Incontinence

valeriecathleen · Feb 10, 2010

Yes, but she is also tube fed every 2-1/2 hours so her diaper is changed before feedings.

What is her family doing at home?

mustlovepoodles, RN · Feb 10, 2010

I have a 14yo son who is profoundly mentally handicapped. He wears diapers, so I'll tell you how they do it at school. Christian is in a self-contained class and is trip-trained; the school nurse is NEVER involved in his diaper changes.His parapro is responsible for toileting him. He is ambulatory so they take him to the bathroom every 2 hours, unless he's going through a bad patch and then then take him every 90 minutes. He makes a BM at the same times of day so it is highly unusual for him to have a BM accident. Urine accidents are fairly frequent. If he wets his Depends they have a private corner in the room with a hip high clinic-type table that they can change diapers on and sanitize between kids . We send Depends, wipes, butt cream and lots of extra clothes to school periodically. It is sooooo not a big deal.

School policy is that any child who has diarrhea twice in a day has to go home. Christian rarely has an upset stomach, but he has been sent home a time or two merely for diarrhea( which I don't dispute--who wants to have a PMR kid walking around with runny stools?) The school nurse is a resource in situations like this, not to change diapers but to assess the child and contact parents. (Cutting out his milk cured the diarrhea)

ETA: There are 4 other kids in his class who are in wheelchairs. These kids are also trip-trained and they use the handicapped stall in the restroom. It sometimes takes two people to get them on the potty, but once they're there they'll "make."

hobiehobie · Feb 11, 2010

This student has a 1x1 that has first aid and CPR training, but no medical training. We use a hoyer lift to get her out of the chair, onto the changing table. The 1x1 does the changes, I spot while she is lifted and lowered.

BettyGirard, BSN · Feb 15, 2010

Fortunately, most of those with toilet issues in our school are handled by the special ed parapros (attendants/assistants), they have a changing area complete with shower table down in their area.

I've got a couple of mainstream kids in wheelchairs, one who just prefers to use my bathroom and one who is diapered.

Both do OK without assistance, so I guess I'm lucky. I've also got a few ambulatory incontinents this year who also use my area for changes. Keep their supplies in a cabinet near by.

hobiehobie · Feb 15, 2010

Does the student who is wheelchair bound and diapered have a 1x1? How often are they brought down to be changed and do you assist the 1x1? If not how does the 1x1 change the student? On a table? How does the 1x1 transfer the student?

BettyGirard, BSN · Feb 17, 2010

No, both the students I were referring to are pretty high functioning. As long as it's only a urinary (which it usually is), she's pretty adept at doing the change herself. I'll usually get her stuff out for her when I see her coming just to cut down on the time lost, but let her have her privacy. She'll ask for help on a more messy situation. She had an indwelling last year, but switched this year.

We've got other ones that are more impaired, but as I said the special ed para's take care of most of those without involving me. Since we're in high school some of these kids are pretty large, but some of the paras are really strong. The attendant pretty much has his schedule worked out with the teacher for all the kids he is responsible for. Some are strictly diaper changes, and some are getting them onto the toilet on a timed basis. I'm not too involved in that other than helping set up the plan at the beginning of the year (or when the situation changes).

The two non-wheelchair ones were new to me this year. Showed up at the beginning of the year. One's a mainstreamed pretty high functioning cerebral palsy kid (I can see a hint of a limp as well, but he'd fool most people). The other I'm not exactly sure why he's in diapers. The parents are pretty cagey when I pressed them.