4.3 Intake, Output, Weight, and Specimen Routines

Measuring What Goes In, Comes Out, and Changes

Intake and output (I&O) helps the nurse evaluate hydration, kidney function, nutrition, fluid restrictions, and treatment response. Aides commonly record oral fluids, urine, emesis (vomit), liquid stool, and drainage assigned by the care plan. Fluids are charted in milliliters (mL). The rule is simple: measure what is measurable, and report what is unusual.

Intake

Intake includes liquids the resident drinks and foods that are liquid at room temperature: gelatin, ice cream, sherbet, popsicles, broth, and ice chips when counted by policy. Note that ice chips count as about half their volume because melted ice yields less liquid. Learn your facility's container conversions and record the amount actually consumed, not served.

If a 240 mL glass is served and the resident drinks half, record 120 mL, not 240.

Output

Output includes urine, emesis, liquid stool, and drainage. Measure in a graduate at eye level on a flat surface for accuracy. For a urinary catheter drainage bag, keep the bag below bladder level to prevent backflow, do not let the drain spout touch the graduate or floor (contamination), and reclamp the spout after emptying. On strict I&O, never dump urine, emesis, or liquid stool before measuring unless immediate safety requires it. Report cloudy or bloody urine, sediment, a strong new odor, pain on urination, very low output, or no output in the expected time.

If the resident voids in the toilet and the amount cannot be measured, follow policy for an unmeasured void and tell the nurse; never invent a number to fill a blank.

Daily Weights

A sudden change in weight signals fluid shifts, poor intake, dehydration, or worsening illness. Use the same scale, same time of day, similar clothing, and have the resident void first when possible. Lock wheelchair brakes, balance standing scales, and zero bed scales before reading. A change of about 2 to 3 pounds in one day, or roughly 5 pounds in a week, is reportable. If a value is far from the last weight, recheck per policy before reporting both the number and the context (different scale, heavier clothing).

Specimen Collection

Verify the resident, explain the task, glove and wear other PPE as needed, prevent contamination, label at the bedside, and send promptly. Never leave an unlabeled container to identify later.

• Clean-catch (midstream) urine: clean the perineum front to back, have the resident begin voiding into the toilet, then collect the midstream portion without touching the inside of the cup or lid.
• Stool: must not be contaminated with urine or toilet water; use a collection container or hat.
• Sputum: comes from a deep cough, not saliva; best collected on waking.

If the resident cannot produce the specimen or it is contaminated, tell the nurse rather than substituting or guessing. Document in the required units, and if a measurement was impossible, record it per policy and explain why. The safe answer in testing and practice is always: measure accurately, preserve the sample, report concerns, and never guess.

A Worked I&O Tally

Suppose over a shift a resident drinks a full 240 mL glass of water, half of a 180 mL cup of coffee, all of a 120 mL juice carton, and a 240 mL bowl of broth, and urinates twice measuring 350 mL and 300 mL. Intake is 240 plus 90 plus 120 plus 240, which equals 690 mL. Output is 350 plus 300, which equals 650 mL. You chart these totals in milliliters; you do not round to make them match, and you do not estimate the unmeasured. If intake greatly exceeds output, or output is very low, you report it because it can reflect a hydration or kidney concern.

Weight-Change Math and a Scenario

A resident weighed 162 pounds yesterday and 167 pounds today, a 5-pound gain in 24 hours. That crosses the reportable threshold even though the resident "looks the same." The aide rechecks on the same scale if policy allows, confirms the resident wore similar clothing and voided first, and reports the value plus context. A common exam trap is changing or deleting yesterday's number because today's seems wrong; you never alter the record, you report and let the nurse evaluate.

Specimen and Routine Traps on the Exam

• Recording the amount served instead of the amount actually consumed.
• Estimating an unmeasured void rather than documenting it per policy.
• Sending an unlabeled specimen or one with an uncertain source.
• Collecting saliva instead of deep-cough sputum.
• Letting the drainage bag rise above bladder level or touch the floor.
• Weighing on a different scale or different time of day without noting it.

In each case the safe choice protects accuracy and infection control: identify the resident, measure in the correct units, keep samples clean and labeled, and report anything unusual before you document. These habits make I&O and weights trustworthy clinical data rather than guesses.