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Urinary catheters, I & O and 24 hour urine testing. PN 103. Catheters - may be used for intermittent or continuous drainage -may be introduced into the bladder, ureter, or kidney -type and size determined by location and cause of the urinary tract problem
INTAKE- all those fluids entering the client's body such as water, ice chips, juice, milk, coffee and ice cream. Artificial fluids include: parenteral, central lines, feeding tubes, irrigation and blood transfusion.OUTPUT- all fluid that leaves the client's body such as: urine, perspiration, exhalation, diarrhea, vomiting, drainage from all tubes and bleeding.I & O
Ideal Daily fluid Intake and OutputSource/ AMOUNT/ Route/ AMOUNTH2O consumed as fluid/ 1500ml/ urine/ 1400-1500mlH2O present in food/ 750ml / insensible losses/ 350-400mlH2O produced by oxidation/ 350ml / lungs/ 350-400mlskin / 100mlsweat/ 100-200mlfeces /TOTAL/ 2600ml/ TOTAL/ 2300-2600mlI & O
Purpose:- helps evaluate client's fluid and electrolyte balance- suggests various diagnosis- influence the choice of fluid therapy- document the client's ability to tolerate oral fluids- recognize significant fluid lossesI & O
Mandatory for clients with burns, electrolyte imbalance, recent surgical procedure, severe vomiting or diarrhea, taking diuretics or corticosteroids, renal failure, congestive heart failure, NGT, drainage collection device and IV therapy.I & O
Deviations:Other sources of fluid loss and excessive losses from normal routes:- drainage from catheter or tubes- vomitus- diarrhea- diaphoresis- hemorrhage- ileostomy/ colostomy drainage- excessive urine outputI & O
Average daily water requirement by age and weight:AGE/ ml/ BODY WEIGHT ml/kg3 days/ 250-350ml/80-1001 year/ 1150-1300ml/ 120-1352 years/ 1350-1500ml/ 115-1254 years/ 1600-1800ml/100-11010 years/ 2000-2500ml/70-8514 years/ 2200-2700ml/ 50-6018 years/ 2200-2700ml/40-60adult /2400-2600ml/ 20-30I & O
Nursing Intervention:Intervention/ Rationale1. Ideally intake and output should be monitored/ To obtain an accurate record2. In critical situations, intake and output should be monitored on an hourly basis/ Urine output less than 500ml in 24 hours or less than 30cc/hour indicates renal failure3. Daily weights are often done/ Indicate fluid retention or loss4. Identify if patient undergone surgery or with medical problem / May affect fluid loss5. Make sure you know the total amount and fluid sources once you delegate this task/ To get an accurate measurement
6. Record the type and amount of all fluids and describe the route at least every 8 hours7. If irrigating a nasogastric or another tube or bladder, measure the amount instilled and subtract it from the total output/ To get exact amount8. Keep toilet paper out of client urine output/ For an accurate measurement9. Measure drainage in a calibrated container and observe it at eye level.
A significant change in a client's weight or a significant difference in a client's total intake and output should be reported immediately to the physician.
Clinical Signs of Dehydration:- dry skin and mucous membranes- concentrated urine- poor skin turger- depressed periorbital space- sunken fontanel- dry conjunctiva- cracked lips- decreased saliva- weak pulse
Client's signs of fluid excess:- peripheral edema- puffy eyelids- sudden weight gain- ascites- rales in lungs- blurred vision- excessive salivation- distended neck vein
24 hr. Urine – The kidneys excrete substances at various rates and amounts during a 24 hr. period.
Collection- remind patient not to place toilet paper in collection container. Have patient void before BM to avoid contamination.