6.4 Height, Weight, Intake/Output & Specimen Collection

Height and weight

Accurate trends matter more than a single isolated number. Use the same scale, similar clothing, and approximately the same time of day when the care plan calls for serial weights. Remove or account for extra equipment according to facility procedure. Report an unexpected change rather than deciding independently that it proves fluid overload, dehydration, or malnutrition.

For Pennsylvania’s ambulatory-weight skill, the client wears nonskid footwear. Set the scale to zero before the client steps onto the center, obtain the value, assist the client off, wash hands, and record. The result must be within ±2 lb of the evaluator, or ±0.9 kg if recorded in kilograms. Never leave an unsteady resident standing on a scale without needed support.

Standing height is measured without shoes, with posture and gaze aligned as the equipment directs. For a resident who cannot stand, use the facility’s approved bed, segmental, or documented alternative method; do not invent a standing transfer solely to obtain height.

Intake and output

Count liquids taken by mouth and any other intake the care plan assigns. Common examples include water, milk, juice, coffee, broth, gelatin, ice cream, and enteral or IV intake documented by the responsible team member. Output can include urine, emesis, liquid stool, wound drainage, or other measured loss specified in the record.

Useful exam conversions are:

• 1 fluid ounce ≈ 30 mL
• 8 ounces ≈ 240 mL
• 1 cup ≈ 240 mL
• 1 tablespoon ≈ 15 mL
• 1 teaspoon ≈ 5 mL

Many facilities count ice chips as half their measured frozen volume after melting, but candidates should follow the question or facility rule. Record actual intake offered and consumed, not the container’s full capacity. When a resident on a restriction requests more fluid, explain that you will check and notify the nurse; do not secretly give or withhold fluid.

Report a major change from baseline, very low observed output, inability to void, blood, new pain, vomiting, or other concerning findings. Dark or cloudy urine may have multiple causes. The aide reports the observation and symptoms and does not diagnose dehydration or infection from appearance alone.

Exact Pennsylvania urinary-output skill

The hands-on measurement is not performed from a catheter drainage bag. Pennsylvania Skill 13 starts with a bedpan containing urine:

1. Put on clean gloves before handling the bedpan.
2. Pour its contents into the measuring container without spilling or splashing outside the container.
3. Rinse the bedpan and pour the rinse into the toilet.
4. Place the measuring container on a flat surface and read it at eye level. If the level is between marks, round up to the nearest 25 mL/cc.
5. Empty the graduate into the toilet, rinse it, and pour that rinse into the toilet.
6. Remove gloves without self-contamination and wash hands before recording.
7. Record within ±25 mL/cc of the evaluator’s reading.

If the liquid appears halfway between 150 and 175 mL marks, record 175 mL under this skill’s rounding rule. Do not hold the graduate in the air, estimate from bedpan markings, read a hanging drainage bag, or round down.

Specimen collection

Verify the order, resident, specimen type, container, timing, storage, and required precautions before starting. Explain the procedure, provide privacy, use gloves for contact with body fluids, and prevent contamination with toilet tissue, water, disinfectant, or another body fluid.

• Routine urine: collect in the clean receptacle and transfer the requested amount to the labeled container without touching its inside.
• Clean-catch midstream: provide perineal cleansing supplies and instructions; the resident begins voiding, collects the midstream portion without touching the inside of cup or lid, and finishes in the toilet or receptacle. Assist only as trained and preserve privacy.
• Timed/24-hour urine: follow the laboratory start procedure, usually discarding the first void at the start and collecting all urine thereafter through the final void at the end time. If a void is lost, report it immediately; the nurse or laboratory determines restart under policy.
• Stool: prevent urine or toilet-water contamination and take the amount and areas required by the ordered kit. Do not perform a digital rectal procedure.
• Sputum: sputum comes from a deep cough, not saliva. Follow timing and mouth-rinse instructions for the ordered test.

Label in the resident’s presence according to policy, including required identifiers, date/time, specimen source, and collector. Seal the container, place it in the designated transport bag, and send it promptly using required refrigeration or delivery instructions. Never place a specimen with food.