u COURSE TITLE: NURSE ASSISTANT IN_A LONG-TERM CARE PACLUITY UNIT JV FOOD SERVICE SON PLAN: BL INFORMATION TOPIC: EV-8 AND DEMONSTRATION: TV-3 OBSERVE, MEASUBE. AND RECORD FLUID INTAKE AND OUTPUT (Lesson Title) OBJECTIVES - THE STUDENT WILL BE ABLE TG: Information 1. Define terms presented in this lesson. 2. List three routes to administer fluids 2 Identify key points in measuring fluid intake and output. 4, List finids that aust; be nieasured for oral intake. minster household measurenient equivalents to cubic centimeters, 6. Define, what is meant by the term “lrequent fluids.” 7. Identify mothods of administering frequent. Mnids. 8. Identify key paints of distributing drinking water, 8. Convert liquid measurements in cancas to cubic centimeters (milliliters), Demonstration, 10, Distribuia drinking water according ts the steps of procedure, TL. Measure Suid intake acvording to the steps of procedure 12, Measure Muid oulput according to the steps of procedure. OUTLINE: 1. Teems and Defimtions A. Diaphoresis - excessive sweating B. Graduate - a container marked with lines for measuring liquids: Observe, Measure, and Record Fiuid Intake and Output 46hie Mm. ©. Milliliter (mali - same as eubie cxtimeter (ee) D. 1&0 fintake and output) - to moasnrs and record all liquids ingested and expefled by the resident Routes to Administer Fluid A. Oral PO) - inta the month B. Intravenous (LV) - inte the vein C.— Nasogastrie (NG) tube or gastrostomy (C) fubo- into the stomach Measurement of Hhuid Intake and Output - Key Points Average orl intake for an adult. is 2.000 to 8,000 0 of fluid per day, which is approximately 2 to 8 quarts. ‘Total body output should be about she same, Because the biman body is 60% water, this liquid is absolutely essential to tia, As'a nurse assistant, one of your responsibilities is te make sare your residents have enough fluids. I ordor to help you meet. your residents’ nesds, you will learn what t9 observe and how te measure aud record the intake and output of Aids for your residents, A normal, healthy porson takes in 2,000 to 3,000 ee por day. We eliminate fluids as perspiration (450-1,050 celday), through breathing (250-500 ce/day), through feces (60-200 celday), and as urine (1,00 cefday). Most adulis need to consume an average of 600-800 ce of fluids during an 8-hour shift. Many residents sleep during the night shift so sdditional fade must be consumed durmg the day and evening shifts B. ‘Tho physician or charge wurse may restrict or meourage fluid intake. It is the charge nurse's respousibility to know what hae been ordered and to communicate this information lo the purse assistant, ©. When “intake and output" (&0) is ordered, accuracy is very important and the resident and his/her family should be informed of the procedure. D. Keep paper aud 4 pou at the resident's bedside for cach 8-hour shift to record 180. H. The nurse assistant generally checks and records the resident's liquid intake at mealtime and botwoen meals, ¥ Intake and output are totated and recorded at, the end of cach shift and at the ond of the 24-hour poriod (per facility policy) G. Al mealtime, chevk resident's tray hefore serving and after the rosident, has eaten to fletormine intake of liquids. Remember to include any foods that turn liquid if allowed to stand ab room lemperature, Observe, Measure, and Record Fluid Iniake and Output 462Vv. H. To determine the amount that hax bow taken, measure wator thatds left before emplying the wator pitcher. 1. Observe resident for signs of dehydration or edema, See Unit IV, Lesson Plan |, Nutrition.) JL Measure urinary output accuraiely each time bedpan, urinal, specimen, drainage bag. or beside commode are emptied, using an agcerate graduate, See Figure a1) Figure 2.1 Graduated Urine Specimen Container K. Measure and record any othor body dis charges such as vornitus and diaxthea Mention diapboresis on 1&0 record if vesident. perspires profusely NOTE: If unable te measure acceirately, estimate amount and record estimated ameunt on chart, L. Measure flnids in a rigid oontainer. Be cause cathetor bags are not alwa accurate, drain dato a geaduale then observe and record output. M. When looking at » transparent graduate, read st at eve level, (See Pigure 8.2.) Figure 8.2 Reading a Trawsparent N. If the resident is incontineni, record Gatnenieal Bye hav the number of times on the 1&0 shoot. Fluids That Must. be Measured for Oral Intake A. Water, coffee, tea, broth, ioe chips, and gelatin B. Juices and carbonated beverages (oda) ©. ieg eromm, mill shakes, sherbet, milk, and cream @g., Half and Hatt) Measurement Equivalents from Household to Cubic Centimeters (oc) ‘A. Various size containers are used in facilities, Nurse assistants must learn tho fuid content of the containers used at the facility where they are employed Thoro are different types of graduate measures. Be sure to measure and record fluid intake and output correctly. (Soe Figure 3.3. NOTE: The soda can demonstrates # size comparison anil is provided for reference.) Observe, Meusute, and Record Fluid Intake and Outpat 463VL Figure 3.3 - Graduate Measures & NOTE: Moyt wator pitebors contain 1 quart, or 1,000 es. FF eup @ oz) = 240 1 If toe = 2A0 e 30 ce then Bon 2 Can be applied ty any amouat G. Common container s 1. Coffee/ier eop Gor, 180 ee, 180 mL 2. Water pitcher 32 a2. 960 ce, $60 mi 3% Styrofoam cup 6 07, 180 ex, 180 ml 4 Waterimilk glass Boz, 240 c¢, 240. ml 5. Soup bow! Bae, 180 ec, 180 ml Jell-O, one serving 407, 120¢2, 120 inl 7. lee chips 2 Tbsp, 80 ee, 30 wil 8 Juice ghase doz, 120.0, 120 mb Frequent Fluids A. Means taking in more than the usu number of drinks, Phiids should he offered at least every 2 hours, 1B. Reasons why elderly tay take less fluids: Diminished sense of thirst, 2% Fluids are not readily available ar placed within reach. 3. Afraid of dribbling urine Observe, Measure, aud Record Fluid Intake and Output +64VIL How A B vil Afraid of having to get up and go to batinoom at nighl 5. Difficulty holding @ glass, pouring Lguid from pitcher, ete. to Administer Frequent Muids Place Ouids within reach. Offer small amounis frequently (at feast every 2 hows). Offer a variety of fluids, Encourage foods with high Ruid content. (padding, watermelon) Offer favorite beverages. Offer fluids at frequent intervals when resident is unable io obtain fluids by hinselifieeself. If goat has been set, assist resident to reach it. during timp set. Explain that dribbling sometimes rosults from infection or irritation. Thorefare. more fiuids are needed, Check resident daring aight and ussist to bathroom as needed: provide a night Tight: Distribule Drinking Water AL B, D. Ensure that fresh water is aé Lhe resident's bedside at all times unless he/she je NPO. Offer water af regular intervals and at meals, Drinking glasses and pitchers are collected daily and sent to the dietary depariment. where they are sanitized through a dishwashing process. Redistribute glasses and pitchers so that resident is tint without water. Hf the resident. requires thickened liquids, de not refill the pitcher with water, (ollow facility policy for thickened liquids.) Ifa resident requires a special cup, make sure it is at the bedside. Observe, Measuse, and Record Fluid Intake and Output 65Measuring and Recording Fluid Intake and Output Directions: Use the fluid intake and output record on the next page, Put the following information in the propor column and tolal the figures. Compute the intake and output. A. Date- May 11 B, Name - ddhn Middleman, dr C. South Wing: Room 255 D_ Method of Administration: Oral EB, 7:30am, Urine 500 ce 8:00am, Grape juice 4 juice glass Milk 14 Beas glase Coftue coffeo emp 980.1. Water 180 ue 12:00 Noon Tea Soup 1:00 p.m, Water 1:15 pan, Urine BOO ce 2:00 p.m, Apple juiee 1 juice: glass 215 p.m. Vomiius 120 0¢ 3:20 pam. Toa 1 6-07 glasa 5:00 p.m Orange juive ¥ juice glass 30 pm, Urine 400 ce 6:30 pan, Wator 150 o% 8:45 p.m. Ginger ale San 9:00 p.m. Urine 300 ce. 30:00 p.m. Water 80 ce. 10:15 p.m, 200 ec Obsorve, Measure, and Record Piuid Inake'and Quipat 6CARE. CENTER FLUID INTAKE and OUTPUT RECORD Room: INTAKE OUTPUT Method | Solution | Amount Urine Others Admin. Received Amount [ying | Amount TOTAL, Tar= 30 co 6-02 Water Glass = 240 ce 4-0z Juice Glass~ 120 ce *6-0z Soup Bowl ~ 180 ce 6-02 Styrofoam Cup = 180 ec *Jell-O, one 4-07 serving = 120 cc *Measure servings in cach facility to establish an accurate measure, Observe, Measure, und Record Flnid Intake and Output 467IX Demonstrate Procedures for Distributing Water, aud Measuring and Recording Fluid x intako and Output Summary and Conclusion A. Terms and definitions B, Routes to administer fluida CG. Measurement. of fuid intake and output - key D. Fluids that mast be measured for oral intake BE. Measurement equivalents from hovscbold 1 cubic centimeters Ge) F, Frequent fluids G. How to adminisier fuiment Ouids TH. Distribute drinking water 1. Review the procedures for distributing water, and measuring and recording fluid intake and eutpnt This lesson has shown you the importance of fluids and. has prepared you ie identify those fluids that must be recorded as intake and cutput. You should uew be ready to accurately identify and measure fluids, ‘Observe. Measure. and Record Fluid Intake and Output 468