Daily weights provide a relative accurate assessment of a client’s fluid status. while all routes of fluid intake and all routes of fluid loss or output are measured and recorded

1. • Body Weight
Mr. JHONEE F. BALMEO
• Intake and Output

2. Body Weight
 Daily weights provide a relative accurate assessment of a
client’s fluid status.
 Significant changes in weight over a short time (e.g.,
more than 5 pounds in a week or more than 2 pounds in 24
hours) are indicative of acute fluid changes.

3. Body Weight
 Rapid losses or gains of 5% to 8% of total body weight indicate
moderate to severe fluid volume deficits or excesses.
 To obtain accurate weight measurements, the scale should be
balanced before each use, and the client should be weighed
(a) at the same time each day (e.g., before breakfast and
after the first void),
(b) wearing the same or similar clothing, and
(c) on the same scale.

4. Body Weight
 Regular assessment of weight is particularly important for
clients in the community and extended care facilities who are at
risk for fluid imbalance.
 Maintaining a healthy or ideal body weight requires a balance
between the expenditure of energy and the intake of nutrients.
 Generally, when energy requirements of an individual equate
with the daily caloric intake, the body weight remains stable.

5. Body Weight
 Ideal body weight (IBW) is the optimal weight recommended
for optimal health. To determine an individual’s
approximate IBW, the nurse can consult standardized tables
or can quickly calculate a value.
 The nurse should use great caution in suggesting that these
weights apply to all clients.

6. Body Mass Index (BMI)
 Many health professionals consider the body mass index to
be a more reliable indicator of a person’s healthy weight.
 For people older than 18 years, the body mass index (BMI)
is an indicator of changes in body fat stores and whether a
person’s weight is appropriate for height, and may provide
a useful estimate of malnutrition.

7. Body Mass Index (BMI)
 *the results must be used with caution in people who have fluid
retention (e.g., ascites or edema), athletes, or older adults.
 To calculate the BMI:
 1. Measure the person’s height in meters, e.g., 1.7 m
 2. Measure the weight in kilograms, e.g., 72 kg
 3. Calculate the BMI using the following formula:

8. Body Mass Index (BMI)

11. Body Mass Index (BMI)
 Another measure of body mass is percent body fat.
 Percent of body fat can be measured by underwater
weighing and dual-energy x-ray absorptiometry (DEXA),
but these methods are time consuming and expensive.
Other indirect, but more practical measures include waist
circumference

12. ?
 The nurse is caring for clients with diabetes. After evaluating the
nutritional status of the clients, which client does the nurse
expect to be at risk of malnutrition?
 1) Client 1
2.) Client 2
3) Client 3
4) Client 4

13. Beginning the Physical Examination:
General Survey
 Once you understand the patient’s concerns and have
elicited a careful history, you are ready to begin the
physical examination.
 At first you may feel unsure of how the patient will relate
to you. With practice, your skills in physical examination
will grow, and you will gain confidence.

14. Weight Changes.
Weight changes result from changes in body tissues or body fluid.
Good opening questions include
 “How often do you check your weight?”
 “How is it compared to a year ago?”
If there are changes, ask,
 “Why do you think it has changed?”
If weight gain or loss appears to be a problem, ask about the
amount of change, its timing, the setting in which it occurred,
and any associated symptoms.

15. Weight Changes.
 In patients who are overweight or obese, plan a thorough
assessment to avert the high risks of associated morbidity
and mortality. Ask when the weight gain began. Was the
patient overweight as a child? Are the parents overweight?
 Explore any clinically significant weight loss, defined as
loss of 5% or more of usual body weight over a 6-month
period.

16. Weight Changes.
 Mechanisms include decreased food intake due to anorexia,
depression, dysphagia, vomiting, abdominal pain, or financial
difficulties; defective gastrointestinal absorption or inflammation;
and increased metabolic requirements.
 Ask about abuse of alcohol, cocaine, amphetamines, or opiates, or
withdrawal from marijuana, all associated with weight loss. Heavy
smoking also suppresses appetite.

17. Weight Changes.
 Throughout the history, be alert for signs of malnutrition.
Symptoms may be subtle and nonspecific, such as
 weakness,
 easy fatigability,
 cold intolerance,
 flaky dermatitis, and
 ankle swelling.

18. Weight Changes.
 Securing a good diet history of eating patterns and
quantities is essential. Ask general questions about intake
at different times throughout the day, such as
 “Tell me what you typically eat for lunch.”
 “What do you eat for a snack?”
 “When?”

19. Obesity at a Glance
 ●◗ More than 68% of U.S. adults are overweight or obese
(BMI >25).
 ●◗ More than 17% of U.S. children and adolescents are
overweight and 15% are obese.
 ●◗ Health Disparities: the prevalence of overweight or
obese populations is higher in certain ethnic and income
groups:
 ●◗ Women: black women—77%; white women—59%

20. Obesity at a Glance
 ●◗ Women: women with an income <130% of the poverty threshold
are 50% more likely to be obese than those at higher income levels
 ●◗ Men: black men—71%; white men—72%
 ●◗ Adolescents: highest prevalence in Mexican-American boys and
girls (46%; 42%), black girls (46%), white boys from lower-income
families
 ●◗ Overweight and obesity increase risk of heart disease,
numerous types of cancers, type 2 diabetes, stroke, arthritis, sleep
apnea, infertility, and depression. Obesity may increase risk of
death.

21. Obesity at a Glance
 ●◗ More than 85% of people with type 2 diabetes and 20% of
people with hypertension or elevated cholesterol are overweight
or obese.
 ●◗ Obesity is increasing worldwide. In the world’s poorest
countries, being poor is associated with underweight and
malnutrition; but being poor in a middle-income country
adopting a Western lifestyle increases the risk of obesity.

22. Factors Affecting Nutrition
 Although the nutritional content of food is an important
consideration when planning a diet, an individual’s food
preferences and habits are often a major factor affecting
actual food intake. Habits about eating are influenced by

23. Factors Affecting Nutrition
 Development
People in rapid periods of growth (i.e., infancy and
adolescence) have increased needs for nutrients.

24. Factors Affecting Nutrition
 Sex
Nutrient requirements are different for men and women
because of body composition and reproductive functions

25. Factors Affecting Nutrition
 Ethnicity and Culture
Ethnicity often determines food preferences. Traditional
foods (e.g., rice for Asians, pasta for Italians, curry for
Indians) are eaten long after other customs are abandoned.

26. Selected Variations in Nutritional Practices
and Preferences Among Different Cultures
 AFRICAN AMERICAN HERITAGE
 ■ Gifts of food are common and should never be rejected.
 ■ Diets are often high in fat, cholesterol, and sodium.
 ■ Being overweight may be viewed as positive.
 ■ Many are lactose intolerant (Gaskin & Ilich, 2009).

27. Selected Variations in Nutritional Practices
and Preferences Among Different Cultures
 ARAB HERITAGE
 ■ Many spices and herbs are used such as cinnamon, allspice, cloves,
mint, ginger, and garlic.
 ■ Meats are often skewer roasted or slow simmered; most common
are lamb and chicken.
 ■ Bread is served at every meal.
 ■ Muslims do not eat pork, and all meats must be cooked well done.
 ■ Beverages are drunk after the meal, not during; alcohol is
prohibited.

28. Selected Variations in Nutritional Practices
and Preferences Among Different Cultures
 CHINESE HERITAGE
 ■ Foods are served at meals in a specific order.
 ■ Each region in China has its own traditional diet.
 ■ Traditional Chinese may not want ice in their drinks.
 Foods are chosen to balance yin and yang in order to avoid
indigestion.

29. Selected Variations in Nutritional Practices
and Preferences Among Different Cultures
 JEWISH HERITAGE
 ■ Dietary laws govern killing, preparation, and eating of
foods.
 ■ Meat and milk are not eaten at the same time; dairy
substitutes (e.g., margarine) are permitted.
 ■ Pork is one meat that is forbidden to eat.
 ■ All blood must be drained from meats.
 ■ Always wash hands before eating.

30. Selected Variations in Nutritional Practices
and Preferences Among Different Cultures
 MEXICAN HERITAGE
 ■ Rice, beans, and tortillas are core, essential foods.
 ■ Many are lactose intolerant. Leafy green vegetables and
stews with bones provide calcium.
 ■ Larger body size may be viewed as a positive attribute.
 ■ Sweet fruit drinks, including adding sugar to juice, are
popular.

31. Factors Affecting Nutrition
 Beliefs About Food
Beliefs about effects of foods on health and well-being can
affect food choices. Many people acquire their beliefs about
food from television, magazines, and other media.

32. Factors Affecting Nutrition
 Personal Preferences
People develop likes and dislikes based on associations with
a typical food. A child who loves to visit his grandparents
may love pickled crabapples because they are served in the
grandparents’ home. Another child who dislikes a very strict
aunt grows up to dislike the chicken casserole she often
prepares.

33. Factors Affecting Nutrition
 Religious Practices
Religious practice also affects diet. Some Roman Catholics
avoid meat on certain days, and some Protestant faiths
prohibit meat, tea, coffee, or alcohol. Both Orthodox
Judaism and Islam prohibit pork.

34. Factors Affecting Nutrition
 Lifestyle
Certain lifestyles are linked to food-related behaviors.
People who are always in a hurry probably buy convenience
grocery items or eat restaurant meals.

35. Factors Affecting Nutrition
 Economics
What, how much, and how often a person eats are
frequently affected by socioeconomic status. For example,
people with limited income, including some older adults,
may not be able to afford meat and fresh vegetables.

36. Factors Affecting Nutrition
 Medications and Therapy
The effects of drugs on nutrition vary considerably. They
may alter appetite, disturb taste perception, or interfere
with nutrient absorption or excretion. Nurses need to be
aware of the nutritional effects of specific drugs when
evaluating a client for nutritional problems.

37. Factors Affecting Nutrition
 Health
An individual’s health status greatly affects eating habits and
nutritional status. Missing teeth, ill-fitting dentures, or a
sore mouth makes chewing food difficult.

38. Factors Affecting Nutrition
 Alcohol Consumption
The calories contained in alcoholic drinks include both those
of the alcohol it self and of the juices or other beverages
added to the drink. In total, these can constitute large
numbers of calories

39. Factors Affecting Nutrition
 Advertising
Food producers try to persuade people to change from the
product they currently use to the brand of the producer.
Popular actors are often used to influence television
viewers’ or radio listeners’ choices.

40. Factors Affecting Nutrition
 Psychological Factors
Although some people overeat when stressed, depressed, or
lonely, others eat very little under the same conditions.
Anorexia and weight loss can indicate severe stress or
depression.

41. Types of Weighing Scales In Hospitals
 Due to the sensitive nature of work conducted by
professional medical organisations, achieving high levels
of weighing accuracy is vital in order to provide successful
operations, diagnoses and other services.

42. Types of Weighing Scales In Hospitals
 Theatre, Swab and Mortuary Scales

43. Types of Weighing Scales In Hospitals
 Bed Weighing Scales

44. Types of Weighing Scales In Hospitals
 Flat Scales

45. Types of Weighing Scales In Hospitals
 Baby Scales

46. Other Types of Weighing Scales In Hospitals
 Salter scale

47. Other Types of Weighing Scales In Hospitals
 Physician weighing scale

48. ?
 Body mass index (BMI)
a) is a way to measure central obesity
b) is synonymous with obesity
c) of 27 corresponds to morbid obesity
d) is a measure of lean body mass to fat mass.
e) measures obesity by considering both
weight and height..

49. ?
 Complications of obesity include all of the following EXCEPT:
a) Arthritis
b) coronary artery disease
c) gall stones
d) obstructive sleep apnea
e) type I (insulin dependent) diabetes mellitus

50. INTAKE AND OUTPUT
 All routes of fluid intake and all routes of fluid loss or output
are measured and recorded

51. Fluid Intake and Output.
 Measurement and recording of all fluid intake and output (I &
O) during a 24-hour period provides important data about a
client’s fluid and electrolyte balance.
 Generally, I & O are measured for hospitalized clients,
particularly those at increased risk for fluid and electrolyte
imbalance.

52. Fluid Intake and Output.
 The unit used to measure I & O is the milliliter(mL). In
household measures, 30mL is roughly equivalent to1fluid
ounce, 500mL to 1pint, and 1,000mL to 1quart.
 To measure fluid intake, nurses convert household
measures such as a cup or soup bowl to metricunits.

53. Fluid Intake and Output.
 It is important to inform clients, family members, and all
caregivers that accurate measurements of the client’s
fluid I & O are required, explaining why and emphasizing
the need to use a:
 bedpan, urinal, commode, or in-toilet collection device
(unless a urinary drainage system is in place).

54. Measuring I&O
 To measure fluid intake, each item of fluid consumed or
administered is recorded, specifying the time and type of
fluid. All of the following fluids need to be recorded:

55. Measuring I&O
 Oral fluids:
Water, milk, juice, soft drinks, coffee, tea, cream, soup, and
any other beverages. Include water taken with medications.

56. Measuring I&O
 Ice chips:
Record the fluid volume as approximately one-half the
volume of the ice chips. For example, if the ice chips fill a
cup holding 200 mL and the client consumed all of the ice
chips, the volume consumed would be recorded as 100 mL.

57. Measuring I&O
 Foods that are or become liquid at room temperature:
These include ice cream, sherbert, custard.

58. Measuring I&O
 Tube feedings:
Remember to include the volume of water used for flushes
before and after medication administration, intermittent
feedings, residual checks, or any other water given via a
feeding tube

59. Measuring I&O
 Parenteral fluids:
The exact amount of IV fluid administered must be
recorded, since some fluid containers may be overfilled.

60. Measuring I&O
 IV medications:
IV medications that are administered as an intermittent or
continuous infusion must also be included (e.g., ceftazidime
1 g in 50 mL of sterile water). Most IV medications are mixed
in 50 to 100 mLof solution.

61. Measuring I&O
 Catheter or tube irrigants:
Fluid used to irrigate urinary catheters, nasogastric tubes,
and intestinal tubes must be recorded if not immediately
withdrawn as part of the irrigation.

62. Measuring I&O
 Urinary output:
Following each voiding, pour the urine into a measuring
container, note the amount, and record the amount and time
on the I &O form.
For clients with retention catheters, empty the drainage bag
into a measuring container at the end of the shift (or at
prescribed times if output is to be measured more often).
*urine output often is measured hourly*

63. Measuring I&O
 Vomitus and liquid feces:
The amount and type of fluid and the time need to be
specified.

64. Measuring I&O
 Tube drainage:
This includes gastric or intestinal drainage.

65. Measuring I&O
 Wound and fistula drainage:
Drainage may be recorded by documenting the type and
number of dressings or linen saturated with drainage, or by
measuring the exact amount of drainage collected in a
vacuum drainage (e.g., Hemovac) or gravity drainage
system.

66. I & O Documentation
 Fluid I & O measurements are totaled at the end of the
shift (every 8 to 12 hours), and the totals are recorded in
a client’s chart. In intensive care areas, nurses may record
I & O hourly.
 Usually the staff on the night shift totals the amounts of I
& O recorded for each shift and records the 24-hour total.

67. I & O Documentation
 Clients whose output substantially exceeds intake are at risk
for fluid volume deficit, whereas clients whose intake
substantially exceeds output are at risk for fluid volume
excess.
 In assessing a client’s fluid balance it is important to consider
additional factors that may affect I&O

68. ?
 The following items are on your client's lunch tray; pick the ones
that would be included as intake:
a) Milk.
b) Bread
c) Carrots
d) Roast beef
e) Vegetable soup.
f) Jell-o.

69. ?
 Intake and output is measured over a period of:
a) 2 hours
b) 12 hours
c) 1 week
d) 24 hours.

70. ?
 When a client is on restricted fluids, which of the
following would you NOT do:
a) Alternate fluids
b) Give frequent oral hygiene
c) Record on I&Q slip
d) Give frequent sips of fluid.

71. References:
 Audrey Berman . . . [et al.]. – 9th ed. (2012)
KOZIER & ERB’S Fundamentals of NURSING
Concepts, Process, and Practice.
 Bickley, Lynn S. -11TH ED. (2013) Bates’ guide
to physical examination and history-taking.