Height, Weight, and Intake & Output (I&O)

Height Measurement

Height is measured on admission and then periodically per facility policy - typically monthly in long-term care, or more often for residents on growth-monitoring or nutritional protocols. The CNA measures height in most Indiana LTC facilities.

Technique:

1. Have the resident remove shoes and stand against a flat wall or stadiometer with heels, back, and head touching the wall.
2. The resident looks straight ahead, chin level.
3. Lower the measuring arm or place a flat object (a book or ruler) on top of the head, parallel to the floor.
4. Mark the point on the wall or read the stadiometer.
5. Measure to the nearest quarter inch or half centimeter per facility policy.
6. Document in the chart.

For a resident who cannot stand (bedridden, wheelchair-bound, or unable to bear weight), measure arm span instead: have the resident extend both arms to the sides, measure fingertip to fingertip across the back, and document as "arm span (resident unable to stand)." Arm span approximates height in adults. Alternatively, measure knee height and use a conversion formula; the licensed nurse or dietitian typically does this.

Weight Measurement: Standardization Is Everything

Weight is the most variable measurement in the body. It changes with fluid intake, urination, bowel movements, meals, clothing, time of day, and the scale used. To track a true weight change rather than measurement noise, every weight must be taken under the same conditions:

• Same time of day - typically early morning, after toileting and before breakfast.
• Same clothing - same gown or same amount of clothing each time.
• Same scale - do not switch scales between readings; even calibrated scales vary slightly.
• Same conditions - same time relative to meals, dialysis, or other events that shift fluid.

Technique:

1. Wash hands, don gloves if contact is likely.
2. Zero the scale before the resident steps on.
3. Have the resident wear the same clothing as previous weighings (or a gown if the facility standard).
4. If the resident can stand, have them step onto the scale, stand still, and wait for the reading to stabilize.
5. If the resident cannot stand, use a wheelchair scale: weigh the wheelchair alone first, then weigh the resident in the wheelchair, and subtract the wheelchair weight. Some facilities use a lift scale that supports the resident in a sling.
6. Record the weight to the nearest quarter pound or tenth of a kilogram per facility policy.
7. Compare to the previous weight. If the change is significant (see below), report immediately.

When Weight Change Must Be Reported

A sudden weight gain usually means fluid retention - heart failure, kidney failure, or IV fluid overload. A sudden weight loss usually means dehydration - fever, diarrhea, inadequate intake, or diuretic effect. Both are emergencies and must be reported immediately.

Intake and Output (I&O)

I&O tracks every fluid that enters and leaves the resident's body over a defined period - typically an 8-hour shift or a 24-hour day. The licensed nurse uses the totals to assess fluid balance. The CNA measures and records each intake and output event.

Intake (In)

Every fluid container in the resident's room should have volume markings (ounce and mL). If a container is not marked, use a measured cup to pour and record. Do not estimate - a glass that looks like 8 ounces may be 6 or 10.

Output (Out)

Urine is the most important output to measure accurately. The 24-hour urine total is compared against the 24-hour intake to assess fluid balance. A resident who takes in 1500 mL and puts out 800 mL has a positive balance of 700 mL - some of which is normal (insensible loss through breathing and skin is about 400-600 mL/day). A resident who takes in 1500 mL and puts out 200 mL has a dangerous negative balance and must be reported immediately.

Documentation in TPR Order

Vital signs and measurements are documented in a consistent order on the flowsheet:

1. T - Temperature (with route notation)
2. P - Pulse (rate and rhythm)
3. R - Respiration (rate, depth, ease)
4. BP - Blood pressure (systolic/diastolic)
5. Height/Weight - per schedule
6. I&O - per shift and 24-hour totals

This order is not arbitrary - the nurse reads down the column to see the full picture. A temperature of 101 with a pulse of 110 and respiration of 24 tells a consistent story of fever and compensatory tachycardia. The same temperature with a pulse of 60 tells a different story. The order makes patterns visible at a glance.

Vital Signs Reference Table

The table below summarizes the normal ranges for the four vital signs covered in this chapter. Use it as a quick reference on the flowsheet.

When to Report to the Licensed Nurse

The CNA reports, does not diagnose. Report immediately for any of the following:

• Any vital sign outside the normal range, unless the care plan documents a different baseline.
• Any sudden change from the resident's baseline, even if the number is within the textbook range.
• An irregular pulse, irregular respiration, or apnea period.
• Labored, shallow, or noisy breathing regardless of rate.
• Cyanosis (bluish lips, nail beds, or skin).
• A weight change of 2-3 pounds in a day or 5 pounds in a week.
• An I&O imbalance - intake far below output (dehydration risk) or output far below intake (fluid overload risk).
• Any measurement you could not obtain clearly (lost the Korotkoff sound, could not feel the pulse, resident moved during the count) - do not guess.

The licensed nurse decides what the numbers mean. The CNA's job is to gather the numbers accurately, document them completely with route and observations, and report anything abnormal or changed. This is the core of the CNA's data-gathering role in the Indiana LTC facility.

Common I&O Errors

• Forgetting to record a fluid. If the resident drinks water from the pitcher and you do not measure and record it, the intake total is wrong. Every fluid event must be documented in real time - do not wait until end of shift to estimate.
• Estimating instead of measuring. A glass "that looked like 8 ounces" is not a measurement. Use a measured cup or a container with markings.
• Not counting ice chips as half-volume. Ice is roughly half water by volume. A cup of ice chips (8 oz) counts as about 4 oz of fluid.
• Not documenting output. Urine that is discarded without being measured is lost data. Every void should be poured into a graduated container and recorded.
• Counting a fluid twice. If you record 120 mL of water given with medications, do not also count it as part of the meal intake. Each fluid is recorded once.

The 24-Hour Total

At the end of the 24-hour period (typically midnight to midnight, or per facility policy), the CNA or the licensed nurse adds up all intake and all output. The totals are compared. A balanced I&O has intake roughly equal to output plus insensible loss (400-600 mL/day through skin and breathing). A large positive balance (intake much more than output) suggests fluid retention. A large negative balance (output much more than intake) suggests dehydration. The nurse interprets the totals; the CNA provides accurate shift-by-shift measurements.

Weight and the Care Plan

Some residents are on a weight-gain protocol (nutritional rehabilitation after illness) or a weight-loss protocol (obesity management, heart failure fluid restriction). The care plan specifies the target rate and the report threshold. A resident on a fluid restriction may be weighed daily and the nurse may adjust the restriction based on the trend. Always read the care plan for weight orders before weighing a resident for the first time.

The Resident Who Refuses

A resident has the right to refuse any measurement, including vital signs and weight. If the resident refuses, do not force the measurement. Document the refusal, the reason given (if any), and notify the licensed nurse. The nurse may re-approach the resident, may reschedule the measurement, or may note the refusal in the care plan. The CNA's job is to respect the refusal, document it factually ("Resident declined weight measurement, stated 'not today', refused after explanation of purpose"), and report - not to argue or coerce.