Post on 24-Dec-2015
Toilet Training
Developmental Needs
The urinary and intestinal systems need to be intact
Functions of the Kidney
Control of sodium balance Controls chloride balance Controls water balance Controls potassium balance Excretes organic acids Conserves bicarbonates Excretes waste products
Physical and Health Impairments
Cerebral palsy Spina Bifida or spinal cord injury Congenital abnormalities Duchene muscular dystrophy
Prerequisites for Toileting
Stability in pattern of elimination Daily 1- to 2-hour periods of dryness A chronological age of 2 years or
older
“Bladder training” Void on a time table Regulate fluid intake Encourage fluids about ½ hr prior to voiding Avoid excessive intake of citrus juices,
carbonated, artificially sweetened, or caffeine beverages
Schedule diuretics in morning Avoid using diapers Provide positive reinforcement
Approaches for Toileting
Traditional methods: rely on toileting students when they are likely to experience bowel or bladder tension
Rapid methods: require students to consume extra fluids, creating more frequent bladder tension and thus additional opportunities for toileting
Stages of Toilet Training
Regulated Toileting Self-initiated Toileting Toileting Independence
Assistive Devices for Toileting
Stand alone toilets Devices that fit over toilets Risers Pads and supports
Assistive Strategies
Environmental Arrangement
Assistive Strategies
Environmental Arrangement Transfers
Assistive Strategies
Environmental Arrangement Transfers Positioning
Assistive Strategies
Environmental Arrangement Transfers Positioning Abdominal Massage
Assistive Strategies
Environmental Arrangement Transfers Positioning Abdominal Massage Medication
Principles for Toilet Training Familiarize the student with the toilet Associate toileting activities with the
bathroom Establish times to use the bathroom Determine whether a boy should sit or
stand to urinate Reinforcing success Teach child to perceive feelings of fullness Teach proper hygiene
Trip Training Method (Azrin & Foxx)
Positive reinforcement Positive practice to inhibit
inappropriate toileting behavior Immediate feedback for inappropriate
urination Increase in quantities of liquids Scheduling
Trip Training methods
Pretraining data Setting the schedule Instruction Bowel Training
Toileting Problems Urinary tract infections Constipation Impaction Diarrhea Over hydration Intestinal parasites Skin breakdown Pica and Fecal smearing
Constipation
Fewer than 3 bowel movements/week Small, dry, hard stool, no stool Slow movement through GI tract
allowing for reabsorption of fluid Straining, pain, cramps, decreased
appetite, headache Must identify regular elimination
pattern
Causes of constipation Insufficient fiber and fluid intake Immobility or inactivity Irregular defecation habits Change in routine, emotional
disturbance Lack of privacy Chronic use of laxatives medications
Types of Laxatives Bulk-forming: increase bulk in intestines Emollient/stool softener: delays drying,
allows fat and water penetration of feces Stimulant/irritant: irritates mucosa or nerve
endings to induce propulsion Lubricant Saline/osmotic: draws water into intestine
to stimulate peristalsis
Laxative Contraindictions
Nausea Cramps Colic Vomiting Undiagnosed abdominal pain
Fecal Impaction
A mass or collection of hardened, puttylike feces in the rectal folds
Results from prolonged retention and accumulation of fecal material
Oil retention enema, cleansing enema, suppositories, softeners
Last resort: manual removal
Signs of fecal impaction
Passage of liquid stool (seepage) Desire to defecate but unable Rectal pain Distended abdomen Anorexia Nausea/vomiting
Diarrhea
Passage of liquid stools with increased frequency
Rapid movement through the GI tract Spasmodic cramps, increased bowl
sounds, mucus, nausea, vomiting, irritation of rectal area, fatigue, weakness, malaise
Causes of diarrhea
Stress, anxiety Medications Allergy Food intolerance Disease surgery
Bowel incontinence
Loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter
Flatulence Presence of excessive flatus in the
intestines and inflation of the intestines Abdominal distension Causes: bacterial action, swallowed air, and
gas diffusion from the blood stream Foods surgery, narcotics can cause
flatulence Treatment: antiflatulent agent such as
antacids
Management issues
Individualized Health Plan Augmentative Communication Diet Activity Level Gender of personnel helping student Training in inclusive settings
Urinary Catheterization/Devices
Process of inserting a tube into the bladder to eliminate urine
Sterile Catheter CIC: long, thin tube is inserted
through the urethra and into the bladder on an intermittent basis
Problems and emergencies
Infection Inability to pass the catheter Omission of catheterization No urine Urine between catheterization Soreness, swelling, discharge Bleeding
Credé
Manual compression of the bladder Used with individuals with decreased
bladder tone who have decreased outlet resistance
Prescribed by a physician No equipment. However, a folded towel
may be used. Used in conjunction with CIC
Ostomies and Colostomies
Colostomies and other ostomies
Ostomy: artificial opening Three types
Ostomies of the urinary system Ostomies of the small intestine Ostomies of the large intestine
Equipment
Colostomy bags Iliostomy bags Ureterostomy bags Skin barrier
Strategies
Emptying bags Changing bags
Problems and emergencies
Gas and odor Leakage Skin problems around stoma Bleeding from stoma Diarrhea or vomiting Obstruction Change in stoma appearance