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CNA Skills Accurately Measuring Intake and Output Monitoring

Accurately measuring intake and output is one of the skills that CNAs need to be competent at.  What goes in must come out.  Fluid balance in our bodies is extremely important.  We all need water to live.  The amount of fluid in (intake) and the amount of fluid out (output) must be equal.  Too much fluid in the body can cause the body to swell resulting in edema, too little water in the body can cause dehydration. 

When measuring intake and output you will be given this information from the nurse and it will be on the residents care plan.  Generally Certified Nursing Assistants should be routinely monitor fluid balance (I&O) for the following residents:

  • All residents receiving tube feedings
  • Residents with catheters
  • Residents with urinary tract infections
  • Residents with physician orders for fluid restrictions or orders to encourage fluids
  • Residents with specific physician orders for additional liquid (fluid)
  • Residents who are known to be dehydrated or who are at risk for dehydration
  • Residents with certain cardiovascular and kidney illnesses that are at high possibility for fluid imbalance
  • Residents receiving intravenous fluids or parenteral nutrition therapy
  • Any resident who develops a fever, vomiting, diarrhea or a nonfebrile infection, unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of breath

Certified Nursing Assistants are required to observe residents who may have fluid imbalances or those who are at higher risk of dehydration by calculating intake and output (I&O) during each shift.  I&O monitoring should be taken seriously. Nurses need to establish a realistic intake goal for each resident for each shift. Certified Nursing Assistants should encourage fluids before leaving for their shift when establishing goals for fluid intake.

Fluid is usually divided as follows:

Day shift:          1/2 of total 24-hour fluid goal
Second shift:     1/3 of total 24-hour fluid goal
Third shift:        1/6 of total 24-hour fluid goal

For residents that are ordered a fluid restriction, total fluid allowance for each shift can be distributed in the same quantity listed above. Nurse can Modify the amounts listed as necessary to personalize fluid intake to the resident’s individual needs.

Measuring Intake and Output

Locate liquid foods for the resident and record their intake according to them.
Based on facility policy, either record in cubic centimeters or milliliters.
The output is measured by pouring the urine of the resident into a graduate.
While using a gloved hand to hold the graduate, use a gloveless hand to flush down the toilet.
Disinfect each and every appliance, based on facility policy used.
In the output form, record the urine output with a pen.
Report any form of unusual characteristic for the urine to the nurse.