10.1 Intake, Output, and Urinary Output Measurement (Skill 13)

10.1 Intake, Output, and Urinary Output Measurement (Skill 13)

Quick Answer: Record what you are assigned. Intake is oral fluids, foods that are liquid at room temperature, and ice chips at typically half the melted volume. The licensed nurse records intravenous (IV) fluids unless you are specifically assigned a measured amount. Output is urine, emesis, liquid stool, and assigned wound drainage. Skill 13: gloves before the bedpan; pour into a graduate without spilling; rinse the bedpan into the toilet; measure at eye level on a flat surface; if the level is between lines, round up to the nearest 25 mL/cc; empty and rinse the graduate into the toilet; remove gloves and wash before recording. Critical element: ±25 mL/cc of the evaluator. 30 mL = 1 oz. Report oliguria, polyuria, and hematuria. Never estimate.

Why I&O is on the exam

On the 2024 National Nurse Aide Assessment Program (NNAAP) outline Colorado uses, Technical Procedures is leaf I.B.3 (older NNAAP outlines called it Therapeutic/Technical Procedures) inside Basic Nursing Skills (I.B). Basic nursing skills are 35% of the 60 scored written items — about 21 questions that also cover infection control, safety, and data collection. I.B.3 items ask whether you measure, convert, and report fluids — not whether you can diagnose kidney failure.

Skill 13 — Measures and Records Urinary Output is one of the five measurement skills. The Colorado Skills Evaluation always includes one measurement skill among the four random skills (plus hand hygiene). If Skill 13 is in your set, that may be the measurement you cannot miss. Miss the critical element and that skill is not satisfactory — and you must pass all five skills in 30 minutes.

/practice/co-cnaPractice questions with detailed explanations

What counts as intake

Intake is fluid that goes into the body. Record only what you are assigned to record.

• Oral fluids: water, juice, milk, coffee, tea, soda, broth, and liquid nutritional supplements.
• Foods that are liquid at room temperature: ice cream, sherbet, gelatin, popsicles, and thin soups. Some facilities also count pudding as fluid — follow the assignment sheet.
• Ice chips: typically recorded at half the volume of the cup, because ice melts to about half. An 8-ounce cup of ice chips is usually 4 oz, which is 120 mL — not 240 mL.
• Enteral feedings and IV fluids: the licensed nurse usually records these. If you are assigned only the oral tray, you do not invent an IV total from the pump screen unless that is your assignment and the nurse has shown you how the facility documents it.

You do not guess leftover coffee. You look at the marked cup, the known container size, or the milliliter marks. A half-finished 240 mL carton is 120 mL, not about a glass.

What counts as output

Output is fluid that leaves the body.

• Urine — the Skill 13 number, plus any measured urinal, commode, or hat you are assigned.
• Emesis (vomit) — measure when you can pour it. If emesis soaks linen, tell the nurse what you saw; do not invent a tidy milliliter number.
• Liquid stool — diarrhea that can be poured and measured.
• Wound drainage or suction — only if you are assigned and trained to empty that device.

Formed stool is usually charted as a bowel movement, not as milliliters, unless the nurse gives a different instruction. Incontinent urine that cannot be poured is a report, not a Skill 13 estimate.

Conversion you must know

30 mL = 1 ounce (oz). Milliliters (mL) and cubic centimeters (cc) are the same volume on this exam.

Worked example: the person drinks 6 oz of coffee and 4 oz of juice and takes an 8 oz cup of ice chips. Coffee is 180 mL. Juice is 120 mL. Ice chips are 120 mL (half of 240). Assigned oral intake is 420 mL. Do the math on paper if you need to. Do not eyeball 420 as 400.

Skill 13 — Measures and Records Urinary Output

The official Colorado card does not open with an explain step. It opens with gloves. Follow the handbook steps in order:

1. Puts on clean gloves before handling the bedpan.
2. Pours the contents of the bedpan into the measuring container without spilling or splashing urine outside the container.
3. Rinses the bedpan and pours the rinse into the toilet.
4. Measures the amount of urine at eye level with the container on a flat surface. If the level is between measurement lines, round up to the nearest 25 mL/cc.
5. After measuring, empties the measuring container into the toilet.
6. Rinses the measuring container and pours the rinse into the toilet.
7. Before recording output, removes and disposes of gloves (without contaminating self) into a waste container and washes hands.
8. Critical element: Records the contents of the container within plus or minus 25 mL/cc of the evaluator's reading.

On the unit you still protect privacy when you handle a bedpan — Skill 4 covers that sequence. On Skill 13, the scored work is the pour, the measure, and the record.

Technique that actually scores

• Gloves go on before you touch the bedpan. Touching a used bedpan with bare hands and then gloving for the pour is a missed first step.
• Pour at the toilet so a splash stays in a place you can clean. Do not carry an open graduate across the skills room at chest height.
• The graduate sits on a flat surface — the counter, not a tilted toilet seat, not in your hand in midair.
• Your eyes are level with the meniscus (the curve at the top of the liquid). Looking down from standing height makes the volume look larger. Looking up from a squat can make it look smaller.
• Graduation lines on many graduates are every 25 mL/cc. If the urine sits between 250 and 275, you round up to 275. You do not split the difference to 260. You do not round down to be conservative.
• Empty and rinse into the toilet. Pouring rinse into a sink used for clean supplies is a contamination fail.
• Wash after gloves come off and before you write. Recording 275 mL with urine-contaminated fingers fails the before-recording step even if your number is perfect.

The evaluator measures the same urine. Your number must land within ±25 mL/cc. If the evaluator has 250 and you write 200, you fail the critical element. Colorado records measurement skills on the digital Candidate Results form at the test site — the number you enter is the number that is scored.

Report oliguria, polyuria, and hematuria

You do not diagnose kidney disease. You report the fact.

• Oliguria — unusually small urine output. Training often flags less than about 30 mL per hour or a shift total far below the person's usual. A nearly dry bedpan after several hours in a person who normally voids is a verbal report, not a shrug.
• Polyuria — unusually large urine output. Large frequent voids, or a graduate that fills twice in an hour when that is new, go to the nurse.
• Hematuria — blood in the urine: pink, red, rusty, or obvious clots. Report color, amount, and whether the person has pain or burning.

Also report dark concentrated urine, cloudy urine with a foul odor, sudden incontinence in a usually continent person, and no void in a time window the nurse flagged. Then document the measured amount and that the nurse was notified.

Never estimate on Skill 13

Written items love the estimate trap. On the unit, if urine soaks the sheets and cannot be poured, you tell the nurse what you saw and follow the facility method. On Skill 13, the urine is in a bedpan so you can pour it. Never estimate a graduate. Never write about 200. Never skip the flat surface because you are in a hurry.

Colorado scenario

You are in a Credentia Colorado skills room in Lakewood. Skill 13 is your measurement skill. The volunteer has used a bedpan. You pick up the bedpan with bare hands, pour into a graduate while holding it in the air over the trash can, glance from standing height, decide the line is basically 250, write 250 on the recording form, then put on gloves to rinse.

That sequence misses the card in several places. Gloves first. Pour without spilling. Rinse the bedpan into the toilet. Set the graduate on a flat surface and read at eye level. If the meniscus sits between 250 and 275, round up to 275. Empty and rinse the graduate into the toilet. Remove gloves, wash, then record. Your number must be within ±25 mL/cc of the evaluator.

That afternoon on a Pueblo long-term-care unit, Mrs. Ortega is on I&O. She ate a 4 oz sherbet (120 mL), drank 6 oz of water (180 mL), and had an 8 oz cup of ice chips. You record the ice as 120 mL (half of 240), not 240. Oral intake is 120 + 180 + 120 = 420 mL. The nurse records the IV. Her urine for the shift is 90 mL of rusty fluid. You do not write voided small amount and move on. You measure 90 mL, report oliguria and possible hematuria to the licensed nurse, and document the number and the report.

Exam traps

• Estimating instead of measuring.
• Reading the graduate in the air or from standing height.
• Rounding down when the level is between 25 mL lines.
• Recording before gloves are off and hands are washed.
• Counting a full cup of ice chips as the full volume.
• Charting IV fluids you were not assigned to record.
• Ignoring rusty, red, or almost-absent urine because the person seems comfortable.
• Treating mL and cc as different units on this exam.