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Mortality: Deaths associated with os to mies appear to be or complications from cancer (Gutman, 2011; Dorman, low (between 0. Colos to my may be performed at several locations: the versus penetrating trauma or cancer) and comorbidities ascending, transverse, descending, or sigmoid colon. Transverse colos to my is positioned in the mid- to -right (small intestines) (Everhart, 2008). Colon: Part of the intestine that s to res digested food and absorbs Appliance: Formal term for an os to my pouch or os to my bag. Also referred to as the large intestine or the large Colec to my: Surgical removal of the colon (also known as the bowel. Irrigation: Enema that is brought through the s to ma, used by Rectum: Lowest portion of the large intestine. Skin barrier: Solid square or round piece of adhesive material Os to my: Umbrella term that refers to the surgically created open that is used to protect the skin from s to ol. Types of os Stenosis: Narrowing or tightness of the s to ma, which may cause to mies for fecal diversion include colos to my and ileos to my. Peristalsis: Progressive waves of motion, which occur without S to ma: Opening at the end of the colon or ileum; this is brought voluntary control, to push contents through the intestine. S to mas may protrude above Pouching system: Device worn over the s to ma, which acts as a skin level (preferable), be flush at skin level, or retracted reservoir for the s to ol that empties out of the s to ma. Pouch below skin level (may be a complication) (Dorman, 2011; ing systems are made of two primary components: a wafer Butler, 2009). Care Settings Related Concerns Care is handled in an inpatient acute care surgical unit. Procedure, prognosis, therapeutic regimen, and potential needs, potential complications, and community resources. Demonstrate behaviors or techniques to promote healing and/or prevent skin breakdown. Note: An early pos to pera tive complication (possibly within 24 hours) is s to ma ischemia or necrosis due to vascular insufficiency with sub sequent retraction and stenosis, with potential early surgical revision (Borwell, 2011; Butler, 2009). Ulcerated areas on s to ma may be from a pouch opening that is to o small or a faceplate that cuts in to s to ma. In clients with an ileos to my, the effluent is rich in enzymes, increasing the likelihood of skin excoriation. Use soap only if area is Maintaining a clean and dry area helps prevent skin breakdown covered with sticky s to ol. Measure both width and size of the opening in the skin barrier of the appliance must length of s to ma.
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Encourage light activities initially, Client can expect to feel tired when she goes home and needs with frequent rest periods, increasing activities and exercise to plan a gradual resumption of activities, with return to as to lerated. Identify individual restrictions, such as avoiding heavy lifting Strenuous activity intensifies fatigue and may delay healing. Avoid tub baths and surgical repairs, and prolonged sitting potentiates risk of douching until physician authorizes. Showers are permitted, but tub baths and douching may cause vaginal or incisional infections and are a safety hazard. Discuss dietary modifications, medicinal bulk agents, and Postsurgical bowel dysfunction may be short-term or long stimulation by supposi to ry, as indicated. Identify dietary needs, such as high-quality protein, complex Facilitates healing and tissue regeneration, helps correct anemia carbohydrates, and additional iron. Note: Certain vegetables, such as broccoli, cab foods to include and avoid in managing menopausal bage, cauliflower, brussels sprouts, and turnips, may have symp to ms. Some foods and substances to avoid or limit include rich dairy prod ucts, sugar, fried foods, caffeine, alcohol, and nicotine. This would seem to support the reason that most physicians continue to support the use of hormone re placement therapy, especially in younger women who have surgically induced menopause. Encourage taking prescribed drug(s) routinely, for example, Establishes routine for taking drug and reduces potential for with meals or at bedtime. Determine when patch should be discontinuing drug because of nausea that is often an early changed, wearing time altered. Discuss potential side effects, such as weight gain, increased Development of some side effects is expected but may require skin pigmentation or acne, breast tenderness, headaches, problem-solving for the client to continue the hormones, and pho to sensitivity. Recommend cessation of smoking, especially when receiving Some studies suggest an increased risk of thrombophlebitis, estrogen therapy. These substances are numer bioflavonoids, calcium, magnesium, selenium, evening ous and available and have been the object of media primrose oil, black cohosh, angelica, and wild yam. Provides opportunity to ask questions, clear up misunderstand ings, and detect developing complications. Note: Client needs to discuss with the physician her particular require ments for follow-up pelvic exams with Pap smear, once sur gical healing has occurred. Identify signs and symp to ms requiring medical evaluation, Early recognition and treatment of developing complications, such as fever or chills, change in character of vaginal or such as infection or hemorrhage, may prevent life-threaten wound drainage, and bright red bleeding. May desire additional information or opportunity to discuss feelings or concerns with women with similar experiences.
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Evaluate functional impairment and quality of life collaborate with the patient (and if possible, the family) to Major depressive disorder can alter functioning in numer minimize the impact of these potential barriers [I]. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 17 of complications or a full-blown episode of major depres to patients who do not respond to other treatments [I], sion [I]. Patients should also be to ld about the need to given the necessity for dietary restrictions with these med taper antidepressants, rather than discontinuing them ications and the potential for deleterious drug-drug inter precipi to usly, to minimize the risk of withdrawal symp actions. Selection of an initial treatment mo tion with treatment, availability of social supports, and the dality should be influenced by clinical features. If antidepressant side effects do occur, an initial or psychosocial stressors) as well as other fac to rs. Because the effectiveness of anti individuals with major depressive disorder who have asso depressant medications is generally comparable between ciated psychotic or cata to nic features [I], for those with an classes and within classes of medications, the initial selec urgent need for response. As with patients who are receiving phar also important to assess the quality of the therapeutic al macotherapy, patients receiving psychotherapy should be liance and treatment adherence [I]. For patients in psy carefully and systematically moni to red on a regular basis to chotherapy, additional fac to rs to be assessed include the assess their response to treatment and assess patient safety frequency of sessions and whether the specific approach [I]. Marital and tient continues to show minimal or no improvement in family problems are common in the course of major de symp to ms, the psychiatrist should conduct another thor pressive disorder, and such problems should be identified ough review of possible contribu to ry fac to rs and make ad and addressed, using marital or family therapy when indi ditional changes in the treatment plan [I]. In patients capable of adhering to dietary and medica ment after completing the continuation phase [I]. Continuation phase a depression-focused psychotherapy has been used during During the continuation phase of treatment, the patient the acute and continuation phases of treatment, mainte should be carefully moni to red for signs of possible relapse nance treatment should be considered, with a reduced [I]. To prevent a relapse of Due to the risk of recurrence, patients should be mon depression in the continuation phase, depression-focused i to red systematically and at regular intervals during the psychotherapy is recommended [I], with the best evidence maintenance phase [I]. Ben continuing antidepressants or reducing antidepressant zodiazepines may be used adjunctively in individuals with doses. Demographic and psychosocial fac to rs patient alliance, the availability and adequacy of social sup Several aspects of assessment and treatment differ be ports, access to and lethality of suicide means, the presence tween women and men. When patients exhibit cognitive medications to women who are taking oral contraceptives, dysfunction during a major depressive episode, they may the potential effects of drug-drug interactions must be have an increased likelihood of future dementia, making it considered [I]. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 21 available treatment options for the patient and the fetus [I]. Issues relating to the family situation and family his For women who are currently receiving treatment for de to ry, including mood disorders and suicide, can also affect pression, a pregnancy should be planned, whenever pos treatment planning and are an important element of the sible, in consultation with the treating psychiatrist, who initial evaluation [I]. In women who are pregnant, planning to become to possible signs of bipolar illness in the patient. Family his to ry of a response therapy, or for those with a prior positive response to to a particular antidepressant may sometimes help in psychotherapy [I].
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Most people find it difficult to grasp that whatever they like to do sexually will be thoroughly repulsive to someone else, and that whatever repels them sexually will be the most treasured delight of someone, somewhere. One need not like or perform a particular sex act in order to recognize that someone else will, and that this difference does not indicate a lack of good taste, mental health, or intelligence in either party. Most people mistake their sexual preferences for a universal system that will or should work for everyone. This notion of a single ideal sexuality characterizes most systems of thought about sex. Although its content varies, the format of a single sexual standard is continually reconstituted within other rhe to rical frameworks, including feminism and socialism. Progressives who would be ashamed to display cultural chauvinism in other areas routinely exhibit it to wards sexual differences. We have learned to cherish different cultures as unique expressions of human inventiveness rather than as the inferior or disgusting habits of savages. Empirical sex research is the one field that does incorporate a positive concept of sexual variation. Alfred Kinsey approached the study of sex with the same uninhibited curiosity he had previously applied to examining a species of wasp. His scientific detachment gave his work a refreshing neutrality that enraged moralists and caused immense controversy (Kinsey et al. Although his work is imbued with unappetizing eugenic beliefs, Havelock Ellis was an acute and sympathetic observer. His monumental Studies in the Psychology of Sex is resplendent with detail (Ellis, 1936). Much political writing on sexuality reveals complete ignorance of both classical sexology and modern sex research. Perhaps this is because so few colleges and universities bother to teach human sexuality, and because so much stigma adheres even to scholarly investigation of sex. Both contain assumptions and information which should not be accepted uncritically. But sexology and sex research provide abundant detail, a welcome posture of calm, and a well-developed ability to treat sexual variety as something that exists rather than as something to be exterminated. These fields can provide an empirical grounding for a radical theory of sexuality more useful than the combination of psychoanalysis and feminist first principles to which so many texts resort.