Input Output Chart

Nursing Ruler

12 Jun 202205:51

Summary

TLDRThis video script discusses the importance of a 'Documentation' form used in hospitals to track patient intake and output. It details the process of recording vital information such as patient demographics, medical condition, and the amount of intake and output over a 24-hour period. The script also covers how to document various measurements like temperature, pulse, respiration, and blood pressure, emphasizing the significance of this form in evaluating a patient's health condition in ICUs and surgical wards.

Takeaways

😀 The video is about a documentation form used in hospitals to track patient intake and output.
📝 The form records various patient details such as name, age, sex, religion, registration number, ward and unit information, and bed number.
🏥 It is commonly used in both ICU and surgical wards to monitor the health condition of the patients.
🕒 The form requires 24-hour updates, indicating the time and date of each entry.
🌡 Vital signs such as temperature, pulse, respiration, and blood pressure are recorded on the form.
💊 Intake details include the type and quantity of fluids, medications, and other substances administered to the patient.
🚰 Output is documented, including urine, stool, and other excretions, along with the method of collection.
📊 The form helps in calculating the balance of intake and output to evaluate the patient's health status.
📋 The documentation process involves nurses and other healthcare professionals who are responsible for accurate record-keeping.
✍️ The final charting includes a total calculation and balance, which is crucial for patient care and monitoring.
👩‍⚕️ The video emphasizes the importance of this form for healthcare providers to make informed decisions about patient treatment.

Q & A

What is the purpose of the documentation form discussed in the video?
-The documentation form discussed in the video is used to track the intake and output of patients in a hospital, which helps in evaluating their health condition.
What does the term 'Intake Output Chart' refer to in the context of the video?
-The 'Intake Output Chart' refers to a record that is maintained in hospitals to monitor the amount of fluid intake and output for patients over a specific period, typically every 24 hours.
What information is typically recorded on the Intake Output Chart for each patient?
-The Intake Output Chart records details such as the patient's name, age, sex, religion, registration number, ward and unit information, bed and room number, diagnosis, date of admission, and vital signs like temperature, pulse, and blood pressure.
How often is the Intake Output Chart updated according to the video?
-The Intake Output Chart is updated every 24 hours to reflect the patient's intake and output over that period.
What are the different types of intake that might be recorded on the chart?
-The types of intake that might be recorded include oral, through a nasogastric tube, intravenous, intramuscular, and subcutaneous.
What is meant by 'output' in the context of the Intake Output Chart?
-In the context of the Intake Output Chart, 'output' refers to the amount of fluid the patient expels, such as urine, vomit, or any other form of excretion.
How is the patient's vital signs data recorded on the chart?
-The patient's vital signs, including temperature, pulse, and blood pressure, are recorded at specific times, such as in the morning, and the values are noted down on the chart.
What is the significance of monitoring a patient's intake and output?
-Monitoring a patient's intake and output is crucial for assessing their hydration status, kidney function, and overall health condition, which aids in their medical care and treatment.
How is the balance of intake and output calculated on the chart?
-The balance is calculated by subtracting the total output from the total intake, which gives an idea of the net fluid balance in the patient's body.
What actions are taken after the final charting is completed?
-After the final charting, the total intake and output are recorded, the balance is calculated, and the information is kept in the patient's record for further medical evaluation and care.
Why is it important to document the patient's religion and other demographic information on the chart?
-Documenting demographic information like religion can be important for cultural and personal care considerations, ensuring that the patient's beliefs and preferences are respected during their hospital stay.

Outlines

00:00

📋 Hospital Patient Documentation Process

This paragraph discusses the documentation process used in hospitals to track patient intake and output. It explains the importance of recording vital signs such as temperature, pulse, respiration, and blood pressure at specific intervals, typically every 24 hours. The documentation includes patient details like name, age, sex, religion, registration number, ward and unit information, bed and room numbers, diagnosis, and admission date. It also covers the intake of various substances like oral fluids, intravenous drugs, and the method of administration, as well as the output such as urine and stool. The paragraph emphasizes the nurse's role in maintaining these records and the significance of accurate documentation for evaluating the patient's health condition.

05:02

🗂 Understanding ICU and Surgical Ward Forms

The second paragraph emphasizes the importance of specific forms used in ICUs and surgical wards for tracking the intake and output of patients. It highlights how these forms help in understanding the patient's health status by evaluating the balance between what is given to the patient and what is expelled. The paragraph suggests that understanding this process is crucial for healthcare professionals and encourages viewers to subscribe for more informative content, inviting them to share their thoughts in the comment section if they find the information valuable.

Mindmap

Keywords

💡Documentation

Documentation in this context refers to the official records or reports that are kept for the purpose of providing information or evidence. In the video's theme, it is crucial as it pertains to maintaining patient records within a hospital setting. The script mentions a 'sample documentation form' which is used to track a patient's intake and output, an essential aspect of monitoring a patient's health condition.

💡Intake and Output Chart

An Intake and Output Chart is a specific type of documentation used in healthcare to record the quantities of fluid a patient consumes and expels over time. It is a key tool for assessing a patient's hydration status and overall health. The script describes this chart as a tool used in every hospital to monitor how much intake a patient is receiving and what output is produced, which is crucial for evaluating the patient's health.

💡Vital Signs

Vital signs are a group of medical measurements that are taken to assess a person's state of health. They include temperature, pulse, respiration, and blood pressure. In the script, vital signs are mentioned as part of the documentation process, where the nurse records the patient's temperature, respiration, and blood pressure, indicating the patient's current health status.

💡Diagnosis

A diagnosis is the identification of the nature of an illness or other problems by examination of the symptoms. In the script, the diagnosis is mentioned as a part of the patient's record, indicating the condition the patient is admitted to the hospital with, which could be a surgical or medical condition.

💡Admission Date

Admission Date refers to the date when a patient is officially accepted into a hospital for treatment. In the script, it is noted as a part of the intake and output documentation, signifying the starting point from which the patient's health is monitored.

💡Timing

In the context of the script, timing refers to the specific times at which the patient's vital signs are recorded or when certain medical actions are taken. It is important for tracking the patient's condition over time and ensuring that care is administered at appropriate intervals.

💡Intravenous

Intravenous, often abbreviated as IV, refers to the administration of fluids or medications directly into a vein. In the script, it is mentioned as one of the methods through which intake is provided to the patient, highlighting the various ways in which patients receive necessary fluids or medications.

💡Output

Output in this medical context refers to the measurement of what a patient expels from their body, such as urine, vomit, or other fluids. The script discusses recording the patient's output, which is important for understanding the patient's fluid balance and overall health.

💡Balance

Balance in the script refers to the calculation of the difference between the intake and output of a patient. It is a critical step in assessing the patient's fluid status and ensuring that the patient is properly hydrated or that any excess fluid is accounted for.

💡ICU

ICU stands for Intensive Care Unit, a specialized unit in a hospital that provides intensive care medicine. The script mentions ICU as one of the locations where the documentation form is extensively used, indicating the importance of detailed patient monitoring in critical care settings.

💡Medical Ward

A medical ward is a section of a hospital where patients with various medical conditions are treated. In the script, it is mentioned alongside ICU and surgical ward as places where the documentation form is used, showing the form's relevance across different hospital departments.

Highlights

Introduction to the documentation form used for tracking patient intake and output in hospitals.

Explanation of the 48-hour chart that records patient intake and output every 24 hours.

Details on the documentation of sperm count, patient's name, age, sex, and religion.

Mention of the registration number, ward, and unit where the patient is admitted.

Description of the medical and surgical wards, and the ICU where the patient might be.

Importance of noting the bed and room numbers for patient tracking.

Documentation of the patient's diagnosis and admission date.

Instructions on how to record intake and output timing and activities.

Recording vital signs such as temperature, pulse, respiration, and blood pressure.

Guidance on documenting the patient's condition and any special instructions.

Explanation of how to record the amount of intake provided to the patient.

Details on the types of intake methods such as oral, enema, intravenous, and intramuscular.

Recording the quantity of intake such as milk, water, and medication.

Instructions on documenting the patient's output, including urine, stool, and other fluids.

How to calculate and record the total intake and output balance for the patient.

The significance of this form in the ICU and surgical wards for patient health evaluation.

Encouragement for viewers to subscribe and comment for more information on the next video.