Intake and Output Measurement

1Step-by-Step Procedure

1. 1

   Gather equipment: intake and output (I&O) record or flow sheet, graduated measuring container (urinal, hat, graduate), pen, gloves for handling output.

2. 2

   Wash hands.

3. 3

   Identify the resident and explain the I&O procedure.

4. 4

   Inform the resident (and family) that all urine must be measured and not discarded; place a "hat" collection device in the toilet if the resident uses the toilet.

5. 5

   Measure all fluid intake at each meal and snack: note the volume of all liquids consumed (water, juice, coffee, tea, milk, soup broth, ice chips, gelatin, ice cream). Convert ice chips to approximately half their volume in ml.

6. 6

   Document each intake item in the appropriate column of the I&O record immediately, including the time.

7. 7

   For output: put on gloves before handling any urine or other body fluids.

8. 8

   Pour urine from the urinal, hat, or catheter bag into a graduate measuring container.

9. 9

   Hold the graduate at eye level on a flat surface to read the measurement accurately at the bottom of the meniscus.

10. 10

    Record the amount in the output column immediately.

11. 11

    Empty and rinse the measuring container; pour urine into the toilet.

12. 12

    Remove gloves and wash hands.

13. 13

    Record other output as applicable: emesis (vomit), drainage, wound output, diarrhea — estimating volume as accurately as possible.

14. 14

    At the end of the shift, total all intake and all output and record the shift totals.

15. 15

    Report significant imbalances (output greatly less or more than intake) or total output less than 30 ml per hour to the nurse immediately.

What the Examiner Is Watching For

• ✓

  Gloves are worn when handling urine and other output.

• ✓

  Graduated container is read at eye level.

• ✓

  Both intake and output are documented accurately and immediately.

• ✓

  Ice chips are calculated at approximately half their volume in liquid.

• ✓

  Abnormal findings are reported to the nurse.

Common Mistakes That Cause Failure

• ⚠

  Discarding urine before measuring — always measure first.

• ⚠

  Reading the graduate from above rather than at eye level — this causes parallax measurement error.

• ⚠

  Not converting ice chips to liquid equivalent (half the volume).

• ⚠

  Not documenting immediately — memory errors lead to inaccurate records.

• ⚠

  Forgetting to total intake and output at the end of the shift.

Tips for Exam Day

• →

  Measure at eye level on a flat surface — hold the graduate steady and get down to its level.

• →

  Read at the bottom of the meniscus (the curved surface of the liquid).

• →

  Ice chips = half the cup volume in ml — this is commonly tested.

• →

  Report output less than 30 ml per hour or any significant imbalance.