Complex I & O Question

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Ok Question.

I have done simple I & O problems and could do those fairly well. Now we have complex I & O problems that are confusing me. Can someone help with this and kind of let me know a good way to do these? Thanks.

Question 1: At 1500, the patient had an IV of 0.45 NS infusing at 60ml/hr. THe patient had hematemesis of 450 ml at 1530. The doctor ordered 2 units of pRBC to infuse over 3 hr each, followed by an IV of 0.9NS at 125 ml/hr. The nurse discontinued the current IV at 1600 to start the 1st unit of pRBC. Prior to the 2nd unit of pRBC, 50ml of 0.9NS was given over 15 minutes. The client voided twice on your shift (375ml, 450ml). Calculate the patient's total I & O starting at 1500 and ending at 2300. ****One unit of pRBC's = 250ml****

How do you do these types of problems without getting totally confused?

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Specializes in Telemetry, ICU.

1) Assign negative values to your outputs. For this problem, this means:

-450 (emesis), -375 (void 1), and -450 (void 2).

2) Seperate the positive volumes for each intake (eg, calculate each one seperately) For this problem, this means [may help to lable each intake with a single word, or removing the "0.45", "0.9", etc to avoid confusion]:

a) halfNS from 1500-1600 (total of 60ml or 60mls/hr x 1hr)

b) 1st unit PRBCs from 1600-1900 (total of 250ml or 83.3mls/hr x 3hrs)

c) NS from 1900-1915 (total of 50ml or 200mls/hr x 0.25hrs)

d) 2nd unit PRBCs from 1915-2215 (total of 250ml or 83.3mlhs/hr x 3hrs)

e) NS from 2215-2300 (total of 93.75ml or 125mls/hr x 0.75hrs)

3) Take the total sum of all amounts and you have your answer. I'm not gonna do it for you ;)

There may be other methods that work better for you, or I may have misread/mistyped something, so don't take my advice as gospel. Try several different methods and one will stick with you.

Good luck!

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Specializes in LDRP.

is the answer 117.5? lol i just tried it dont feel like reworking through it to see if im right.

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Ok the way you broke it down really helped. When I worked it out the first time before posting I did not take into consideration giving the NS over 15 minutes which changed the time. I also gave the total 125 ml/hr NS for a full hour instead of for 45 minutes. Both of these made me come up with 735ml. I did it again according to your steps and got 703.75ml. I guess leaving it to the hundredths place would be ok since we were told if the patient is unknown out it at hundredths.

So if the problems says "over" 15 minutes or "over" 20 minutes this will change the times?

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Specializes in Telemetry, ICU.

Yeah- "over" means the duration of the administration. At my school, we rounded to the tenths place on adults and the hundredths place for peds. Make sure to double check what your instructors want though.

I actaully didn't work through it. I'll try to shortly though, now that I've seen your effort and answer :)

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Specializes in Telemetry, ICU.

I get -1275ml for output (-900 between the two voids and -450 for the emesis) and 703.75 for intake (500ml of blood, 60ml halfNS, and 143.75ml NS). That comes to -571.25 by my calculations...

Its disturbing that we have come up with three different answers... We need an expert to step in (or maybe I just need some sleep)...

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I get -1275ml for output (-900 between the two voids and -450 for the emesis) and 703.75 for intake (500ml of blood, 60ml halfNS, and 143.75ml NS). That comes to -571.25 by my calculations...

Its disturbing that we have come up with three different answers... We need an expert to step in (or maybe I just need some sleep)...

Well actually I did get 1275 ml for the output and 703.75 ml for the Intake so we both got the same answer. Not sure about that other answer though but I do believe it's incorrect. Thank you for your input.

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I'll second the -571.25

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Ok I see how you got the -571.25 but what does it mean?

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It means they lost over half a liter of fluid and the acids/electrolytes that go with it

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