Section 5.3: Measuring Weight, Intake, & Output

Measuring Weight, Intake, and Output

Accurately measuring and recording a resident’s weight and fluid balance are vital nursing assistant responsibilities. These measurements are used by the healthcare team to monitor nutritional status, assess kidney and heart function, and determine medication dosages (such as diuretics). Even minor errors in these measurements can lead to serious clinical complications.

Measuring Resident Weight

A resident's weight is a key indicator of hydration, nutritional status, and fluid retention. Sudden weight gain can indicate that the resident is retaining fluid, which is a common sign of worsening heart failure or kidney disease. Sudden weight loss may indicate malnutrition or dehydration.

Procedure for Measuring Weight

To ensure accuracy, you must follow these rules:

1. Zero the Scale: Before the resident steps onto the scale, make sure the scale is balanced or calibrated to zero.
2. Consistency is Key: Weight should be measured at the same time of day (preferably first thing in the morning, before breakfast and after the resident's first void).
3. Clothing: The resident should wear similar clothing for each weigh-in (e.g., a lightweight gown or pajamas).
4. Safety Precautions: Always ensure the resident is wearing non-skid footwear. If the resident is unsteady, assist them onto the scale using a gait belt and stand close by to prevent falls. If the resident uses a wheelchair or is bedbound, use a specialized wheelchair scale or bed scale according to manufacturer instructions, making sure to subtract the weight of the wheelchair (tare weight).

---

Measuring Fluid Intake

Fluid intake includes all fluids that the resident consumes by mouth, as well as any foods that are liquid at room temperature.

What Counts as Fluid Intake?

• Water, juice, milk, coffee, tea, and sodas.
• Soups and broths.
• Ice cream, sherbet, and frozen yogurt.
• Gelatin (Jell-O) and popsicles.
• Nutritional supplements (such as Ensure).
• Note: Pureed foods do not count as fluid intake.

Converting Ounces to Milliliters (mL)

In healthcare, fluid intake is measured in milliliters (mL) or cubic centimeters (cc). These two units are identical in volume (1 mL = 1 cc). In Utah, "mL" is the standard abbreviation preferred on exams and documentation.

• The Golden Rule: 1 ounce (oz) = 30 milliliters (mL).

To calculate fluid intake, multiply the number of ounces consumed by 30.

Worked Example: Meal Intake Calculation

• Scenario: For breakfast, Mr. Thompson drinks half of an 8 oz milk carton, all of a 4 oz glass of orange juice, and a full 6 oz cup of coffee. How many mL of fluid did he consume?
• Calculation:
  1. Milk: 8 oz x 0.5 = 4 oz. 4 oz x 30 mL = 120 mL.
  2. Orange Juice: 4 oz. 4 oz x 30 mL = 120 mL.
  3. Coffee: 6 oz. 6 oz x 30 mL = 180 mL.
  4. Total Intake: 120 mL + 120 mL + 180 mL = 420 mL.

---

Measuring Fluid Output

Fluid output includes all fluids that leave the resident's body. This includes urine, emesis (vomit), liquid stool, and wound drainage.

Technique for Measuring Output

1. Collect the fluid in a bedpan, urinal, or commode bucket.
2. Pour the fluid into a graduate container (a measuring cup marked in mL). Never read the measurements directly from a bedpan or urinal, as these are not calibrated for accuracy.
3. Place the graduate container on a flat, level surface.
4. Bend down so your eyes are at eye level with the top of the fluid. Read the measurement at the bottom of the meniscus (the curve formed by the liquid).
5. Empty the fluid into the toilet, rinse and disinfect the graduate container, and document the measurement.
6. When emptying a urinary drainage bag (for a resident with an indwelling catheter), open the drain clamp, drain the urine into the graduate container without letting the drain tube touch the container, close the clamp, and follow the same measurement steps.

---

Bladder and Bowel Observation

Monitoring the characteristics of a resident’s urine and stool is vital for identifying infections, bleeding, or gastrointestinal issues.

• Urine Observations: Normal urine is pale yellow, clear, and has a mild odor. You must report:
  • Hematuria: Blood in the urine (urine appears pink or red).
  • Cloudy or dark urine: Can indicate infection or dehydration.
  • Foul-smelling urine: A common sign of a Urinary Tract Infection (UTI).
  • Dysuria: Pain or burning during urination.
• Stool Observations: Normal stool is brown, soft, and formed. You must report:
  • Melena: Black, tarry stools, which indicate bleeding in the upper gastrointestinal tract.
  • Clay-colored or white stools: Can indicate gallbladder or liver issues.
  • Diarrhea or constipation: Frequent liquid stools or hard, dry stools that are difficult to pass.

---

Specimen Collection

CNAs frequently assist with collecting specimens for laboratory analysis. Always wear gloves and practice strict infection control when handling specimens.

1. Routine Urinalysis: Collect urine in a clean bedpan or urinal and pour it into a labeled specimen cup.
2. Clean-Catch (Midstream) Urine Specimen: Used to detect bacteria. Clean the perineal area first. Have the resident start urinating, then place the sterile specimen cup under the stream of urine to collect a "midstream" sample without touching the cup to the skin.
3. Stool Specimen: Use a tongue blade to transfer a small amount of stool from a bedpan or commode bucket (avoiding urine or toilet paper contamination) into a labeled specimen container.
4. Sputum Specimen: Collected from the lungs (not saliva). The resident should cough deeply and spit directly into a sterile container, preferably first thing in the morning.