INTAKE AND OUTPUT WORKSHEET - Weebly
INTAKE AND OUTPUT WORKSHEET
Mr. Jones had an appendectomy yesterday. He was placed on I&O and a full liquid diet. He is receiving IV fluids at the rate of 100cc/hr. The following things occurred during 24 hours. Record all intake and output under the correct times on your VAMC I&O record. Next add up the totals for intake and outpuit for each 8 hour period. Then add up the 24 hour and record in the lower right corner.
12mn IV 1000 cc bottle started @ 100cc/hr
4am used urinal 550 cc
used bedpan liquid brown BM 300 cc
7am water pitcher filled @ 12mn has ½ remaining
used urinal 375cc
8am BREAKFAST 1 ½ c coffee
1 glass orange juice
½ carton milk
10am used urinal 400cc
12noon LUNCH 1 carton milk
1 bowl broth
1 small bowl ice cream
1 small bowl jello
2pm used urinal 550cc
3pm water pitcher filled @ 8am has 2/3 remaining
4pm vomited 550cc dark green emesis
5pm DINNER------Diet changed to clear liquids
1 small bowl of jello
½ bowl broth
½ regular glass of 7UP
6pm 1 regular glass of 7UP
8pm used urinal 450cc
10pm used urinal 500cc
11pm water pitcher filled at 4pm had ½ of water remaining
Water pitcher=900cc Milk carton=1/2 pint (8oz) Juice glass=120cc
Small bowl= 100cc Regular glass=240cc Soup bowl= 200cc
Coffee cup= 200cc
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