STRICT I&O'S help

[NYCRN6]

I am doing a project on Intake and Output and have to do a presentation to my floor because we are starting to do flowsheets (in addition to computers), which are not part of legal documentation however it is to help people to do their I&O's more. I don't need to hear why we shouldn't do this... I want to ask "Why are strict I&O's important" on a cardiac floor and in general?

Why I&O's are important?

Everyone has a role RN, PCA's, UC's

Determine medical treatment of a patient; could affect ordering of medications

Gauges fluid balance

Specific diagnoses that require strict monitoring of intake and output

-CHF

-Kidney Disease

-SIADH

-DI

-Risk for ICP

Indication of nourishment and hydration

Dehydrated from diarrhea/vomiting/decreased PO intake

Overhydrated from increased PO intake

IVF

Daily Weights; corresponds with I&O. If weight increases very often the medical team will look at the I&O's to see if there is a correlation

Prevent double documentation or no documentation

If there are any more you can think of that would be great! thank you

[Zee_RN, BSN, RN]

Maintaining an accurate I&O keeps you from getting your butt chewed out by the cardiologist who is trying to manage his/her refractive CHF patient. :)

Seriously, you've listed very good reasons for maintaining accurate I&Os. We all know there are times when it is difficult but since CHF is the #1 re-admission diagnosis in hospitals, we *must* manage it for our patients' sake. If the patient "misses the hat," please double-hat the toilet. The cardiologist does not want to look at the I&O sheet and see "BRP" written in the output column. And daily weights are just as important.

(Oh, and pulmonologists hate it when the chest tube drainage isn't recorded....Oh, and surgeons hate it when the JP drainage isn't recorded....) You get the picture. Since I'm the manager, it's me they come to and say "Can you tell me why your staff didn't record yesterday's output?" And inevitably, the one patient that got missed was the one it was most crucial on.

I applaud your efforts in ensuring an accurate collection of data.

[Daytonite, BSN, RN]

Make sure you review your facility policy and procedure book and any pre-printed care plans with regard to anything pertaining specifically to intake and output measurement so that it gets addressed and reinforced in your presentation. Your flow sheets, if they are new, need to reflect what your policies and procedures say, or your policies and procedures need to be changed to reflect what is going to be required on the flow sheets (whoever was on the committee that developed the flow sheets should have been aware of this)

Why I&O's are important?

To determine fluid/electrolyte (sodium) gains and losses/loss of plasma proteins

• Fluid gains (Nursing Diagnosis: Excess Fluid Volume - Problem: increased isotonic fluid retention)
  • isotonic overhydration causes circulatory overload and interstitial edema in patients with poor cardiac function , CHF, and pulmonary edema
    
  • hypertonic overhydration, though rare, occurs with
    • too much ingestion of sodium
      
    • rapid infusion of hypertonic saline
      
    • unmonitored sodium bicarbonate therapy

    [*]hypotonic overhydration (water intoxication) and electrolyte imbalances occurs with

    • early renal failure
      
    • CHF
      
    • SIADH
      
    • unmonitored IV fluid therapy
      
    • using hypotonic IV fluids to replace isotonic fluid loss
      
    • irrigating wounds and body cavities with hypotonic fluids

  [*]Fluid losses (Nursing Diagnosis: Deficient Fluid Volume - Problem: decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.)

  • isotonic dehydration (hypovolemia)
    • most common type of dehydration with water loss that causes a decrease in circulating blood volume and inadequate tissue perfusion; occurs with
      • vomiting, diarrhea, GI suctioning, actively draining GI drainage tubes
        
      • conditions that produce polyuria (hyperglycemia, patients getting hyperosmolar tube feeding)
        
      • fever - increases urine output as well as insensible loss through the lungs due to hyperpnea)
        
      • other conditions that produce insensible fluid losses
        • sweating - sodium is also lost through sweat
          
        • third spacing (sequestration and trapping of fluid from the vascular space to another portion of the body, i.e. pleura, peritoneum, pericardium, joints, bowels, interstitial spaces after burns or trauma) - this fluid for all intents and purposes is considered lost
          • these fluids cannot be directly measured
            
          • body weight does not decrease, but may increase
            • intestinal obstruction
              
            • ascites
              
            • peritonitis, pancreatitis
              
            • pericarditis
              
            • hemothorax

    [*]hypertonic dehydration

    • more water than electrolytes are lost
      
    • occurs with:
      • excessive sweating
        
      • hyperventilation
        
      • ketoacidosis
        
      • prolonged fevers
        
      • uncontrolled diarrhea
        
      • early stage of renal failure
        
      • diabetes insipidus

    [*]hypotonic dehydration

    • more electrolytes than water is lost
      
    • occurs with:
      • chronic illness
        
      • overinfusing too much hypotonic IV fluid
        
      • renal failure
        
      • chronic malnutrition