Nurse Jeremy is evaluating a client’s fluid intake and output record. Fluid intake and urine output should relate in which way?
A. Fluid intake should double the urine output.
B. Fluid intake should be approximately equal to the urine output.
C. Fluid intake should be half the urine output.
D. Fluid intake should be inversely proportional to the urine output.
Correct Answer: B. Fluid intake should be approximately equal to the urine output.
Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient’s fluid differs depending on each patient’s clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.
Option A: Fluid intake that is double the urine output indicates fluid retention. Monitor for peripheral edema, pulmonary edema, or hepatomegaly. It is important to consider underlying cardiac dysfunction or renal failure and adjust volumes of administration accordingly. These patients might require a lower maintenance fluid rate than expected for their body weight.
Option C: Fluid intake that is half the urine output indicates dehydration. A drop of at least 20 mm Hg systolic blood pressure or 10 mm Hg diastolic blood pressure within 2 to 5 minutes of quiet standing after 5 minutes of supine rest indicates orthostatic hypotension. Dehydrated or elderly patients who have lost sensitivity in their baroreceptors in their blood vessels might display these findings.
Option D: Normally, fluid intake isn’t inversely proportional to the urine output. One can see weight gain in states of fluid excess and weight loss in states of fluid deficit. It is also helpful to look at patient records to see any recent outpatient visits before hospitalization, which might indicate a patient’s normal baseline weight.