Download - Toilet Training. Developmental Needs The urinary and intestinal systems need to be intact
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Toilet Training
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Developmental Needs
The urinary and intestinal systems need to be intact
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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
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Physical and Health Impairments
Cerebral palsy Spina Bifida or spinal cord injury Congenital abnormalities Duchene muscular dystrophy
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Prerequisites for Toileting
Stability in pattern of elimination Daily 1- to 2-hour periods of dryness A chronological age of 2 years or
older
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“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
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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
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Stages of Toilet Training
Regulated Toileting Self-initiated Toileting Toileting Independence
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Assistive Devices for Toileting
Stand alone toilets Devices that fit over toilets Risers Pads and supports
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Assistive Strategies
Environmental Arrangement
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Assistive Strategies
Environmental Arrangement Transfers
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Assistive Strategies
Environmental Arrangement Transfers Positioning
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Assistive Strategies
Environmental Arrangement Transfers Positioning Abdominal Massage
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Assistive Strategies
Environmental Arrangement Transfers Positioning Abdominal Massage Medication
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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
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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
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Trip Training methods
Pretraining data Setting the schedule Instruction Bowel Training
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Toileting Problems Urinary tract infections Constipation Impaction Diarrhea Over hydration Intestinal parasites Skin breakdown Pica and Fecal smearing
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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
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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
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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
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Laxative Contraindictions
Nausea Cramps Colic Vomiting Undiagnosed abdominal pain
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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
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Signs of fecal impaction
Passage of liquid stool (seepage) Desire to defecate but unable Rectal pain Distended abdomen Anorexia Nausea/vomiting
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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
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Causes of diarrhea
Stress, anxiety Medications Allergy Food intolerance Disease surgery
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Bowel incontinence
Loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter
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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
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Management issues
Individualized Health Plan Augmentative Communication Diet Activity Level Gender of personnel helping student Training in inclusive settings
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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
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Problems and emergencies
Infection Inability to pass the catheter Omission of catheterization No urine Urine between catheterization Soreness, swelling, discharge Bleeding
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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
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Ostomies and Colostomies
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Colostomies and other ostomies
Ostomy: artificial opening Three types
Ostomies of the urinary system Ostomies of the small intestine Ostomies of the large intestine
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Equipment
Colostomy bags Iliostomy bags Ureterostomy bags Skin barrier
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Strategies
Emptying bags Changing bags
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Problems and emergencies
Gas and odor Leakage Skin problems around stoma Bleeding from stoma Diarrhea or vomiting Obstruction Change in stoma appearance