Final answer:
The total fluid balance for the patient on this shift is 1,645 mL.
Step-by-step explanation:
To calculate the total fluid balance for the patient on this shift, we need to calculate the input and output. The patient received TPN (total parenteral nutrition) at a rate of 100 mL/hr for the whole shift except for the hour when the patient received PCN (penicillin) intravenously. So, the TPN input would be 100 mL/hr multiplied by the number of hours the patient was on TPN (0700-1000 and 1100-1900, which is 11 hours). This gives us a total TPN input of 1,100 mL.
The patient also had 8 oz of coffee at 0900, which is equivalent to approximately 240 mL. In addition, the patient had 6 oz of ice cream at 1400, which is equivalent to approximately 180 mL. These two inputs should be added to the total fluid balance.
For the output, the patient had 250 mL of output from emptying the osteomy bag at 1600, 375 mL of urine at 0800, and 150 mL of urine at 1500. These three outputs should be added to the total fluid balance.
The TPN order was changed at 1200 from 100 mL/hr to 150 mL/hr. To calculate the additional TPN input during this time, we need to subtract the hour during which TPN was held for the PCN administration. So, there are 6 hours (1200-1300 and 1400-1900) when the patient was on the increased TPN rate. Multiplying 150 mL/hr by 6 hours gives us an additional TPN input of 900 mL.
Thus, to calculate the total fluid balance, we add up the TPN input (1,100 mL) with coffee input (240 mL), ice cream input (180 mL), and the additional TPN input (900 mL), which gives us a total input of 2,420 mL. We also add up the outputs (250 mL osteomy output, 375 mL urine at 0800, and 150 mL urine at 1500), which gives us a total output of 775 mL. Finally, to find the total fluid balance, we subtract the total output from the total input: 2,420 mL - 775 mL = 1,645 mL.