The Big Picture
Your body needs the right balance between fluid coming in and fluid going out. Too much or too little water in the body can cause serious harm.
Some clients need their fluids measured, increased, or restricted. Others cannot have anything by mouth. CCAs also need to follow specific steps when measuring fluids and when helping clients eat or drink.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- Intake means the amount of fluid taken into the body. Output means the amount of fluid lost from the body.
- Normal fluid balance means intake and output are equal.
- Special fluid orders may encourage fluids, restrict fluids, or require nothing by mouth.
- Intake and output measurements must be accurate and recorded.
- Follow the care plan when helping a client with food or fluids.
- Report changes in a client’s eating habits to your supervisor.
Jump to:
Course Notes: Key Ideas You Need to Know
Understanding Fluid Balance
Fluid balance means balancing the amount of fluid taken into the body with the amount lost.
| Term | Meaning |
|---|---|
| Intake | The amount of fluids taken into the body |
| Output | The amount of fluids lost from the body |
For normal fluid balance, intake and output must be equal. Too much or too little water in the body can cause harm and can even result in death.
When Intake and Output Are Not Equal
If fluid intake is greater than fluid output, body tissues can swell with water. This condition is called edema.
Edema is common in clients with heart and kidney diseases.
Dehydration means that the amount of water in body tissues has decreased. It occurs when fluid output is greater than fluid intake.
Common causes of dehydration include:
- low fluid intake
- vomiting
- diarrhea
- bleeding
- excessive sweating
- increased urine production
Normal Fluid Requirements
An adult needs 1,500 mL of water each day to survive.
About 2,000 to 2,500 mL of fluid each day is needed for normal fluid balance.
Water needs increase with:
- hot weather
- exercise
- fever
- illness
- excessive fluid loss
Minimum water needs also vary with age.
Fluid Needs of Infants and Young Children
Infants and young children have more body water than adults. Because of this, they need a higher fluid intake.
Excessive fluid loss can quickly cause death in infants and children.
Fluid Needs of Older Persons
Older persons are at risk for diseases that affect fluid balance. These include heart disease, kidney disease, cancer, and diabetes.
Many older people also take medications that cause the body to lose fluid or retain water. This places older persons at risk for both edema and dehydration.
Older persons may also have a decreased sense of thirst. Their bodies may need water even when they do not feel thirsty.
Some fluid lost through sweating or breathing out cannot be measured.
CCA action: Offer water to older clients at least every 1 to 2 hours.
Special Fluid Orders
A physician may specify how much fluid a client can have during a 24-hour period. Common fluid orders appear in the care plan.
Encourage Fluids
An order to encourage fluids means the client needs to drink more.
The order states the amount the client should take in and provides a variety of allowed fluids.
When this order applies:
- keep fluids within the client’s reach
- regularly offer fluids to clients who cannot feed themselves
- keep intake records
Restrict Fluids
A fluid restriction limits fluids to a specific amount.
When fluids are restricted:
- offer fluids in small amounts
- use small containers
- remove the water pitcher or keep it out of sight
- provide frequent oral hygiene
- keep intake records
Frequent oral hygiene helps keep the mucous membranes of the mouth moist.
Nothing by Mouth, NPO
NPO comes from the Latin term nil per os, which means nothing by mouth.
A client who is NPO cannot eat or drink anything.
Clients are usually NPO:
- before and after surgery
- before certain laboratory tests
- before certain X-ray procedures
- during treatment of certain illnesses
A client who receives tube feeding may also be NPO.
When a tube-fed client is NPO, an NPO sign is usually posted above the bed. The water pitcher and glass are removed.
Frequent oral hygiene remains important.
Safety: You must make sure an NPO client does not swallow any fluid.
Why Intake and Output Are Measured
Some clients need their daily fluid intake calculated to make sure they receive enough fluid.
Other clients have their daily fluid intake compared with their daily urinary output.
When ordered, the CCA keeps intake and output records, often called I&O records.
I&O records are used to:
- evaluate fluid balance
- evaluate kidney function
- help plan medical treatment
- monitor clients who have special fluid orders
Unequal intake and output amounts alert the health care team that interventions are needed to correct fluid balance.
Fluid intake also provides information about how the client’s heart and kidneys are performing. Accuracy is essential.
What Counts as Intake
Measure and record all fluids taken by mouth.
Examples include:
- water
- milk
- coffee
- tea
- juice
- soup
- soft drinks
Also count fluids given through intravenous (IV) therapy and tube feedings.
The fluid found in soft or semi-solid foods also counts. Examples include:
- ice cream
- sherbet
- custard
- pudding
- jelly
- popsicles
What Counts as Output
Measured output includes:
- urine
- vomitus
- diarrhea
- wound drainage
Measurements to Remember
Intake and output are measured in millilitres, mL, or cubic centimetres, cc. These measurements are equal in amount.
Remember these approximate measurements:
- 30 mL = 1 ounce
- 500 mL = about 1 pint
- 1,000 mL = about 1 quart
You also need to know the serving size of bowls, cups, glasses, and other containers. This information may appear on the I&O record or in the policy manual .
Equipment Used to Measure Fluids
A graduate is a container used to measure fluids.
It can measure:
- leftover fluids
- urine
- vomitus
- drainage from suction
A graduate has markings for millilitres or cubic centimetres and ounces.
Plastic urinals and kidney basins are also marked with measurements.
Recording I&O
Record each intake or output amount in the correct column on the I&O record.
At the end of the shift:
- Total the amounts.
- Record the totals on the client’s chart.
In facilities, staff also share the totals during end-of-shift reporting.
I&O recording monitors the client’s food intake or fluid balance. It also keeps the health care team informed and is required for legal reasons.
Involving the Client
Explain why intake and output are being measured and how the measurement may benefit the client’s well-being.
Some clients measure and record their own intake. Family members may sometimes help.
For measuring output, the client may use:
- a urinal
- a commode
- a bedpan
- a specimen pan
Remind the client:
- not to void in the toilet
- not to place toilet tissue in the container used for measurement
Follow medical asepsis and Standard Practices when measuring intake and output.
Supporting Quality of Life
When measuring intake and output, promote:
- dignity
- independence
- individualized care
- preferences
- privacy
- safety
Measuring Intake and Output: Pre-Procedure
Follow the steps in order.
- Identify the client according to employer policy. This prevents one client from being mistaken for another.
- Explain the procedure to the client.
- Perform hand hygiene.
- Collect the I&O record, graduate, and gloves.
- Provide privacy.
Measuring Intake
- Put on gloves.
- Measure intake:
- Pour the remaining liquid from the serving container into the graduate.
- Keep the graduate level and measure the amount at eye level.
- Check the consumed amount as recorded on the I&O record.
- Subtract the consumed amount from the full serving amount and record the intake amount.
- Repeat these steps for each liquid.
- Total the intake amounts for all liquids.
- Record the time and amount on the I&O record.
Measuring at eye level with the graduate kept level helps provide an accurate measurement.
Measuring Output
- Measure output:
- Pour the fluid into the graduate used for measuring output.
- Keep the graduate level and measure the amount at eye level.
- Dispose of the fluid in the toilet without splashing.
- Clean and rinse the graduate. Dispose of the rinse in the toilet and return the graduate to its proper place.
- Clean and rinse the bedpan, urinal, kidney basin, or other drainage container. Discard the rinse in the toilet and return the item to its proper place.
- Remove your gloves and perform hand hygiene.
- Record the amount on the I&O record.
- Remove the privacy measures.
After Measuring I&O
Report and record: Report and record your actions, observations, and basic assessments according to employer policy.
This information is reported and recorded for legal reasons and to keep the rest of the health care team informed.
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition uses the broad phrase “basic assessments.” In Nova Scotia, the current Continuing Care Assistant Occupational Standards of Practice uses the term observational point of care assessment (POC). The CCA observes the person and the care environment before, during, and after care to recognize changes that need to be escalated to a supervisor. The observations include the person’s diet and nutritional intake. (novascotiacca.ca)
A POC observational assessment is not a nursing assessment. It does not permit the CCA to complete a comprehensive evaluation used for clinical decision-making or care planning. (novascotiacca.ca)
Why this matters in Nova Scotia: A CCA observes and escalates changes within the care plan, but does not perform a nursing assessment.
Official source: Continuing Care Assistant Occupational Standards of Practice
Last checked: September 20, 2026
Feeding Safety
Check the care plan before helping a client with food or fluids.
An allergy is a sensitivity to a substance that causes the body to react with signs or symptoms.
Safety: Check the care plan for food or liquid allergies and intolerances.
Shopping and Meal Preparation
If you shop for a client’s food in a community setting, check the expiry date on everything you buy.
If you prepare a client’s meals:
- follow the client’s recipes
- do not substitute ingredients without the client’s permission
Helping a Client Eat
When assisting a client with eating, follow the care plan. Provincial or territorial legislation outlines the policy that the facility or agency needs to follow.
Clients with dysphagia have special dietary needs to avoid choking. Follow the care plan.
Report: Notify your supervisor about changes you observe in the client’s eating habits.
Nova Scotia CCA Note
Sorrentino tells the CCA to follow the care plan when assisting with eating. In Nova Scotia, the current Occupational Standards of Practice specifically includes mealtime assistance in CCA practice. The CCA provides feeding assistance according to the care plan and care-setting policies and procedures. The standards also include using adaptive feeding devices and applying strategies to prevent choking and other identified risks related to nutritional intake. (novascotiacca.ca)
The exact duties a CCA performs in a Nova Scotia workplace also depend on the employer’s scope of employment and employer policies. The employer must keep that scope within provincial requirements and the boundaries of regulated health professionals’ scopes of practice. (novascotiacca.ca)
Why this matters in Nova Scotia: Feeding assistance is part of current CCA practice, but the CCA must follow the care plan, workplace policies, and the duties approved for that employment setting.
Official source: Continuing Care Assistant Occupational Standards of Practice
Last checked: September 20, 2026
Exam Clue Words
- Must: An NPO client must not swallow any fluid during oral hygiene.
- Follow the care plan: Use the client’s care plan when assisting with eating and when a client has dysphagia.
- Report: Notify your supervisor when you observe changes in a client’s eating habits.
Fast Review
Use these points for a quick final review:
- Intake is fluid taken into the body. Output is fluid lost from the body.
- Normal fluid balance means intake equals output.
- Intake greater than output can lead to edema. Output greater than intake causes dehydration.
- Adults need 1,500 mL of water daily to survive and about 2,000 to 2,500 mL daily for normal fluid balance.
- Special fluid orders include encouraging fluids, restricting fluids, and NPO.
- NPO means nothing by mouth. The client cannot eat or drink anything.
- I&O includes oral fluids, IV fluids, tube feedings, fluid in certain soft foods, urine, vomitus, diarrhea, and wound drainage.
- I&O is measured in mL or cc, and these measurements are equal in amount.
- Remember 30 mL = 1 ounce, 500 mL = about 1 pint, and 1,000 mL = about 1 quart.
- Keep the graduate level and read the amount at eye level.
- Offer water to older clients at least every 1 to 2 hours.
- Check the care plan for food and liquid allergies or intolerances, follow the care plan when assisting with eating, and report changes in eating habits.
Final Pep Talk
This topic has several numbers, fluid orders, and ordered I&O steps to keep straight. Review them in small groups, then use the Fast Review to check the details that are easiest to mix up.