriate amount of output with 1250ml urine and 150ml emesis to make 1400ml output total.

*Puts away my abacus* Good luck with the rest of your math problems, OP!

[NurseBlaq]

In my drug calc class, we were taught a Glass is a standard 6oz, or 180mL. If you use that, along with other numbers given in these comments, you will get 1535mL for intake.

ETA: the answer of 1535 does not include the IVPB at all. It's 800+120+180+240+180+15

This! The IVPB takes place of IV fluids when running. I think some are counting both but in reality it takes place of the maintenance fluid, not in addition to. Not sure if someone already said that as I haven't read through the whole thread yet.

[Mavrick, BSN, RN]

This! The IVPB takes place of IV fluids when running. I think some are counting both but in reality it takes place of the maintenance fluid, not in addition to. Not sure if someone already said that as I haven't read through the whole thread yet.

This would be true if the nurse programmed an IV pump capable of of infusing a 50ml IVPB secondary in 30 minutes. Not all places do that. It can be given in addition to the maintenance.

Yet another poorly written test question over analyzed by real nurses.

OP you have to learn to play by their rules until you're out from under their thumb.

[Mavrick, BSN, RN]

Whoops, I got 1795 by counting the Ceftriaxone three times instead of once.

What Ceftriaxone? I thought your IVPB was "Pecid"

[KelRN215, BSN, RN]

This! The IVPB takes place of IV fluids when running. I think some are counting both but in reality it takes place of the maintenance fluid, not in addition to. Not sure if someone already said that as I haven't read through the whole thread yet.

Not always. When I worked in the hospital, 50 mL of an IV med would more likely be dispensed in a 60 mL syringe than a bag and would be run on a syringe pump concurrently with an IV fluid.

[dreamerachiever, BSN, RN]

Thanks everyone for you answers! This is for an upcoming dosage exam.

[NurseBlaq]

This would be true if the nurse programmed an IV pump capable of of infusing a 50ml IVPB secondary in 30 minutes. Not all places do that. It can be given in addition to the maintenance.

Yet another poorly written test question over analyzed by real nurses.

OP you have to learn to play by their rules until you're out from under their thumb.

Agreed, it is a poorly written question. However, I've never run maintenance while running an IV piggyback. Based upon the question, it's inferred both aren't run at the same time.

Not always. When I worked in the hospital, 50 mL of an IV med would more likely be dispensed in a 60 mL syringe than a bag and would be run on a syringe pump concurrently with an IV fluid.

The only time I've used a syringe pump is to administer pain medication. I've never had to administer an IVPB via syringe pump so I wasn't answering from that standpoint and it wasn't inferred in the question. However, with the IVPB shortage due to the issues in PR they many are now being dispensed via syringe.

[Julius Seizure]

Not always. When I worked in the hospital, 50 mL of an IV med would more likely be dispensed in a 60 mL syringe than a bag and would be run on a syringe pump concurrently with an IV fluid.

In my mind, it is only called an IVPB when its hung with secondary tubing Y-ed together above the pump and run as a secondary infusion while the primary infusion is set to resume after the med is done. If it is hung to run concurrently on its own pump (whether a bag or syringe), I don't think of that as an IVPB but rather an IVP/IV injection/IV infusion.

Semantics. And, to be clear, have no source to back this up with. It's just how I think of them in my brain. :)

[KrCmommy522, BSN, RN]

I read this post earlier, and I got 1645 mL too! I thought for sure I was messing up if the answer key is different.

The only thing I can think of is missing information. Can the IVPB meds make up the difference? Doesn't that interrupt the D5W infusion?

I've never heard of a med called "Precid" (not saying it doesn't exist, just that I don't know what it is), but I looked up "Prevacid" which is supposed to be infused @ 100/mL an hour - the same rate as the D5W. So, IF the IVPB interrupts the continuous infusion, you have to subtract 50mL of D5W (1/2 hour's worth) from your intakes. That leaves you with a difference of "only" 60 mL... And here I am stumped...

ETA: If my calculations are correct, total intake would be 1595 mL.

I agree!! Those were my thoughts too!! I did the calculations over and over and I'm thinking to myself, "I don't get this! I never had an issue with this in nursing school. I've never had an issue since. What is wrong with this? Then, I realized the name of the med was "Precid" and I'm like I have no idea what that is. I figured it was a typo and meant "Prevacid" But, like you I wasn't sure it didn't exist so thought I'd just try googling it! When I googled "Precid," Prevacid came up. So that made me even more convinced it was a typo. When I looked up Prevacid I also saw it should be infused at 100 mL/hr.

So, with what Velocirobot said:

In my drug calc class, we were taught a Glass is a standard 6oz, or 180mL.

I see now that for some reason, a glass is being counted as 6 oz (180 mL). Like other poster's have stated - it is so ridiculous differentiating between a "glass" and a "cup." I never had anything in nursing school that used a "glass" to describe the amount because, as 203bravo and I stated in our posts, a "glass" comes in many sizes!

My New Calculations:

Stated I&O

•D5W 100 mL/hr at start of shift (0700)

•IVPB 20 mg in 50 mL q8h

•4 oz apple juice

•6 oz chicken broth

•1 cup water

•1 glass milk

•1 tbsp jello

•1250 mL urine out

•150 mL vomit

Calculate 0700 to 1500 = 8 hrs

Conversions:

•1 oz = 30 mL

•1 cup = 8 oz = 240 mL

•1 glass = 1 cup = 6 oz = 180 mL

•1 tablespoon = 15 mL

Intake:

D5W 100 mL/hr at start of shift (0700) = 100 mL/hr x 7.5 hrs = 750 mL

(run 7.5 hrs, because not running during IVPB, and Prevacid runs at 100 mL/hr, so 50 mL would run in 30 min)

IVPB 50 mL q8h = 1 dose = 50 mL

4 oz apple juice = 4 oz x 30 mL = 120 mL

6 oz chicken broth = 6 oz x 30 mL = 180 mL

1 cup water = 240 mL

1 glass milk = 1 glass being 6 oz (instead of 8) = 6 x 30 = 180 mL

1 Tbsp jello = 15 mL

Total Intake:

750 mL + 50 mL + 120 mL + 180 mL + 240 mL + 180 mL + 15 mL = 1535 mL

Output:

Vomit = 150 mL

Urine = 1250 mL

Total Output:

1250 mL + 150 mL = 1400 mL

Intake = 1535 mL

Output = 1400 mL

Jeesh that sure was a confusing problem!! LoL!