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Intake, output chart and feeding problem

associated with illness and nurses
responsibility in meet the client’s nutritional
needs
Prepared by:
Manika Dhakal
Roll.no:11
BNS 2nd year
15th batch
General objective: At the end of the session b.sc 1st year students
will be able to Intake, output chart and feeding problems associated
illness and nurse’s responsibility in meet the client’s nutritional needs.
Specific objectives:

• define intake
• define output
• define fluid intake and output chart
• state the purpose of fluid intake and output measurement
• state indication of intake and output chart
• explain about the ways of maintaining intake and output chart
• introduction of feeding problems
 Cont…

• state the feeding problems associated with illness patient

• explain about the nurse’s responsibility in meeting the
nutritional client’s needs.
Definition of intake
Measurement of all those fluids entering the client’s body
such as water, ice, chips, milk, ice-creams, and fluid include:
parenteral central line, feeding tube, artificial irrigation and
blood transfusion.
Definition of output
Measurement of all fluid
level that leaves the client’s
body such as urine,
perspiration, exhalation,
diarrhea, vomiting, drainage,
bleeding, and wounds.
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Definition of intake and output chart
Measurement of a patient’s fluid intake by mouth, feeding
tubes, of iv catheters and output from kidneys, GI tract,
drainage tubes and wound accurate within 24hrs
measurement and recording in an essential part of patient
assessment.
Purpose of fluid intake and output measurement

Ensure accurate recording keeping.

Prevent dehydration
Prevent circulatory overload.

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Indication of intake and output chart

• Unconscious patient
• Patient with diarrhea and vomiting
• Patient with kidney disorders
• Patient taking diuretic drugs
• Post operative patient
• Patient with burns
• Excessive perspiration
Unconscious patient
Patient with diarrhea and vomiting

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Patient with kidney disorders

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Patient taking diuretic drugs
Post operative patient

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Patient with burns

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Excessive perspiration

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Ways of maintaining intake and output:
• Assess the condition which requires intake output monitoring
• Identify the condition such as surgery, renal diseases, use of
diuretics etc. which alter the fluid intake and output
• Record the type and amount of all fluids the patient has lost
through different route
• Record them as urine, liquid stool, vomitus, tube drainage and
any fluid aspirate from a body cavity
• Don’t assess output by amount only. Consider color changes
and odor etc.
 Cont.…

• If irrigating a nasogastric tube or the bladder, measure the

amount instilled and subtracts it from total output
• For an accurate measurement, keep toilet paper out of you
patient’s urine
• Measure drainage in a calibrated container. Observe it at eye
level and take reading at the bottom of the meniscus.
Household measures such as glass, cup or soup bowl can be
converted to metric units to measure fluid intake.
 Cont.…

• Use different graduated container for different patient.

• Measure and record all intake and output at least every 8
hourly.
Daily intake and output

• Intake:
Ingested liquid: 1500ml
Ingested food: 800ml
Metabolism:200ml

Total intake:2500ml
Output:
• Kidney: 1500ml
• Skin loss: 600ml
• GI:100ml
• Lung: 300ml
• Total output: 2500ml
Positive fluid balance

• Positive fluid balance occurs when the intake of fluids

exceeds the output or loss of fluids from the body(through
urine, sweat etc..)
• In positive fluid balance, the body retains more fluids than it
excretes, leading to an increases in total body fluid volume.
Negative fluid balance

• Negative fluid balance occurs when the loss of fluids from

the body exceeds the intake of fluids.
• In negative fluid balance, the body is losing more fluids than
it can replace, leading to a decreases in total body fluid
volume.
 Introduction of feeding problems
The term feeding difficulties is abroad term used to describe
a variety or mealtime behaviors perceived as problems for a
child or family.
Feeding problem can refer to difficulties or challenges that
arise during the process of eating and feeding..
These problems can manifest in various ways, such as
difficult, swallowing, refusing to eat certain foods, or
experiencing discomfort while eating.
Feeding problems associated with illness
 Disturbance in gastrointestinal function
 Loss of appetite
 Weight loss
 Defective digestion and absorption
 Nausea
 Difficulty in chewing and swallowing in dental problems and
tonsilitis
 Cont.…

• Some illness requires special diets to which patient has to

adjust like:
 Hypertension
Gastric ulcer
Diabetes
Renal disease
Nurse’s responsibility in meeting nutritional
needs of client’s
1. Preparation of patient
2. Preparation of the environment
3. Alternative ways of serving food
 Cont.…
1. Preparation of patient
Inform the patient about the hospital timing of
serving tea, breakfast and lunch etc.
Observe patient’s nutritional status
Explain the patient’s about special diet if
ordered
Explain patient to eat by explaining the
importance of diet
Encourage for oral hygiene
 Cont.…
Provide comfortable position
Control pain, nausea with medications
during meal time
Assist if needed
Observe and record if any unusual
reaction presents to food.

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2. Preparation of the environment

 The environment should be pleasant, there should not be any:

• Offensive smells
• Noise
• Dirt
• Too much heat or cold in the ward
 Cont..
Ward must be clean and tidy
Dressing, enema, medication etc. should not be carried out
during meal time
Offers bedpans or urinals to bedridden patient about a half
hour before serving food.
If patient’s can sit, help them to have fowler’s position with
cardiac table or over bed table
Remain at bed side until the patient feels comfortable.
Attractive ways of serving food
Consider patient’s:
• Cultural and religious values
• Food preferences
• Intolerance
• Allergy to foods
 Foods should be:
• Clean
• Well cooked
• In a covered pot
 Cont…
Foods should not be too hot or cold
Foods should have pleasant flavor so, that the sight and smell
increases his/her appetite
Small and frequent meals are preferable for a sick person
Enough space between meals
Food should be served at correct time in a pleasant manner and
atmosphere
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 Cont…
• Clean water should be provided with meals
• The patient should be given enough time to chew and taste the
food
• Never hurry the patient
• Wash the patient hand make him/her brush his/her teeth after
meals.
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Assignment

• Write down the nurse’s responsibility in meeting the

nutritional needs of the client’s.
References:

• Mandal.GN, subedi(2015), A Textbook of fundamental of

nursing (2nd edn), Dillibazar,Kathmandu ,Makalu publication
house, page.no:262
• Pathak.S, Devkota,R.(2010), A Text book of fundamental of
nursing(revised edn), kamalpokhari,Kathmandu, Vidyarthi
prakashan (p), LTD, page. no:243
• Potter.PA, perry ,AG, stockert, PA,Hall.AM(2016).potter and
perry’s fundamental of nursing, Reed Elsevier India private
limited, page.no;21
 Cont.…

Verghese,A, Shrestha. S, Thapa. S,Bantawa,S,

singh.S(2063),Fundamental of nursing(2 nd edn), Dillibazar,
Kathmandu, Dhaulagiri offset press, page.no:173 to 174
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