Basic I & O Question

Nurses General Nursing

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Specializes in A little of this & a little of that.

I have been working for almost 30 years and have always done I & O the same way. I record all fluids the patient has taken po, tube or IV but not food (unless food intake ordered) or liquid meds. If I crush a med to put in a tube, I add the amount of water added to the crushed tablet to I & O as well as flushes.

I'm working on a home care case where intake is via GT. The patient is an infant on a ketogenic formula. Three times a day she gets a 15 gram po feeding. The ketogenic diet requires that all carbs be balanced with fats, provided in a soluble form (micropids). After 15 grams of po food she gets 15 ml of microlipids through the tube. Also, of coure, most meds are liquids.

I was told by another nurse on the case yesterday that I'm doing Intake wrong. She says that liquid meds & microlipids must be added into I & O. I have been taught they should not be. The Case Manager isn't available til Monday to settle this. Just wondering what you all think.

Catherine

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Specializes in Cardiac Telemetry, ED.

If they are fluids, then yes, they would be counted as liquid, right? However, whenever we have a pt. on tube feeding, we always count the free water separately.

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Specializes in A little of this & a little of that.

I was taught that if they aren't used by the body as fluids they don't count. So that the liquid meds being generally mixed with sorbitol or alcohol elixir wouldn't count & "liquid fat" wouldn't count. This is where the confusion lies.

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Specializes in PICU/NICU.

I would have to agree that the microlipids and liquid meds should be included in the I/O intake- especially in an infant. I even count my IV flushes(even less than 1 cc) in the count.

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Specializes in PICU/NICU.
I was taught that if they aren't used by the body as fluids they don't count. So that the liquid meds being generally mixed with sorbitol or alcohol elixir wouldn't count & "liquid fat" wouldn't count. This is where the confusion lies.

I really don't know about home care, but lipids "liquid fat" in our kidds are usually given IV over 18-24 hours and they are always counted as liquid.

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Specializes in Cardiac Telemetry, ED.

I was taught that anything that is liquid at room temperature is a fluid.

I guess you'll have to ask your CM what the P&P is.

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Specializes in A little of this & a little of that.

Thanks for your replies. I absolutely will ask on Monday. I do include even the small flushes & water mixed with crushed meds. I'm very very careful & precise. So, it wa upsetting to me that I may be doing it wrong. I may just be out of date on this one.

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Specializes in PICU/NICU.
Thanks for your replies. I absolutely will ask on Monday. I do include even the small flushes & water mixed with crushed meds. I'm very very careful & precise. So, it wa upsetting to me that I may be doing it wrong. I may just be out of date on this one.

Let us know what is decided... I'm curious:)

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Specializes in NICU, Post-partum.

I can only speak for infants.

At our hospital, we calculate all intake...which is everything IV...including meds, flushes, etc.

With infants, obviously, the intake will be liquid..and the infants we have that are not on TPN and Lipids...their PO intake is calculated no differently.

With adults, we were taught in school that with food, it depends on what the item is, whether or not you would count it in I&O.

If it's drinks, yes...ice cream or frozen...yes...a soup...yes...steak? Nope.

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The Keto diet is a very special situation, the 'usual' rules for what is included in I & O don't apply. Anything and everything that is not solid needs to be included in the I & O (including meds).

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