Introduction
Fluid balance is a term used to describe the balance of the input and output of fluids in the body to allow metabolic processes to function correctly (Welch, 2010). Fluid constitutes around 52% of total body weight in women and 60% in men. This consists of water and molecules containing, for example, sodium, chloride and potassium (Mooney, 2007). These compounds disassociate into particles which carry an electrical charge; these particles in solutions are called electrolytes. For example, sodium chloride (NaCl) dissolves in solution to form an equal number of positively charged sodium (Na+) ions, and negatively charged chlorine (C1-) ions (Waugh, 2007).
Plasma electrolytes are balanced as it is important to have the correct concentration of ions in the blood, especially sodium, potassium and magnesium. Too much or too little of these electrolytes can cause cardiac arrhythmias (Docherty, 2006). Fluid intake is obtained from diet i.e. from water and food, and is mostly lost through urine output. It is also lost through the skin as sweat, through the respiratory tract, and in faecal matter.
- Patients with kidney or renal failure.
- Dehydrated patients either by vomiting or diarrhea.
- Patients with scalds or bums.
- Patients with cardiac failure.
- Some patients who have undergone surgery.
- Patients receiving diuretic and corticosteroids therapy.
Aims
· Assess the therapeutic effects of medication
· Monitor fluid overload and dehydration
Requirement for recording Intake and Output
The following are requirements for measuring fluid intake and output;
- Measuring jugs.
- Chart for recording.
- Pen.
- Clock for time recording
- Gloves
- Urinal or bedpan
- Hand washing device
Intake Substances
- Water, porridge, coconut water, light soup and all types of watery foods.
- Intravenous fluids such as dextrose, normal saline, ringers lactate, mannitol.
Output Substances
- Vomitus
- Watery stool/loose stool
- Urine
- Wound/surgical discharges
- Chest drainage thus accumulation of fluid in the lungs
- Gastric contents which may be due to increased interstitial secretion
Causes of errors in measuring fluid intake and output
Factors that lead to errors in
measuring fluid intake and output includes;
- Guess work.
- Poor education given to patients on the need to measure intake and outputs.
- Poor communication between staffs regarding patients who are on fluid intake and output charts.
- Failure to record volumes at the right time.
Steps
1. Establish rapport (Refer to steps)
2. Explain the importance of keeping the fluid balance chart to patient and relatives
3. Obtain fluid intake and output chart (manually or electronically) and confirm with patient’s identity
4. Determine the types of fluid intake or output
5. Observe amount of fluids given to patient
6. Record the amount of oral and intravenous fluids prescribed at the intake column indicating the date and time
7. Add together the values for oral and parenteral fluids
8. Assist patient to void into a bedpan or urinal if possible, empty content into the measuring jug and note the volume OR If there is urine in a urine bag, empty content into the measuring jug and note the volume
9. Record other forms of output such as watery stools, vomitus at the output column indicating date, time and the amount
10. Record all measurements in milliliters
11. Add together all the values obtained for outputs
12. Total the intake and output at the end of every 24 hours
13. Find out amount of fluid retained by subtracting the values of fluid output from the intake
14. Perform hand hygiene
15. Inform the nurse in charge/doctor immediately if amount put out is greater than the amount taken in or when there is abnormally low output
16. Record findings in the appropriate recording software and observation chart
17. Dispose off used items and decontaminate trolley (manual or electronic)
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