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Fekal inkontinans ve hemşirelik yaklaşımı

Yıl 2018, , 39 - 44, 06.12.2018
https://doi.org/10.22312/sdusbed.362880

Öz

Fekal inkontinans (Fİ),
katı veya sıvı haldeki feçesin istemsiz kaçırılmasıdır. Dünya’da milyonlarca
kadını etkileyen Fİ bireyi yalnızca fiziksel olarak değil, aynı zamanda sosyal,
psikolojik ve ekonomik olarak da olumsuz etkileyen patolojik bir durumdur. Fİ,
birey için açıklanması güç, utanç verici bir durum olarak görülebilmektedir.
Bireyler sık sık tuvalete gitme korkuları olduğundan oldukça kısıtlı bir sosyal
hayat yaşar. Fekal inkontinanslı bireyler sosyal izolasyon yaşar. Fekal
inkontinans toplumda bir tabu
olarak görülmesi sebebiyle sorunun saptanması ve değerlendirilmesinde
hemşirelere önemli rol ve sorumluluklar düşmektedir. Literatürde fekal
inkontinansın tanı ve tedavi yöntemleri ile ilgili birçok kaynak bulunmaktadır.
Bu derlemenin amacı, fekal inkontinansın nedenlerini, risk faktörlerini,
güncel tanı ve tedavi yöntemlerini incelemek ve hastalığın tedavisinde her
aşamasında aktif rol alan hemşirelerin sorumluluklarını ve rollerini
belirtmektir. 

Kaynakça

  • 1.Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Neurourology and Urodynamics 2017; 36(1): 10-34.
  • 2.Dedeli Ö, Fadıloğlu Ç, Turan İ, Bor S. İzmir Huzurevlerindeki Yaşlılarda Fekal İnkontinans Sıklığı ve Yaşam Kalitesi Üzerine Etkisi. Turkish Journal of Geriatrics 2008; 11(1): 33-41.
  • 3.Bavel J, Hukkelhoven CW, Vries C, Papatsonis DN, Vogel J, Roovers JPW et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: A ten-year analysis of a national registry. International Urogynecology Journal 2017; 1433-3023: 1-7. doi: 10.1007/s00192-017-3422-4.
  • 4.Meyer I, Richter HE. An evidence-based approach to the evaluation, diagnostic assessment, and treatment of fecal incontinence in women. Current Obstetrics and Gynecology Reports 2014; 3(3): 155-164.
  • 5.Sharma A, Yuan L, Marshall R J, Merrie AEH, Bissett IP. Systematic review of the prevalence of faecal incontinence. British Journal of Surgery 2016; 103: 1589–1597.
  • 6.Canda AE, Terzi C. Anorektal Fizyoloji ve Tanı Yöntemleri. İçinde: Anorektal Bölgenin Selim Hastalıkları, editörler: Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti., 2011; s:17-32.
  • 7.Benezech A, Desmazes-Dufeu N, Baumstarck K, Bouvier M, Coltey B, Reynaud-Gaubert M. Prevalence of fecal incontinence in adults with cystic fibrosis. Digestive Diseases and Sciences 2017;1-7. doi: 10.1007/s10620-017-4825-2.
  • 8.Wu JM, Matthews CA, Vaughan CP, & Markland AD. Urinary, fecal, and dual incontinence in older US adults. Journal of the American Geriatrics Society 2015; 63(5): 947-953.
  • 9.Serrano Falcón B, Álvarez Sánchez Á, Diaz-Rubio M, Rey, E. Prevalence and factors associated with faecal impaction in the Spanish old population. Age and Ageing 2017; 46(1): 119-124.
  • 10.Rudolph W, Galandiuk S. A practical guide to the diagnosis and management of fecal incontinence. In Mayo Clinic Proceedings 2002; 77(3): 271-275.
  • 11.Fowles J, Routh K, Ward D, Simpson S. New and emerging technologies for urinary and faecal incontinence. United Kingdom University of Birmingham, 2014; p. 19-20.
  • 12.Fattorini E, Brusa T, Gingert C, Hieber SE, Leung V, Osmani B et al. Artificial muscle devices: Innovations and prospects for fecal incontinence treatment. Annals of Biomedical Engineering 2016; 44(5): 1355-1369.
  • 13.İlçe A, Ayhan F. Yaşlılarda üriner ve fekal inkontinansın belirlenmesi, yaşam kalitesine etkisi: Bilgilendirme ve eğitim. Anatolian Journal of Clinical Investigation 2011; 5(1):15-23.
  • 14.Cameron Institute. Incontinence: The Canadian Perspective, Canada, 2014; p.8-10.
  • 15. Dunivan GC, Heymen S, Palsson OS, Von Korff M, Turner MJ, Melville JL, et al. Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 2010; 202(5): 493-6.
  • 16.Denat Y, Khorshid L. Fekal inkontinansın bakımı ve bakımda kullanılan ürünler. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2009; 12(2): 94-103.
  • 17.Bliss DZ, Mellgren A, Whitehead WE, Chiarioni G, Emmanuel A, Santoro GA et al. Assessment and conservative management of faecal incontinence and quality of life in adults. Incontinence, 5th ed. International Consultation on Urological Diseases and European Association of Urology, Paris 2013; 1444-1485.
  • 18.Bulut T. Fekal İnkontinans. Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S, ed. Anorektal Bölgenin Selim Hastalıkları. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti, 2011; s. 187-214.
  • 19.Buğra D. Rektum ve Anal Bölgenin Cerrahi Anatomisi. Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S, ed. Anorektal Bölgenin Selim Hastalıkları. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti, 2011; s. 3-13.
  • 20.Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstetrics & Gynecology 2007; 110(5): 1034-1040.
  • 21.Townsend MK, Matthews CA, Whitehead WE, Grodstein F. Risk factors for fecal incontinence in older women. The American Journal of Gastroenterology 2013; 108(1): 113-119.
  • 22.Hansen JL, Bliss DZ, Peden-McAlpine C. Diet strategies used by women to manage fecal incontinence. Journal of Wound Ostomy & Continence Nursing 2006; 33(1): 52-61.
  • 23.Vitton V, Soudan D, Siproudhis L, Abramowitz L, Bouvier M, Faucheron JL, et al. Treatments of faecal incontinence: recommendations from the French national society of coloproctology. Colorectal Disease 2014; 16(3): 159-166.
  • 24.Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J. Management of fecal incontinence in adults. Neurourology and Urodynamics 2010; 29(1): 199-206.
  • 25.Markland AD, Burgio KL, Whitehead WE, Richter HE, Wilcox CM, Redden DT, et al. Loperamide versus psyllium fiber for treatment of fecal incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) randomized clinical trial. Diseases of The Colon & Rectum 2015; 58(10): 983-993.
  • 26.Wang JY, Abbas MA. Current management of fecal incontinence. The Permanente Journal 2013; 17(3): 65-73.
  • 27.Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2006; 3.
  • 28.Price R, Bradley R. Assesing and treating faecal incontinence. Nursing Older People 2013; 25(7):16-23.
  • 29.Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, et al. Anorectal Disorders. Gastroenterology 2017; 150(6): 1430-1442.
  • 30.Demirci N, Coşar F. Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri. SDÜ Tıp Fakültesi Dergisi 2009; 16(3): 35-40.
  • 31.Boyle DJ, Prosser KBN, Allison ME, Williams NS, Chan CLH. Percutaneous tibial nerve stimulation for the treatment of urge fecal incontinence. Disease of the Colon & Rectum 2010; 53(4): 432-437.
  • 32.Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum 2007; 50: 1950–1967.
  • 33.Bharucha AE, Rao SS, Shin A. Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders. Clinical Gastroenterology and Hepatology 2017; 15: 1844–1854.
  • 34.Crescent P, Melbourne S, editors. Managing Incontinence in General Practice-Clinical Practice Guidelines. 1st ed. Australian, The Royal Australian College, 2002; p. 19-22.
  • 35.Noh GT, Han J, Cheong C, Han YD, Kim, NK. Novel anal sphincter saving procedure with partial excision of levator-ani muscle in rectal cancer invading ipsilateral pelvic floor. Annals of Surgical Treatment and Research 2017; 93(4): 195-202.
  • 36.Bochenska K, Boller AM. Fecal incontinence: Epidemiology, impact, and treatment. Clinics in Colon and Rectal Surgery 2016; 29(03): 264-270.
  • 37.Ness, W. Faecal incontinence: Causes, assessment and management. Nursing Standard 2012; 26(42): 52-60.
  • 38.Xu S, Zhang Z, Wang A, Zhu J, Tang H, Zhu X. Effect of Self-efficacy Intervention on Quality of Life of Patients With Intestinal Stoma. Gastroenterology Nursing 2017. doi: 10.1097/SGA.0000000000000290.
  • 39.Dalmolin A, Girardon-Perlin NMO, Coppetti LDC, Rossato GC, Gomes JS, Silva M. Educational video as a healthcare education resource for people with colostomy and their families. Revista Gaúcha de Enfermagem 2016; 37(esp): e68373
  • 40.Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2010; 5.
  • 41.Eryılmaz R. Fekal inkontinansta artifisyel sfinkter implantasyonu. Türkiye Klinikleri Journal of General Surgery Special Topics 2014; 7(3): 57-64.
  • 42.Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, et al. Novel bulking agent for faecal incontinence. British Journal of Surgery 2011; 98(11): 1644-1652.
  • 43.de la Portilla F, Reyes-Díaz ML, Maestre MV, Jiménez-Rodríguez RM, García-Cabrera AM, Vázquez-Monchul JM et al. Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: A case series. International Journal of Colorectal Disease 2017; 32(3): 437-440.
  • 44.https://www.nice.org.uk/guidance/cg49, (Erişim Tarihi: 03.11.2017).
  • 45.https://www.rcog.org.uk/, (Erişim Tarihi: 03.11.2017).
  • 46.Çelik DB, Beji NK. Pelvik taban fonksiyon bozuklukları ve hemşirelik bakımı. Florence Nightingale Hemşirelik Dergisi 2012; 20(1): 69-79.
  • 47.Karakuş A, Yanıkkerem E. Postpartum dönemde inkontinans ve yaşam kalitesi: Son 10 yıllık çalışmalar. Celal Bayar Üniversitesi, Sağlık Bilimleri Enstitüsü Dergisi 2015; 2(3): 54-59.
  • 48.Bilgiç D, Beji NK, Yalçın Ö. Assessment of sexual function in patients urogynecology. Türk Jinekoloji ve Obstetrik Derneği Dergisi 2012; 9(3): 142-52.

Fecal incontinence and nursing approach

Yıl 2018, , 39 - 44, 06.12.2018
https://doi.org/10.22312/sdusbed.362880

Öz

Fecal
incontinence (FI ),
involuntary loss of feces state solid or
liquid.
Fecal
incontinence, which affects millions of women worldwide, is a pathological
condition that not only affects the individual physically but also affects both
socially, psychologically and economically. Individuals with fecal incontinence
live in social isolation. The actual prevalence of the disease is not known
definitely because individuals with the
disorder do not express it because of their feelings of embarrassment.
It
is difficult for the individuals with the disease to express the complaints of
fecal incontinence because of their feelings of embarrassment and frustration. Due
to the fact that fecal incontinence is seen as a taboo in the society,
important roles and responsibilities fall on nurses in identifying and
evaluating the problem. The aim of this review is to investigate the causes of
fecal incontinence, risk factors, current diagnosis and identify the
responsibilities and roles of nurses who take active roles at every stage of
treatment of the disease.

Kaynakça

  • 1.Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Neurourology and Urodynamics 2017; 36(1): 10-34.
  • 2.Dedeli Ö, Fadıloğlu Ç, Turan İ, Bor S. İzmir Huzurevlerindeki Yaşlılarda Fekal İnkontinans Sıklığı ve Yaşam Kalitesi Üzerine Etkisi. Turkish Journal of Geriatrics 2008; 11(1): 33-41.
  • 3.Bavel J, Hukkelhoven CW, Vries C, Papatsonis DN, Vogel J, Roovers JPW et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: A ten-year analysis of a national registry. International Urogynecology Journal 2017; 1433-3023: 1-7. doi: 10.1007/s00192-017-3422-4.
  • 4.Meyer I, Richter HE. An evidence-based approach to the evaluation, diagnostic assessment, and treatment of fecal incontinence in women. Current Obstetrics and Gynecology Reports 2014; 3(3): 155-164.
  • 5.Sharma A, Yuan L, Marshall R J, Merrie AEH, Bissett IP. Systematic review of the prevalence of faecal incontinence. British Journal of Surgery 2016; 103: 1589–1597.
  • 6.Canda AE, Terzi C. Anorektal Fizyoloji ve Tanı Yöntemleri. İçinde: Anorektal Bölgenin Selim Hastalıkları, editörler: Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti., 2011; s:17-32.
  • 7.Benezech A, Desmazes-Dufeu N, Baumstarck K, Bouvier M, Coltey B, Reynaud-Gaubert M. Prevalence of fecal incontinence in adults with cystic fibrosis. Digestive Diseases and Sciences 2017;1-7. doi: 10.1007/s10620-017-4825-2.
  • 8.Wu JM, Matthews CA, Vaughan CP, & Markland AD. Urinary, fecal, and dual incontinence in older US adults. Journal of the American Geriatrics Society 2015; 63(5): 947-953.
  • 9.Serrano Falcón B, Álvarez Sánchez Á, Diaz-Rubio M, Rey, E. Prevalence and factors associated with faecal impaction in the Spanish old population. Age and Ageing 2017; 46(1): 119-124.
  • 10.Rudolph W, Galandiuk S. A practical guide to the diagnosis and management of fecal incontinence. In Mayo Clinic Proceedings 2002; 77(3): 271-275.
  • 11.Fowles J, Routh K, Ward D, Simpson S. New and emerging technologies for urinary and faecal incontinence. United Kingdom University of Birmingham, 2014; p. 19-20.
  • 12.Fattorini E, Brusa T, Gingert C, Hieber SE, Leung V, Osmani B et al. Artificial muscle devices: Innovations and prospects for fecal incontinence treatment. Annals of Biomedical Engineering 2016; 44(5): 1355-1369.
  • 13.İlçe A, Ayhan F. Yaşlılarda üriner ve fekal inkontinansın belirlenmesi, yaşam kalitesine etkisi: Bilgilendirme ve eğitim. Anatolian Journal of Clinical Investigation 2011; 5(1):15-23.
  • 14.Cameron Institute. Incontinence: The Canadian Perspective, Canada, 2014; p.8-10.
  • 15. Dunivan GC, Heymen S, Palsson OS, Von Korff M, Turner MJ, Melville JL, et al. Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 2010; 202(5): 493-6.
  • 16.Denat Y, Khorshid L. Fekal inkontinansın bakımı ve bakımda kullanılan ürünler. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2009; 12(2): 94-103.
  • 17.Bliss DZ, Mellgren A, Whitehead WE, Chiarioni G, Emmanuel A, Santoro GA et al. Assessment and conservative management of faecal incontinence and quality of life in adults. Incontinence, 5th ed. International Consultation on Urological Diseases and European Association of Urology, Paris 2013; 1444-1485.
  • 18.Bulut T. Fekal İnkontinans. Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S, ed. Anorektal Bölgenin Selim Hastalıkları. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti, 2011; s. 187-214.
  • 19.Buğra D. Rektum ve Anal Bölgenin Cerrahi Anatomisi. Menteş B, Bulut T, Alabaz Ö, Lenetoğlu S, ed. Anorektal Bölgenin Selim Hastalıkları. Ankara, Miki Matbaacılık Bas. Yay. Ltd. Şti, 2011; s. 3-13.
  • 20.Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstetrics & Gynecology 2007; 110(5): 1034-1040.
  • 21.Townsend MK, Matthews CA, Whitehead WE, Grodstein F. Risk factors for fecal incontinence in older women. The American Journal of Gastroenterology 2013; 108(1): 113-119.
  • 22.Hansen JL, Bliss DZ, Peden-McAlpine C. Diet strategies used by women to manage fecal incontinence. Journal of Wound Ostomy & Continence Nursing 2006; 33(1): 52-61.
  • 23.Vitton V, Soudan D, Siproudhis L, Abramowitz L, Bouvier M, Faucheron JL, et al. Treatments of faecal incontinence: recommendations from the French national society of coloproctology. Colorectal Disease 2014; 16(3): 159-166.
  • 24.Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J. Management of fecal incontinence in adults. Neurourology and Urodynamics 2010; 29(1): 199-206.
  • 25.Markland AD, Burgio KL, Whitehead WE, Richter HE, Wilcox CM, Redden DT, et al. Loperamide versus psyllium fiber for treatment of fecal incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) randomized clinical trial. Diseases of The Colon & Rectum 2015; 58(10): 983-993.
  • 26.Wang JY, Abbas MA. Current management of fecal incontinence. The Permanente Journal 2013; 17(3): 65-73.
  • 27.Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2006; 3.
  • 28.Price R, Bradley R. Assesing and treating faecal incontinence. Nursing Older People 2013; 25(7):16-23.
  • 29.Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, et al. Anorectal Disorders. Gastroenterology 2017; 150(6): 1430-1442.
  • 30.Demirci N, Coşar F. Üriner inkontinans tedavisinde davranışsal tedavi yöntemleri. SDÜ Tıp Fakültesi Dergisi 2009; 16(3): 35-40.
  • 31.Boyle DJ, Prosser KBN, Allison ME, Williams NS, Chan CLH. Percutaneous tibial nerve stimulation for the treatment of urge fecal incontinence. Disease of the Colon & Rectum 2010; 53(4): 432-437.
  • 32.Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum 2007; 50: 1950–1967.
  • 33.Bharucha AE, Rao SS, Shin A. Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders. Clinical Gastroenterology and Hepatology 2017; 15: 1844–1854.
  • 34.Crescent P, Melbourne S, editors. Managing Incontinence in General Practice-Clinical Practice Guidelines. 1st ed. Australian, The Royal Australian College, 2002; p. 19-22.
  • 35.Noh GT, Han J, Cheong C, Han YD, Kim, NK. Novel anal sphincter saving procedure with partial excision of levator-ani muscle in rectal cancer invading ipsilateral pelvic floor. Annals of Surgical Treatment and Research 2017; 93(4): 195-202.
  • 36.Bochenska K, Boller AM. Fecal incontinence: Epidemiology, impact, and treatment. Clinics in Colon and Rectal Surgery 2016; 29(03): 264-270.
  • 37.Ness, W. Faecal incontinence: Causes, assessment and management. Nursing Standard 2012; 26(42): 52-60.
  • 38.Xu S, Zhang Z, Wang A, Zhu J, Tang H, Zhu X. Effect of Self-efficacy Intervention on Quality of Life of Patients With Intestinal Stoma. Gastroenterology Nursing 2017. doi: 10.1097/SGA.0000000000000290.
  • 39.Dalmolin A, Girardon-Perlin NMO, Coppetti LDC, Rossato GC, Gomes JS, Silva M. Educational video as a healthcare education resource for people with colostomy and their families. Revista Gaúcha de Enfermagem 2016; 37(esp): e68373
  • 40.Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2010; 5.
  • 41.Eryılmaz R. Fekal inkontinansta artifisyel sfinkter implantasyonu. Türkiye Klinikleri Journal of General Surgery Special Topics 2014; 7(3): 57-64.
  • 42.Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, et al. Novel bulking agent for faecal incontinence. British Journal of Surgery 2011; 98(11): 1644-1652.
  • 43.de la Portilla F, Reyes-Díaz ML, Maestre MV, Jiménez-Rodríguez RM, García-Cabrera AM, Vázquez-Monchul JM et al. Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: A case series. International Journal of Colorectal Disease 2017; 32(3): 437-440.
  • 44.https://www.nice.org.uk/guidance/cg49, (Erişim Tarihi: 03.11.2017).
  • 45.https://www.rcog.org.uk/, (Erişim Tarihi: 03.11.2017).
  • 46.Çelik DB, Beji NK. Pelvik taban fonksiyon bozuklukları ve hemşirelik bakımı. Florence Nightingale Hemşirelik Dergisi 2012; 20(1): 69-79.
  • 47.Karakuş A, Yanıkkerem E. Postpartum dönemde inkontinans ve yaşam kalitesi: Son 10 yıllık çalışmalar. Celal Bayar Üniversitesi, Sağlık Bilimleri Enstitüsü Dergisi 2015; 2(3): 54-59.
  • 48.Bilgiç D, Beji NK, Yalçın Ö. Assessment of sexual function in patients urogynecology. Türk Jinekoloji ve Obstetrik Derneği Dergisi 2012; 9(3): 142-52.
Toplam 48 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Büşra Yılmaz

Ergül Aslan

Yayımlanma Tarihi 6 Aralık 2018
Gönderilme Tarihi 6 Aralık 2017
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

Vancouver Yılmaz B, Aslan E. Fekal inkontinans ve hemşirelik yaklaşımı. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2018;9(3):39-44.

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