FUNDS EXAM 3
Primary prevention of VTE:
-anticoagulants *not always tho bc try to get up and moving right away after surgery -ROM on UNAFFECTED area -dorsiflex/plantar flex HIGH risk patients: -anticoags ofc -mechanical prophylaxis: SCDs, PCDs, ted hoes
Nursing management of PE:
-bed rest @ semi fowlers -admin O2 as ordered -monitor CV status; including lung sounds -anticoagulant therapy as ordered -anticoagulant monitoring -monitor signs and symptoms of bleeding
Physical (SNS) response to stress:
-diaphoresis (if stress is significant) -restlessness -HA -muscle stiffness/tension -racing heart -shakiness -dilated pupils -^blood sugar -fatigue/GI upset
Role of nurse experiencing stress:
-encourage pt to ID stressor -guide pt to positive adaptive response to stress -ID an action plan to lessen stress -ID when to delay pt teaching to enhance pt learning *think... if stressed/anxious/depressed... make sure patient is CAPABLE, OPEN and WILLING to learn
Emotional responses to stress:
-fear -agitation/anger -hostility -anxiety -suspiciousness -irritability -easily annoyed -feeling powerlessness -feeling overwhelmed
What is the main contributing factor to hip fx?
-osteoporosis
Stages of normal fx healing:
-platelets form clot/inflammation -boney matrix deposition and mineralization -bone remodels
Clinical Manifestations of a DVT:
-red, tight, taut, unilateral leg edema, pain, tenderness, firm on palpation -deep and small (may not see all of these) patient may say "leg feels full"
Which medical condition places a pt at a high risk for an embolic stroke? *A fib *atherosclerosis *cancer of the brain *antocoagulant therapy
*A fib -Rationale: a fib can cause significant # of embolic strokes
When do we have peak bone mass?
20 y/o
What is a vertebroplasty?
Bone cement is injected into a fractured vertebra; stabilizes and prevents further compression
What diagnostic test is used for osteoarthritis?
X-RAY
How we ____ stress is how our body adjusts to it
perceive
Osteomalacia
abnormal softening of bones
What is the general adaptation syndrome?
(GAS) -by Hans Selye 3 stages: 1) Alarm Reaction- stress first happens; SNS fight/flight 2) Stage of Resistance- bodies attempt to return to homeostasis= leads to recovery or exhaustion 3) Stage of Exhaustion- can be achieved IF recovery doesn't result; always in stress response, illness occurs
A nurse is preparing a presentation about glucosamine to a group of pt. Which of the following information should the nurse include in the teaching? *"Glucosamine may help to increase joint functionality" *"Glucosamine can be used in treatment of herpes simplex infections" *"Glucosamine can improve age related memory impairment" *"Glucosamine is derived from red peppers"
*"Glucosamine may help to increase joint functionality
At which rate must the blood flow in the brain be maintained for normal functioning?
750 to 1000 mL/min *20% cardiac output
What can we do to slow bone loss? A) nothing B) increase calcium to 200mg a day C) increase weight bearing exercise D) include swimming in the exercise regime
C
What is recommended for a pt. who has osteoarthritis? A) take calcium with antacids B) continue to exercise even to the point of pain C) continue to exercise to improve balance and flexibility D) use acupuncture for pain
C
Who is the guru of pain?
Margo McCaffery= pain is what the patient SAYS it is
Is GAS always maladaptive?
NO. -can be adapted to/adjusted. Depending on: *perception: is it easily manageable? *may be manageable but challenging? What do you need to achieve? *threat?may exceed existing resources you have= equilibrium disruption
4 key personality characteristics that aid in coping and helps buffer the effect of stress:
1) Resilience- resourcefulness, flexibility, good problem solving 2) Hardiness- commitment to get things done, be open to change 3) Attitude- positivity, makes a big difference in disease progression 4) Optimism- fight till the end, see that there's hope
Which medical condition places a pt at a high risk for an thrombotic stroke? *A fib *atherosclerosis *cancer of the brain *antocoagulant therapy
*atherosclerosis -Rationale: atherosclerosis causes narrowing of the blood vessels and reduces cranial blood flow
A nurse is preparing a presentation at a senior center about age-related musculoskeletal changes. Which of the following changes should the nurse plan to include? *decreased muscle mass *thickened vertebral disks *reduced chest width *increased force of isometric contraction
*decreased muscle mass -Rationale: muscle mass and strength decreases with aging
A nurse is assisting an older adult pt who sometimes loses her balance while walking. Which of the following devices should the nurse use when helping the pt ambulate? *gait belt *jacket harness *4 wheeled walker *cane
*gait belt -Rationale: the nurse should use a gait belt to help support the pt during ambulation. A gait belt helps keep the pt. center of gravity stable and helps maintain balance and prevent falls.
Risk factors of VTE (venous thromboembolism)
1) venous stasis= blood not moving (think varicose veins... all stretched out/not moving.& large) 2) endothelium damage= trauma (ortho surgery)/contusion 3) hypercoaguability= thicc blood; can't move easily, ^lipids in blood, MANY platelets
Sympathetic Nervous System Response to Stress:
^HR ^BP ^Blood perfusion skeletal muscles*to be able to react Bronchial dilation Pupil dilation*to see better ^Blood glucose Sodium and Water retention Decrease in immune response
A nurse is assisting a pt who has received crutches in an urgent care center following a foot injury. Which of the following statements should the nurse identify as an indication that the pt needs further teaching? *"I will keep spare crutch tips handy." *"I will bear the weight of my body on my hands." *"I will inspect my crutches every day for signs of wear." *"I have a set of my brother's crutches in my basement I can also use."
"I have a set of my brother's crutches in my basement I can also use." -Rationale: The pt should not use crutches that belong to someone else. The pt.'s crutches must fit his body dimensions, not someone else's.
A nurse is teaching a pt who is perimenopausal and has recurrent lower back pain. Which of the following pt statements indications and understanding of the teaching? *"I can wear heels up to 2 1/2 inches in height." *"I should sleep lying flat with my legs extended straight." *"I should increase high potassium foods in my diet." *"I should keep my weight within 10 percent of my ideal weight."
"I should keep my weight within 10 percent of my ideal weight." -Rationale: Excessive body weight can place increased stress on the lower back structures. The nurse should evaluate the pt. weight and make a plan for weight reduction prn to ease stress on pt. lower back.
A nurse is caring for a pt. who has osteoarthritis and asks about the use of glucosamine. Which of the following should the nurse make?(Select all that apply... duh duh duhhhhh) *"Glucosamine might increase bleeding" *"Glucosamine can help lower your blood pressure" *"Glucosamine can increase blood glucose levels" *"Glucosamine hydrochloride has been shown to decrease the discomfort of osteoarthritis." *"Pt. who have shellfish allergies might experience reactions when taking glucosamine"
*"Glucosamine might increase bleeding" ***and what else***
A nurse is teaching a pt who has a hx falls about home safety. Which of the following statements should the nurse identify as an indication that the pt understands the instructions? *"I will keep my walker at the end of my bed" *"I will keep the fluorescent ceiling light on in my room at night" *"I will place an area rug at the entry of my bathroom" *"I will place a bath seat in my shower to use when I bathe"
*"I will place a bath seat in my shower to use when I bathe." -Rationale: A bath seat can help reducing slipping and falling in the bathtub or shower
A nurse at an extended care facility is instructions a class of assistive personnel (AP) about client use of assistive devices during ambulation. Which of the following instructions should the nurse give the APs about clients' use of a cane? *"When the pt moves, he should move the cane forward first." *"The pt should not hold the cane on the weak side of his body." *"The grip should be level with the pt waist." *"The pt should first move the strong leg then the weak one."
*"When the pt moves, he should move the cane forward first." -Rationale: When the pt moves, he should first move the cane forward about 30.5 cm (12 in). Then he should move the weak leg even with the cane. Finally, he should bring the strong leg forward and ahead of the can and his weak leg.
A nurse is caring for pt who requires cold applications with an ice bad to reduce swelling and pain of an ankle injury. Which of the following actions should the nurse take? *Apply the bag for 30 min at a time *Reapply the bag 30 min after removing it *Allow room for some air in the bag *Place bag directly on the skin
*Apply the bag for 30 min at a time -Rationale: the nurse should leave the bad in place for 30 min, but should check the pt. skin after 15 min to make sure there are no adverse effects
Secondary prevention of VTE/DVT:
*BLOOD WORK: -CBC- wbc, rbc, hgb, hct, platelets -***Ddimer= not 100% accurate but drawn when suspect a DVT; will be elevated if present -***Duplex US/doppler= when go over and vein doesn't collapse -fibrin monomer complex ***DIAGNOSTIC TEST*** -venous compression ultrasound, norm veins collapse; DVTs don't due to thrombus *Other INVASIVE Tests: -Venography: MRI, need dye to look in area; but need good kidney function to do that. -CTV; may be contraindicated if poor kidney function with concern for dye excretion
A nurse is helping an older adult pt to ambulate in the hallway for the first time since admission. The pt has brought her standard walker from home. To ensure proper use of the walker and safety of the pt, which of the following actions should the nurse take? *Check that the pt lifts the walker and then places it down in front of her *Walk in front of the pt. to guide her in moving the walker *Have the pt. move one leg forward with the walker *Make sure that the upper bar of the walker is level with the pt waist
*Check that the pt lifts the walker and then places it down in front of her -Rationale: The pt should lift the walker and advance it about 15 cm (6 in) and then set it down. This allows her a wide base of support while she moves forward.
The little TURTLE was SAD bc he KNEW he was lost, but was unable to COUNT how many TURNS to make or ASK for help.
*Left side brain stroke *slow performance *depression/anxiety *impaired math concepts *inability to decipher R/L *impaired speech and language
A nurse is teaching a group of patients about osteoarthritis. Which of the following recommendations should the nurse include in the teaching? *Use Echinacea to manage joint pain *Apply ice to the joint before exercising *Maintain a recommended body weight *Reduce the amount of purine in the diet
*Maintain a recommended body weight -Rationale: Obesity is a risk factor for the development of osteoarthritis. Maintenance of an ideal weight is one way a pt can prevent added wear and tear on joints.
A nurse is teaching a pt about crutch walking using the 3-point gait. Which of the following statements by the nurse should be included in the teaching? *"Look down at your feet before moving the crutches" *"Place one crutch forward with the opposite foot and then place the second *"Move both crutches forward while standing on the unaffected leg, then lift and swing your body past the crutches." *"Support your body weight on the underarm crutch pads
*Move both crutches forward while standing on the unaffected leg, then lift and swing your body past the crutches
A nurse is caring for a pt who has limited hand movement. Which of the following actions should the nurse take to assist the pt with feeding? *place the pt in a lateral position *provide an adaptive feeding device for the client *initiate a liquid diet for the client *arrange the food groups clockwise on the client's plate
*Provide an adaptive feeding device for the pt. -Rationale: Adaptive devices, such as utensils with bent or angled handles, wide handles, or foam handles, are helpful for pt whose handle mobility is limited because these devices promote independence
A nurse is caring for a pt who has osteoporosis and takes a daily calcium supplement. Which of the following adverse effects of calcium should the nurse suspect when the pt reports having flank pain? *Hepatitis *Hip fx *Renal stones *Pancreatitis
*Renal stones -Rationale: calcium supplements can cause renal stones. Pt should increase their H2O intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.
The RECKLESS CHEETAH flew into SPACE without a MALLET... NBD, maybe next TIME!
*Right side brain stroke *impulsive *rapid performance/short attn span *spatial-perceptual deficits *impaired judgement *minimize problems *impaired time concepts RIGHT BRAIN STROKE= L SIDED PARALYSIS (hemiplegia)
Monitoring Labs for Warfarin and Heparin Therapeutic Ranges:
*WARFARIN* -INR: 2.0-3.0; determines warfarin dose -PT 2x control (22 sec) *HEPARIN* (quick med!) -aPTT monitoring (norm 25-35) -therapeutic= 2x control -monitor q 4-6hr early in tx and during change of tx
A nurse is teaching an older adult pt who has osteoporosis about beginning a program of regular physical activity. Which of the following recommendations should the nurse make? *High impact exercises *Walking briskly *Riding a bike *Stretching exercises
*Walking briskly -Rationale: weight-bearing exercises are essential for maintaining bone mass. Walking is an appropriate activity for an older pt to promote weight bearing and to maintain bone mass.
Which medical condition places a pt at a high risk for an hemorrhagic stroke? *A fib *atherosclerosis *cancer of the brain *antocoagulant therapy
*anticoagulant therapy
A nurse is assessing an older adult pt who has experienced some loss of bone density. The nurse observes a "hunchback" curvature of the pt. spine. The nurse should expect the provider to document which of the following? *scoliosis *kyphosis *lordosis *ankylosis
*kyphosis -Rationale: kyphosis, a forward, "hunchback" curvature of the spine, is an abnormal angulation of the posterior curve of the thoracic spine resulting from multiple compression fractures, usually a result of osteoporosis. It is most common in older adults and tends to increase with aging.
A nurse is completing discharge teaching with a pt. Of the following barriers to learning, which should the nurse interpret as a need to postpone teaching? *pain *hearing loss *pt culture *motor impairment
*pain -Rationale: If the pt. reports pain, the nurse should address pain first and then DC instructions second
A nurse is completing a physical assessment of a pt who has early osteoarthritis. Which of the following manifestations should the nurse expect? *symmetric joints affected *pain worsens with activity *weight loss *ulnar deviation
*pain worsens with activity -Rationale: typical cycle of pain and relief in a pt. who has early osteoarthritis consists of pain with activity and pain relief with rest. As the disorder progresses, pt can experience joint pain even while at rest. -symmetry pain, weight loss and ulnar deviation are all manifestations of RA
A nurse working in a community health center is preparing a flow sheet detailing essential screenings according to age group. At which developmental stage on the chart should the nurse add scoliosis? *infant *toddler/preschooler *pre-adolescent/adolescent *older adult
*pre-adolescent/adolescent -Rationale: scoliosis is a condition involving a lateral curvature to the spine. The nurse should include screening for scoliosis during the pre-adolescence/adolescence age group: for girls in grades 5-7 and boys grade 8-9.
A nurse is teaching a pt who has osteoarthritis. Which of the following should the nurse include in the teaching? *apply a heat pack at a temp below body temp *elevate affected joint on a large pillow *take acetaminophen as the primary med to treat the pain *decrease foods high in purines
*take acetaminophen as the primary med to treat the pain -Rationale: the nurse should instruct the pt to take acetaminophen to treat osteoarthritis
Medication for tertiary prevention:
-Heparin: IV in combo with Warfarin (Coumadin). Heparin is d/c when warfarin is therapeutic. Warfarin continues on. OTHERS: -dabigatran (pradaxa) PO -rivaroxaban (xarelto) PO -apixaban (eliquis) PO ****DONT BE ON ANY OF THIS AND TAKE NSAIDS BC INCREASED R/F BLEEDING****
How does the: -Liver -GI -Reproductive -Overall health Respond to stress?
-Liver *Glycogenesis-- ^ blood glucose -GI *Acid reflux, decreased peristalsis, N/V/Heartburn -Reproductive *Males= decreased sperm # *Females= irregular cycles -Overall health *Stress induced immunosuppression *Exacerbation of previous medical conditions (asthma)
SNS Regulatory mechanisms include which system? Key players?
-Nervous system: Hypothalamus & Endocrine System *Hypothalamus*: stimulate both the SNS and endocrine system. *Adrenal Medulla*: (middle) releases epi and norepi preparing for fight/flight *Adrenal Cortex*: (outside) releases corticosteroids (cortisol) when stress response and GLUCOSE INCREASES; why? Bc in high stress... need ENERGY which comes from ^ GLUCOSE. -good short term... but not long bc hyperglycemia
What are the clinical manifestations of Osteoarthritis and Osteoporosis (silent thief)?
-Osteoarthritis= slow, progressive, noninflammatory disorder of the synovial joints (not systematic... may inflame time to time, but not constant) *change to joints *Herberden's Node or Bouchard's Node= joints are swollen in the digits *start off healthy joint-->thinning of cartilage/bone spur/jagged edge in joint--> cartilage is destroyed, bone on bone, painful *cartilage is destroyed, new tissue is formed *begins at ago 20-30 y/o, don't see effects around age 50. -Osteoporosis= brittle, less dense bone. OsteoCLAST activity is > OsteoBLAST= bone loss/breakdown, don't know it's occurring until loss is significant. *1/2 women have fx r/t osteoporosis *1/4 men have fractures r/t osteoporosis --> fx most often in spine, hips, and wrists --> start to see gradual bone loss at 35 --> greatest loss seen when when go through menopause ---> disease of age
Clinical manifestations of a hip fx:
-affected hip= external rotation; adduction, and shortening -bruising at the site
Cognitive responses to stress:
-difficulty concentrating -short attention span -forgetfulness -memory lapses/loss -lack of creativity -worrying -ambivalence -impaired judgement -lack sense of humor
Long term effects of stress on the body:
-mood/behavior -memory -sleep -eating -emotional well being -immune system -pain throughout the body (fibromyalgia usually is a stress response)
What is done when a PE is suspected?
-spiral CT scan (contrast dye) -vent perfusion -chest XR -d dimer -angiograpgy (arterial visualization -- needs contrast) -Vent/Perfusion/PQ scan -pulmonary angiography--expensive and invasive
Protocol for DVT patients
-ted hose -legs elevated during day -minimal movement until clot is stabilized -continue meds, drink fluids -watch for bleeding
Primary prevention DVT *(MEDS)* :
-thrombin inhibitors (indirect): Heparin *subq for pts at risk or enoxaprin (low molecular weight heparin) OTHERS: -dabigatran (pradaxa) PO -rivaroxaban (xarelto) PO -apixaban (eliquis) PO
Risk factors of VTE/DVT- (Virchow's Triad)
-venous stasis= not moving blood in that area (varicose veins, lack of venous elasticity & don't open or close any more) -damage to endothelium of inner lining of a vessel (deep contusion)/traumatic damage (ortho surgery) -hyper-coagulability (thick blood) severe anemia, hormone therapy, ^lipids in blood, platelets
What is important about adaptation and coping with stress? What does this allow?
-we adjust to achieve HOMEOSTASIS -allows for person to make physiological and behavioral changes in order to manage stress
What screening test is used to determine osteoporosis? A) xray B) QUS scan C) MRI of the hips D) serum calcium
B
Which substances are released into the circulating blood stream during a period of great stress? A) GRE B) Glucocorticoids C) ATP D) ADHD
B) Glucocorticoids
A nurse is assessing a patient who is experiencing chronic stress. Which of the following should the nurse expect? A) Hypotension B) Viral infection C) Increased energy D) Increased cognitive awareness
B) Viral infection
What is a type of temporary immobilization for hip fx?:
BUCK'S TRACTION: 24-48 hrs if surgery is needed due to injury
What are maladaptive behaviors?
Behaviors or actions that run counter to what is in one's own best interest
Which of the following are physiological stress reactions? A) constricted pupils, low blood sugar, dyspepsia B) forgetfulness, worry, suspicion C) HA, restlessness, ^blood sugar D) irritability, slowed HR, slowed GI motility
C) HA, restlessness, ^blood sugar
Your patient has moderate pain due to osteoarthritis. As a nurse, what medication would you suggest to manage her daily pain? A) Aspirin B) Dexamethasone C) Acetaminophen D) Corticosteroid injection
C- best for arthritis
Coping with stress can be...
CONSTRUCTIVE: (positive) -alter attitude to stress by= exercise, journaling, seeking professional assistance (tertiary) DESTRUCTIVE: (negative) -substance use -ruminating on situation or stressor -inability to move beyond current situation
What tests are performed ASAP on a stroke pt? And how soon? Why performed?
CT scan within 25 min of arrival and read by a radiologist within 45 total minutes (looking for a brain bleed aka HEMORRHAGE) If hemorrhage=surgery
A stroke with an ABRUPT onset without a severe headache-- what type of stroke would you suspect?
Embolic= a clot is lodged in cerebral artery or pulm with minimal collateral circulation
ASA may be given within the first 24-48 hours of onset of stroke symptoms if signs of ________ stroke are NOT present
HEMORRHAGIC! Admin aspirin will only promo MORE BLEEDING! ASA is "A OK" for Ischemic (thrombo/embo) stroke
A pt claims to be having the "worst headache of my life"-- what type of stroke would you suspect?
Hemorrhagic= brain bleed= increased pressure/HA
What are the risk factors and primary prevention practices r/t mobility?
Impaired Mobility can lead to: -altered sleeping patterns -constipation -urinary retention/urgency -activity intolerance *orthostatic hypotension -social= depression -skin= pressure injuries -lungs= stasis of secretions=pneumonia; DIB/SOB ------------------------------------ OSTEOPENIA= -lower than norm bone density. But SMALL (penia) decline so WE DON'T KNOW THIS OCCURS, but happens with age -asian americans -small frame -women -congenital/intestinal disease -smoking -etoh -caffeine -insufficient calcium and vit D -pregnancy/breastfeeding PREVENTION: -weight bearing exercise -weight loss= less stress on bones! -TEACH!: recommended daily intake *Vit D= 20 min in sun, or 1000-2000 IU= helps calcium absorb & V IMPORTANT (fish) *Calcium= 500mg-600mg b.i.d. (cheeses, milk) -------------------------------- OSTEOARTHRITIS: (non-mod rf) -age -neuro changes -endocrine disorders -congenital/skeletal deformities (mod rf) -weight -job/hobby that overuses joints -meds (maybe)= STEROIDS*** PREVENTION: -weight management -physical activity/protecting joints
A stroke with a GRADUAL onset is what type?
Ischemic/Thrombotic= buildup collateral circulation & deficits not as severe
Stages of sleep:
NREM and REM NREM: 75-80% of sleep cycle -stage 1: transition from wakefulness to sleep; uncontrolled muscle jerks -stage 2: fall into sleep but easily aroused to wakefulness; HR and R slow, body temp decreases -stage 3 & 4: 10% of sleep, deep sleep/delta sleep REM: 20-25% of a person's nightly sleep time -HR, R, BP, metabolic rate, body temp increase or fluctuate; ACTIVE DREAMING; skeletal muscle tone and deep tendon reflexes are depressed (this is good bc you don't want to react to whack dreams and physically hurt yourself in real life by REACTING to them)
Tertiary prevention and tx osteoporosis and osteoarthritis:
OSTEOPOROSIS: -stop smoking (if already have smoking problem) -continue exercise adequate nutrition -decrease ETOH -BIPHOSPONATES: help slow resorption (breakdown) of calcium from the bone *these meds absorb best on empty stomach, take first thing in AM 30 min before breakfast & sit up after taking, drink water -------------------------------- OSTEOARTHRITIS: -pain management -assistive devices -meds: NSAIDs, Ibu= 2800-3200 mg/day (r/f kidney tox), naproxen q12h BID, **ACETAMINOPHEN USED MO. OFTEN= 325mg, 500mg, 650mg; 3800-4000 mg/day (r/f liver tox) -capsaicin (chili pepper) -corticosteroid... big needle -lidocaine topical tx -or possible joint replacement
Secondary preventions and diagnostic studies of osteoporosis/osteoarthritis:
OSTEOPOROSIS: -BEST: DEXA/DXA scan (dual energy Xray; look at T&Z score) *women= get before 65 y/o or when post menopausal *don't tx osteopenia; just make sure pt. KNOWS it is present *if normal scan?= 10 yrs later *men= get done around 70 y/o CHECK LABS: -serum calcium -phosphorus -alkaline phosphatase -Vit D ---------------------------------- OSTEOARTHRITIS: -fall risk assessment -mobility assessment -screening *XRAY IS BEST HERE!!= can see joint spacing. DO FIRST! *CT/MRI don't go unless needed CHECK LABS: -ESR (systemic inflammation-rule out RA), CBC, renal and liver function NO CURE; but can.. -manage pain -balance of rest/exercise -heat/cold therapy -acupuncture -yoga -glucosamine and chondroitin (depends on supplement and duration) -joint replacement
Complications from untreated DVT:
PE- emboli travels and lodges in small vessels of lung *s/s: dyspnea, CP, back pain, hemoptysis (bloody sputum), crackles, tachycardia, hypotension, low O2, maybe low grade fever *massive PE= death
Who identified ways to promo sleep in the hospital setting?
Trossman -alternative light sources in evening (red light) -quiet time 2pm-4pm & 10pm-5am -fix squeaky equipment -limit alarms (scanners) -bundle care during night time hours
Crutches up and down stairs
UP: -push DOWN on crutch and bring good leg UP, crutches UP DOWN: -crutches on stair, bad leg down
Primary prevention for stress:
exercise, nutrition, support system
global aphasia
expressive and receptive aphasia- limited ability to speak and understand language
Wernicke's aphasia
expressive aphasia- fluent
Broca's aphasia
expressive aphasia- nonfluent
What is a kyphoplasty?
inserting a balloon into the vertebral space and is inflated; helps restore the height of the vertebral body.
neologism aphasia
pt. forms new words (makes up own language)
Secondary prevention for stress (SCREEN):
screening scales, coping inventory