nursing management: lower gastrointestinal problems chapter 43 overview copyright © 2011, 2007 by...

Nursing Management:Lower Gastrointestinal ProblemsChapter 43 OverviewCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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DiarrheaEtiology and PathophysiologyClinical ManifestationsDiagnostic StudiesCollaborative CareCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management:Acute Infectious Diarrhea Nursing AssessmentNursing DiagnosesPlanningNursing Implementation



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Fecal Incontinence Etiology and PathophysiologyDiagnostic Studies and Collaborative Care



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Nursing Management:Fecal Incontinence Nursing AssessmentNursing DiagnosesPlanningNursing Implementation



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Constipation Etiology and PathophysiologyClinical ManifestationsDiagnostic Studies and Collaborative CareNutritional therapyCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management: Constipation Nursing AssessmentNursing DiagnosesPlanningCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management: Constipation Nursing ImplementationAcute interventionPreoperative carePostoperative careAmbulatory and home careEvaluation Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Acute Abdominal PainEtiology and Pathophysiology



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Acute Abdominal PainCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-9. Signs and symptoms of colorectal cancer by location of primary.


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Acute Abdominal PainCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-2. Etiology of acute abdominal pain and pathophysiologic sequelae.


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Acute Abdominal PainClinical ManifestationsDiagnostic Studies and Collaborative Care



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Nursing Management:Acute Abdominal PainNursing AssessmentNursing DiagnosesPlanningNursing ImplementationAcute interventionPreoperative carePostoperative careAmbulatory and home careEvaluationCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Chronic Abdominal PainCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Irritable Bowel Syndrome Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Abdominal Trauma Etiology and PathophysiologyClinical ManifestationsDiagnostic Studies Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing and Collaborative Management: Abdominal TraumaCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Inflammatory DisordersCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Appendicitis Etiology and PathophysiologyCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Appendicitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-1. In appendicitis the blood supply of the appendix is impaired by inflammation and bacterialinfection in the wall of the appendix, which may result in gangrene.


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Appendicitis Etiology and PathophysiologyClinical ManifestationsDiagnostic Studies and Collaborative CareCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management:Appendicitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Peritonitis Etiology and PathophysiologyClinical ManifestationsDiagnostic StudiesCollaborative Care



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Nursing Management:Peritonitis Nursing AssessmentNursing DiagnosesPlanningNursing Implementation



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Gastroenteritis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management:Gastroenteritis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Inflammatory Bowel DiseaseEtiology and Pathophysiology



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Inflammatory Bowel DiseaseCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-3. Comparison of distribution patterns of Crohns disease and ulcerative colitis, as well as different conformations of ulcers and wall thickenings.


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Inflammatory Bowel DiseaseClinical ManifestationsComplicationsDiagnostic Studies



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Inflammatory Bowel DiseaseCollaborative CareDrug therapySurgical therapy



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Inflammatory Bowel DiseaseCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Table 43-18. Indications for Surgical Therapy for Inflammatory Bowel Disease.


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Inflammatory Bowel DiseaseCollaborative Care, continued Surgical therapyTotal colectomy and ileoanal reservoirCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Inflammatory Bowel DiseaseCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-4. Ileoanal reservoir. A, Formation of a reservoir. B, Posterior suture lines completed. C, J-shaped configuration for ileoanal reservoir. D, S-shaped configuration for ileoanal reservoir.


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Inflammatory Bowel DiseaseCollaborative CareSurgical therapy, continuedTotal proctocolectomy with permanent ileostomyTotal proctocolectomy with continent ileostomyPostoperative careNutritional therapy



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Nursing Management:Inflammatory Bowel DiseaseNursing AssessmentNursing DiagnosesPlanningNursing ImplementationEvaluation



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Gerontologic Considerations:Inflammatory Bowel DiseaseCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Intestinal ObstructionTypes of Intestinal ObstructionMechanical



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Intestinal ObstructionCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-5. Bowel obstructions. A, Adhesions. B, Strangulated inguinal hernia. C, Ileocecal intussusception. D, Intussusception from polyps. E, Mesenteric occlusion. F, Neoplasm. G, Volvulus of the sigmoid colon.


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Intestinal ObstructionTypes of Intestinal Obstruction, continuedNonmechanicalEtiology and PathophysiologyClinical Manifestations



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Intestinal ObstructionCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Table 43-20. Clinical Manifestations of Small and Large Intestinal Obstructions.


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Intestinal ObstructionDiagnostic StudiesCollaborative Care



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Nursing Management:Intestinal ObstructionNursing AssessmentNursing DiagnosesPlanningNursing Implementation Care of nasogastric tubeCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Polyps of the Large Intestine Types of PolypsDiagnostic Studies and Collaborative Care Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Polyps of the Large Intestine Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-6. Endoscopic image of pedunculated polyp in descending colon.


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Colorectal CancerCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-7. Incidence of colorectal cancer. Approximately one half of all colon cancers occur in the rectosigmoid area. Percentages are listed for males (M) and females (F).


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Colorectal CancerEtiology and Pathophysiology Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Colorectal CancerCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Table 43-22. Risk Factors for Colorectal Cancer.


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Colorectal CancerCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-8. A, Carcinoma of the cecum. The fungating carcinoma projects into the lumen but has not caused obstruction. B, Carcinoma of the descending colon. This circumferential tumor has heaped-up edges and an ulcerated central portion. The arrows identify separate mucosal polyps.


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Colorectal CancerClinical Manifestations Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Colorectal CancerCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-9. Signs and symptoms of colorectal cancer by location of primary.


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Colorectal CancerDiagnostic Studies Collaborative CareCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Colorectal CancerCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Table 43-25. Classification System Used to Stage Colorectal Cancer.


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Colorectal CancerCollaborative Care, continued Surgical therapy Chemotherapy and biologic and targeted therapyRadiation therapy Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management: Colorectal CancerNursing AssessmentNursing DiagnosesPlanningNursing ImplementationHealth promotionAcute interventionPreoperative care Postoperative care Ambulatory and home careEvaluationCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Ostomy Surgery TypesCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Ostomy Surgery Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-10. Types of ostomies.


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Ostomy Surgery Types, continuedEnd stomaCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Ostomy Surgery Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-11. Sigmoid colostomy. Distal bowel is oversewn and left in place to create Hartmanns pouch.


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Ostomy Surgery Types, continuedLoop stomaCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Ostomy Surgery Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-12. Loop colostomy.


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Ostomy Surgery Types, continuedDouble-barrel stoma Kock pouch Ileoanal reservoir Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Nursing Management: Ostomy Surgery Preoperative CarePostoperative CareColostomy CareColostomy irrigationsIleostomy Care



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Nursing Management: Ostomy Surgery Adaptation to an OstomySexual Function After Ostomy Surgery



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Diverticulosis and Diverticulitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-13. Diverticula are outpouchings of the colon. When they become inflamed, the condition is diverticulitis. The inflammatory process can spread to the surrounding area in the intestine.


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Diverticulosis and Diverticulitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-14. In diverticular disease, the outpouches (arrows) of mucosa appear as slitlike openings from the mucosal surface of the open bowel.


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Diverticulosis and Diverticulitis Etiology and PathophysiologyClinical Manifestations and Complications



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Diverticulosis and Diverticulitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-15. Complications of diverticulitis.


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Diverticulosis and Diverticulitis Diagnostic Studies



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Nursing and Collaborative Management:Diverticulosis and Diverticulitis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Hernias Types



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Hernias Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-16. A, Types of hernias. Fig. 43-16. B, Indirect inguinal hernia.


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Hernias Clinical Manifestations



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Nursing and Collaborative Management: Hernias Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Malabsorption SyndromeCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Celiac DiseaseEtiology and PathophysiologyClinical ManifestationsDiagnostic Studies and Collaborative Care



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Lactase Deficiency Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Short Bowel Syndrome Clinical ManifestationsCollaborative Care



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Gastrointestinal Stromal Tumors GASTROINTESTINAL STROMAL TUMORSCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Anorectal Problems Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Hemorrhoids Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-17. Anatomic structures of the rectum and anus withexternal and internal hemorrhoids.


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Hemorrhoids Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-18. Thrombosed external hemorrhoids.


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Hemorrhoids Etiology and PathophysiologyClinical ManifestationsDiagnostic Studies and Collaborative Care



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Nursing Management:HemorrhoidsCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Anal FissureCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Anorectal AbscessCopyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Fig. 43-19. Common sites of anorectal abscesses and fistula formation.


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Anal Fistula Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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Pilonidal Sinus Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


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