Intake and output (I&O) is the measurement of the fluids that enter the body (intake) and the fluids that leave the body (output). The two measurements should be equal. (What goes in…. must come out!)

        The metric system is used for fluid measurement. The measurements should be recorded in ml. (Milliliters).

        The average adult intake is 2500-3000mL. Per day.

        The average output is 2500-3000mL. Per day.

Common metric conversions used for I&O:

        1 c.c. = 1 ml                1 ounce = 30 ml.                     1L. = 1000 ml.

        To convert from ounces to ml. multiply by 30 (Ex. 6 oz. x 30ml. = 180ml.)

        To convert from cc/ml to ounces, divide by 30 (Ex. 240cc / 30cc = 8 oz.)

        Sizes of containers vary. Know your facility’s container measurement system.

INTAKE & OUTPUT: Metric Conversions

        Using the basic volume conversions, convert the following equations to the metric system.

        Basic conversions:

               1 ml. = 1 cc.

               1 ounce (oz.) = 30 ml.

               1 cup = 8 oz.

               1 pint = 2 cups

Hints:

        To convert from ml. or cc. to ounces, divide by 30.

        To convert from ounces to ml. or cc., multiply by 30.

Conversions:

• 1 cc. = ml.
• 2 oz. = ml.
• ½ oz. = ml.
• 4 cc. = ml.
• 8 oz. = ml.
• 6 oz. = ml.
• 4 oz. = ml.
• ½ cup = oz. = ml.
• 2 (8 oz.) cups of coffee = ml.
• 1 (6 oz.) bowl of broth = ml.
• 3 (8 oz.) glasses of water = ml.
• 2 (4 oz.) glasses of ice chips = ml.
• 2 (4 oz.) dishes of gelatin= ml.
• ½ pint of milk = ml.

Nutrition and Fluid Balance

Convert the following measurements.

• 30ml. = oz.
• 2 oz. = ml.
• 2 (8oz.) cups of coffee = ml.
• 1 (6 oz.) bowl of soup = ml.
• 3 (8 oz.) glasses of water = ml.
• 2 (4 oz.) glasses of ice chips = ml.
• 2 (4 oz.) cups of gelatin = ml.
• 100% (6 oz.) bowl of soup = ml.
• 75% (8 oz.) cup of coffee = ml.
• 50% (4 oz.) cup of gelatin = ml.
• 10% (6 oz.) bowl of soup = ml.
• ¼ (4 oz.) cup of gelatin = ml.
• ½ (6 oz.) bowl of soup = ml.
• ¾ (8 oz.) cup of water = ml.

Sources of fluids:

• Oral fluids;
• Food;
• Intravenous fluids.

Sources of fluid excretion:

• Lungs;
• Skin;
• Kidneys;
• Intestines.

Personal care worker responsibilities to promote adequate fluid and food intake.

Tasks that may be performed by the personal care worker to promote adequate fluid and food intake

• Before meal hygiene;
• Position of client to prevent aspiration;
• Serving food trays;
• Feeding a client;
• Use of assistive devices for feeding/drinking;
• Adequate fluids intake or restricting fluids as ordered;
• Encouraging independence while feeding/drinking;
• Post meal hygiene.

Assistance with mealtime:

        Many of the tasks with which you will help clients have been studied and analyzed to find safe, respectful and effective ways for you to assist the client. In this module you will be introduced to ways to assist someone with eating. The assistance with mealtime can be broken into areas. Each is presented below along with the steps to accomplish it.

1. 1.   Preparing the resident to eat.

        For most people, eating is a social event. That is, it is often done with other people. For some clients it may be one of the more important times of the day when they interact with others. So, it is important to help prepare clients for meals. Here are some ways in which you can help:

• Ask the client if he/she would like assistance in brushing his/her hair or putting on make-up.
• Ask the client if he/she needs to use the bathroom. Assist the client according to his/her needs.
• Assist the client in washing his/her hands or face if assistance is needed.
• Ensure that the client has his/her dentures on if they wear them.
• Ask the client where he/she would like to sit in the dining room.

1. 2.   Serving meals and providing assistance during meals.

        As mentioned above, mealtime is an important social time. This time with others is enhanced when the atmosphere is pleasant, calm and enjoyable. While performing your tasks, keep in mind that your calm, relaxed, friendly, encouraging and helpful behavior will go a long way toward making mealtime special. Here are the kinds of tasks you may perform:

• Serve the meal to the client by calmly and quietly placing it within easy reach.
• Make sure the client has all the utensils he/she will need.
• Check the client frequently to see if he/she needs help.
• Offer to cut food for a client who is having difficulty. When cutting food, always make sure the pieces are small to help prevent choking. A client with arthritis may also need help with things such as opening milk containers.
• Offer different food if a client refuses what was offered. Each client has a right to food that is appealing and nutritionally sound.
• Allow the client time to complete one course before starting another.
• If you see any of the following, tell your supervisor:

• A change in the amount of assistance a client needs while eating.
• A change in general behaviors during mealtime such as playing with food, taking food from others, throwing food or falling asleep.
• A change in attitude such as withdrawing, showing anger or frustration.
• Choking while eating or drinking.
• Eating less or more food than usual.
• A refusal to eat.
• Wait for all client to complete their meal before starting another activity or turning on a dishwasher.
• If needed, help the client check their personal appearance before moving away from the table. For example, check to see if there are any food spills or crumbs that need to be cleaned. Help a client to wipe his/her face, if necessary.

        In addition to the basic steps already listed, several other things should be considered. First, it is important that the clients’ cultural preferences and beliefs be considered. For example, you may have a client who wants to pray before each meal. While you do not have to pray with the client, it is important that you sit quietly and respectfully while the client does this. You should also be sensitive to the fact that many people’s food preferences are strongly influenced by their culture, ethnic background and religion. These preferences should be honored when possible.

        You may also have responsibilities to help prepare the dining room for meals. You might be involved in removing clutter or hazards, reducing distractions such as loud noise or cleaning the table. You may also encounter client who don’t eat at times pre-set by the personal care. For example, you may have a client who likes to wake up at 10 a.m. and have a light breakfast of fruit and coffee instead of the 8 a.m. breakfast call. Honor preferences by being flexible.