The document is a checklist for measuring a patient's intake and output as part of a health assessment. It outlines 17 steps for properly measuring and recording a patient's oral intake of fluids, IV fluids, and output including urine and drainage. The nurse is to gather the necessary equipment, explain the procedure to the patient, observe infection control procedures, privately collect intake and output measurements, and accurately record the volumes on the patient's intake and output form and 24-hour record.

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Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
General Tinio, Cabanatuan City, Nueva Ecija
ClinicalLearningSkillsLaboratory
HEALTH ASSESSMENT (NCM 101)
CHECKLIST:
MEASURING INTAKE & OUTPUT
Name: ______________________________________________________________ Score:
Block: ________________________ Date:____________________________
PROCEDURE
Measuring Intake and Output
Performed Comments
YES NO
ASSESSMENT
1. Assess:
 Client’s ability to provide Subj and Obj data
 Color, odor, and consistency of the output
 Urinary or fecal incontinence
 Recent rectal incontinence
 Recent rectal or perineal surgery
 Indwelling catheter
2. Determine:
 Assistive devices that will be required
 Encumbrances to movement, such as an IV
 Medications the client is receiving, as certain
medications may alter the I & O
 Assistance required from other health care personnel
PLANNING
1. Assemble equipment and supplies:
 Assistive devices such as overhead trapeze
 Disposable Gloves (if necessary)
 Bedpan or urinals
 Toilet paper as required
 Graduated container
IMPLEMENTATION
1. Explain to the client what you are going to do, why it is
necessary, and how she can cooperate.
 All fluids taken orally must be recorded on client’s
intake and output form.
2. Wash hands and observe appropriate infection control
procedures.
3. Provide for client privacy.
4. Client must void into bedpan or urinal, not into toilet

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__________________________________________________
Student’sPrintedName and Signature
__________________________________________________
SkillsLaboratoryInstructor
PrintedName and Signature
Remarks:
_____________________________________________________________________________________________________________________________ _______
____________________________________________________________________________________________________________________________________
RatingScale:
Excellent : 96 – 100%
VerySatisfactory : 90 – 95%
VeryGood : 85 – 89%
Good : 80 – 84%
Fair : 75 – 79%
Poor : 74 andbelow
5. Toilet tissue should be disposed of in plastic-lined container,
not in bedpan.
6. Measure all oral fluids in accord with institution policy. Record
all IV fluids as they are infused.
7. Record time and amount of all intake and output in designated
space on bedside form (oral, tube feeding, IV Fluids).
8.  Transfer 8-houor total fluid intaketo graphic sheet on
24-hour I&O record on client’s chart.
9.  Record all fluid intake in appropriate column of 24-
hour record.
10.  Complete 24-hour intake record by adding all 8hour
totals.
11. Output
Apply nonsterile gloves. (If necessary)
12. Empty urinals, bedpan, or foley drainage bag into graduated
container or commode hat.
13.  Remove gloves. Wash hands/hand hygiene
14.  Record time and amount of output (urine, drainage
from nasogastric tube, drainage tube) on I&O record.
15. Transfer 8-hour output totals to graphic sheet or 24-hour I&O
record on client’s chart.
16. Complete 24-hour output record by totaling all 8-hour totals
17. Wash hands/hand hygiene
TOTAL: