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What is the impact of continence problems at school?

Daytime continence problems can have a significant impact on self-esteem, wellbeing and socialisation, as well as learning for the children affected. School staff are not health trained and many do not understand that children can have a medical problem affecting their bladder and/or bowel and are often at a loss to know how to help.

Many adults do not appreciate that children, particularly younger ones may not be aware that they are wet or have soiled and may assume that the child has a behavioural problem. Rules around access to the toilet and drinks can adversely affect all children, but tend to have a disproportionate impact on those with continence difficulties and disabilities.

The role of the healthcare professional
This leads to the question of what can healthcare professionals working with children and young people do to support. The impact of transfer of school nursing and health visiting to a public health role with constraints of commissioning and budgetary restrictions seems to be increasing, but the problem cannot be ignored. There are some simple and fairly quick measures that can be put into place, which are likely to have positive effects:
Health nurses can discuss timely toilet training and explain issues around bladder and bowel health with families at developmental checks. They can signpost to appropriate sources of information, such as those on our website and alert families to early signs of constipation and how to address these.

School nurses can be alert to signs of continence problems at school entry, provide first line advice and refer on if necessary. They can explain continence problems to school staff, ensuring that they understand that inadequate or dirty toilets, which provide poor levels of privacy and where poor student behaviour is unchecked, can discourage students from using them. This may result in pupils avoiding drinking and withholding urine and faeces during the school day.

Schools should be encouraged to consider their policies with respect to access to water bottles and toilets during the day. Staff may also need explanations of normal fluid intake in school age children and to be reminded of the educational and health benefits of children being reminded and encouraged to drink regularly throughout the school day.

Sick Day Medication Dosing For Diabetes

During intercurrent illness, the risk of an adverse drug event could be increased by ongoing use of some medicines. They may cause harm with either continued use or abrupt cessation during illness. Factors to consider for dose adjustment include the type of medicine, formulation and pharmacokinetics, duration of illness and comorbidities.

Patients able to self-manage their diabetes medicines should be provided with a management plan for use during sick days. Patients who are not monitoring their own glucose should be advised to see their doctor when becoming ill.

An understanding of pharmacokinetic factors associated with significant illness (sick days) can be useful to predict and manage patients at most risk. Changes in drug absorption, distribution, metabolism and excretion are well documented in critically ill patients. Unfortunately, there are less data to guide the prescribing of regular medicines in less severe illness.

When the illness is short-lived and relatively minor, changes in physiology and pharmacokinetics are unlikely to be a problem for most medicines and in most patients. However, there are exceptions when patient advice about dose adjustment and monitoring for adverse outcomes may be necessary.

Patients able to self-manage their diabetes medicines should be provided with a management plan for use during sick days. Patients who are not monitoring their own glucose should be advised to see their doctor when becoming ill.

Fact & Fiction About Registered Nurses

Fiction: Nurses are assistants to doctors
Fact: We are actually equal partners in health care, each with a separate and unique yet vital role. One is not an elevated version of the other. Nurses work to keep you healthy and well, helping you to heal when necessary, providing you comfort and care, supporting you at the end of your life, and bringing new life into the world.
Fiction: Most nurses work in hospitals.
Fact: Only about half of all nurses work in hospitals. The rest work in varied settings such as public health, schools, corporations, pharmaceutical companies, wellness centres, law firms, law-enforcement agencies and government agencies, just to name a few. Nurses also work doing health research, setting health-care policy, running not-for-profit and government health agencies, as health care facility administrators, and managing technology and patient-care data.
Fiction: Doctors are the only experts in health care.
Fact: Nurses are health-care experts in their own right. Much of their work involves health teaching to patients and family members. Examples include: Teaching an adolescent (and his/her family) who is newly diagnosed with diabetes how to monitor blood sugar, inject themselves with insulin, prevent complications and so on; working closely with a man who has recently had a heart attack to prepare him for the physical and emotional challenges of his medical condition while returning home and continuing his recovery and rehabilitation; instructing first-time parents how to care for their newborn; providing grief counselling and support to family members of loved ones who are dying or have passed away. These are just a few examples.
Nurses also have expertise in wound care, minimizing the risk of infections, avoiding and treating skin ulcers, managing continence, managing chronic illness, maintaining and attaining health and well-being, providing comfort care and counselling.

How Many Calories do you Really Need?

In a dream world, wine wouldn’t have calories, chocolate would count as a vegetable, and you could eat what you want, while maintaining a healthy weight. Unfortunately, the reality is that calories add up quickly, and when you’re constantly bombarded with cues to eat, it can seem like the world is sabotaging your efforts. But understanding how many calories you really need, and learning to spot where they’re coming from, is the first step toward achieving a healthy weight.

How to Cut Calories to Lose Weight
When it comes to weight loss, what you eat is more important than how much you exercise. Tracking calories is still the best way to get to know your numbers. Of course, nobody enjoys the tedium of recording every sip and morsel! But you’ll identify patterns and habits that may be holding you back from your weight loss goals, quickly spotting those excess calories from, weekly happy hours, daily sweets, and pre-dinner crackers and cheese.
Try the food logging feature in the Fitbit app for at least three days (including one weekend day) to get a sense of how many calories you’re typically eating. Then come up with a new “calories in” goal to meet your weight goal. As a general rule that should be 500 to 750 calories less than the average you logged for those first three days, but pick a reasonable number that you can stick to. Continue to log your food for a few weeks so you can track how closely you’re coming to your new calorie goal. When it comes to weight loss, consistently eating roughly the same amount of calories is key.

Case Management & the Registered Nurse

Case management nurses are registered nurses who coordinate all aspects of care of individual patients. They ensure proper utilization of services and resources and provide assistance within, between, and outside of facilities.

Nurses working in case management facilitate outstanding patient care using fiscally responsible strategies, and are experts at being resourceful. Case managers work with patients, families and other professionals.

Sheehan Health can assist with case management needs of NDIS participants we are savvy communicators, well organized, and creative.

Care Plans

There are many different kinds of care plans in use across community health care, each of them has the same three purposes:
• to ensure that the participant gets the same care regardless of who is providing the care
• to ensure that the care given is recorded accurately & communicated
• to support the participant to identify & manage their condition
Some plans are very simple and focus on the essentials of care – nutrition, mobility, sleeping, oral care and personal hygiene; while others can be very detailed and might include conditions like management of, diabetes, epilepsy, falls prevention, psychological needs, recording of clinical signs.

Sheehan Health can assist with care plan management, contact us on sheehanheatlh.com.au

Case Management & NDIS

Case management, is another community-based clinical role, it can be a long-term relationship, sometimes lasting several years. In this problem-solving and monitoring role, the nurse consultant handles client assessment, care planning, service coordination, and referrals.

We see participants in the home setting, which offers more control and choice over health behaviour’s in relation to the plan of care. We can assist with managing your health care needs related to your disability.

Epilepsy & the NDIS

The NDIS will support the development of an:
Epilepsy Management Plan, to improve the knowledge, skills and confidence of people providing informal and formal supports for a participant. This allows a better understanding of the type of epilepsy a participant has, their triggers, what it looks like before, during and after seizures and how to keep the participant safe.

Epilepsy Emergency Management Plan, this is relevant to participants who require an emergency administration of medications.

Training for family, carers or other people supporting the participant.

Dark Chocolate May Reduce the Risk of Depression

People who eat dark chocolate are less likely to experience symptoms of depression, according to a new study published in the journal of Depression & Anxiety. People with diabetes are twice as likely to have depression as those without.

Dark chocolate has been found to be associated with health benefits such as improved blood vessel health, lower blood pressure, and a reduced risk of type 2 diabetes. To examine the effects of this food on depression data was reviewed from the American National Health and Nutrition Examination Survey from more than 13,000 adults.

Of all the subjects surveyed, 11% reported eating any type of chocolate and 1.4% reported eating dark chocolate. The researchers found that those who ate dark chocolate had significantly lower odds of clinical symptoms of depression compared to those who ate non-dark chocolate.

These results are in line with the majority of experimental studies, which have shown benefit of chocolate consumption for mood, at least in the short-term.

Establishing Good Sleep Hygiene

Sleep problems are very common, reportedly as high as 80% in children with ASD. In typically developing children sleep problems and insufficient sleep can result in daytime sleepiness, learning problems and behavioral issues such as hyperactivity, inattentiveness and aggression. Recent research in children with ASD demonstrates that poor sleepers exhibit more problematic behavior than good sleepers.

Establishing good sleep hygiene by addressing the following domains is a good first step.

Sleep environment: the bedroom should be dark, quiet and cool. As children with ASD might be particularly sensitive to noises and/or have sensory issues, the environment should be adapted to make sure your child is as comfortable as possible.

Bedtime routine: the routine should be predictable, relatively short (20 – 30 minutes) and include relaxing activities such as reading or listening to quiet music. Avoid the use of electronics close to bedtime such as TV, computer, video games etc. that can be stimulating making it difficult for your child to fall asleep.

Sleep\wake schedule: the schedule should be regular with not much of a difference between the weekday and weekend schedule.

Teach your child to fall asleep alone: It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.

Exercise: Daytime exercise can make it easier to fall asleep and children who exercise tend to have deeper sleep.

Avoid allowing your child to exercise too close to bedtime as it can make it difficult for him to fall asleep.
Avoid caffeine particularly close to bedtime, which can be alerting making it difficult for your child to fall asleep. Caffeine is found not only in coffee, but also in tea, chocolate and some sodas.

Naps are helpful for preschool children, but should not be taken late in the afternoon as they can interfere with bedtime.

It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, he may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioural or pharmacological treatment to improve their sleep.

In summary, although sleep problems are common in children with ASD they often can be helped. Better sleep for these children can potentially improve their daytime functioning as well as the sleep of family members.