Tracking I's and O's

This is a really dumb question, but how exactly do you track I's and O's if the pt is ambulatory, goes to the bathroom on own, doesn't have a Foley, drinks and eats without help from me, etc.? Even though I am just a student, I am not necessarily in the room every time the patient does something, i.e., someone may come and take the lunch tray away while I am not there. I guess I'm just a little confused about how to keep track of this as a student. Please don't shoot me for asking a really dumb question!

Also, if the pt does have a Foley, when I get there how do I know if the amount in the bag has already been measured, where to start from to take my own measurement for the rest of the day, etc. ? This should be a simple thing but has me confused.

I work on an Oncology floor and when we have patients who are ambulatory and take care fo themselves we just ask the patient. It is not uncommon for me just to ask, "how many of those pitchers of water do you think you have drank since 0700?" I chart what they tell me under oral intake while the RN's chart all the IV input. The patient's we have on strict I's&O's are different of course because we educate them on how to keep track of it themselves or to always urinate in the hat in the toilet or urinal and let us empty and measure it. If they are ambulatory, don't have IV's, and are drinking okay sometimes we don't need to chart I's&O's, but that is rare. If they urinate and forget to measure and they tell me then at the end of the shift I will write something like 1500 cc + 1 flush. 1500 cc because that is what I know for certain they put in the urinal and the general "flush" because you can't measure that.

As far as the patient having a foley, it hasn't been measured if it is still in the bag. If I empty a foley bag, I measure the amount, then write it on the I&O sheet hanging on the patient's door. The food trays can be a little difficult because sometimes on my floor someone will take the tray before I get in there and they won't chart the amounts taken. When that happens I just ask the patient, "how did you do on your lunch tray? You think you ate half of it or more than half?" Something to that effect. If you are working with staff who does what it required you wouldn't have to worry about it because they should understand that when they take a tray from a room they need to write down the results somewhere.

Hope this helps!

It just all seems so...inexact. I don't feel like I know who is keeping track of what. The staff like to find out which patients have students assigned to them, and then we students are expected to pretty much do everything unless we're not allowed by the school or the facility doesn't permit it (like for some reason students are not allowed to do blood sugar checks on the floor I'm on right now, even though we have on other floors at the same facility). So I feel I don't know if the CNA might also be keeping track of something or what happens if dietary takes the tray away. I noticed that there is a sign on this floor that says ALL patients are supposed to be STRICT I's and O's. But nobody has said anything to us about it as far as I know. Well, the way it is being done, as far as I can tell, is not strict.

Another good way to do it is to have the patient write it down. If they are on strict I's and O's, make sure there is a hat in the toilet (for a female) or a urinal for a male. Then they can pee in there and make sure they either leave it, or record it on the paper for you. Also, make sure they are drinking out of a hospital cup cuz a lot of times those are marked with mL's so you can track how much they drink. I had a patient like this last week who kept forgetting to write things down too- so I just asked him how many times he peed and charted it as "did not save x (however many times he peed)".

Work with your CNA. Find out what they are going to do today and let them know what you are able to do and will be doing. If there is a computer system with charting, you'll be able to go back and look at what has been measured and when it was put in the computer, otherwise it should be in the paper chart, dated and timed as well.

If you have only one patient right now, this is easier than with multiples. Also, I would simply ask your clinical instructor what s/he believes is the best way, or the RNs on the floor. They will know better than us because every hospital (and even every floor!) has their own way of doing things.