The first responsibility is to make sure there is a clear understanding of all orders regarding positioning, fluid intake, diet restriction, weight monitoring, vital signs schedule, and activity. The nursing assistant may be asked to strain the urine for particles, assist with urination, or collect urine samples.
Knowing how to limit fluid is also very important. Most adults take in 2 1/2 to 3 quarts of fluid a day (Hegnar & Acello, 2014). This would be approximately 600 to 800 mL of fluid in an eight-hour shift. However, there is typically more fluid intake in the a.m. Be sure to examine the patient for edema and dehydration. Output of fluid consists of urine, sweat, exhalation from the lungs, and bowel movements. However, be sure to include any diarrhea, vomit or blood loss. A normal adult loses approximately 2 1/2 quarts a day of fluid (Hegnar & Acello, 2014).
There may be an order to monitor and record input and output for the patient. Measuring is typically done in liters or milliliters. A container or graduate is usually provided for this. It is helpful to know how many ounces are in the milliliters. For example, 8 ounces equals 240 mL, 16 ounces equals 480 mL, and 4 ounces equals 120 mL (Hegnar & Acello, 2014). If the patient has an IV or gastric tube, it is recorded separately. If the patient is incontinent, weighing the briefs or sheets can give an estimated output. If the output of urine falls below 30 mL in an hour, it is important to notify the nurse immediately (Hegnar & Acello, 2014).
Vital signs, particularly blood pressure should be taken daily. Blood pressure should be taken in the supine, sitting, and standing positions. Additionally, daily weights are also important to measure if the patient is retaining fluid. Weights should be obtained the same time every day for accuracy. If the weight increases or decreases by 2%, be sure to inform the nurse immediately (Hegnar & Acello, 2014).
It will also be important to monitor the patient’s intake of fluids or food as well as monitoring for any signs of confusion, dehydration, or incontinence. If the patient is bedridden, prevention of pressure ulcers and range of motion may be ordered. Measures to prevent itching such as bath oils, lotions or creams can be used on dry skin. Frequent oral hygiene should also be performed as dry mouth can occur (Hegnar & Acello, 2014). Providing frequent rest periods and emotional support is also important.
Additionally, foods provided should be low in protein, potassium, and sodium (National Kidney Foundation, 2016). Protein can build up and cause more waste in the bloodstream. Sources of protein are typically from animal and plants. Examples our eggs, beans, fish, and chicken. Sodium can cause fluid buildup and should be monitored carefully (National Kidney Foundation, 2016). Observe for signs of edema and high blood pressure (Hegnar & Acello, 2014). Sources of sodium are salt, tenderizers, steak sauce or barbecue sauce. Other sources are crackers, nuts, bacon, and most processed foods or lunchmeat. Instead, suggest the patient use of fresh onion, garlic, lemon juice, salt-free or low sodium salts. Foods high in potassium can affect the heart and muscles (National Kidney Foundation, 2016). These foods include squash, artichoke, bananas, cantaloupe, oranges, black beans, carrots, and chocolate. Instead, suggest apples, blueberries, grape, strawberries, cucumbers, lettuce, rice noodles, or eggplant.