2MM3

What is a randomized control trial used for?

effectiveness of a prevention or treatment/therapy/intervention

What is a randomized control trial?

strongest design, people randomly selected to receive the intervention or not to

What are pros of randomized control trial?

random selection and longitudinal

What are cons of randomized control trial?

cost, long period follow up, generalizability

What is the mechanism of a randomized control trial?

What are cohort analytic studies used for?

effectiveness of a prevention, treatment, intervention

What is a cohort analytic study?

longitudinal, prospective study

- 2 groups people select control or experimental

- NO randomization

- group differences may be due to factors that were there prior to intervention

What are cons of cohort analytic study?

increased bias, expensive

Cohort analytic study

Eligible participants --> non random allocation

--> a) school based --> i) outcome ii) no outcome

--> b) diet exercise --> i) outcome ii) no outcome

What is investigator triangulation?

more than 1 data collector

What is theory triangulation?

findings are examined in relation to existing theories

What is member checking?

come up with an idea and go back to ask the participant

What is PICO?

Population, intervention, comparison, outcome

What is a case control study used for?

exposure is related to an outcome

What is a case-control study?

looks at 2 groups of people, those that were exposed to the intervention and those that weren't (look back in time)

What are pros of case-control studies?

allows assessment of unreachable populations, control group included

What are the negative of case-control studies?

hard to get control group that matched perfectly

What is the mechanism of case-control studies?

Eligible participants

--> outcome --> i) exposure ii) no exposure

--> no outcome --> i) exposure ii) no exposure

What is a cohort study used for?

What is the likelihood that a person will experience or develop the outcome if they are exposed to a disease

What is a cohort study?

participants are followed over time, ensure the disease preceded outcome

What is the mechanism of a cohort study?

eligible participants with exposure

--> outcome

--> no outcome

What is a phenomenological approach?

the lived experience of individuals

What is grounded theory?

the process that shapes behaviour and interaction

What is ethnographic study?

how cultural knowledge, norms, values influence one's life experience within social context of a culture or subculture

What is homogenous sampling?

select participants who have similar narratives of a phenomenon

What is heterogenous sampling?

select participants who can provide different narratives of a phenomenon

What is snowball sampling?

used when no sampling frame exists

What is theoretical sampling?

associated with grounded theory, aim to seek data that challenge emerging ideas

What is environmental data?

home characteristics, community characteristics, access to healthcare

What is the Friedman family assessment model?

identifying data, developmental stage and history, family structure, family function, family coping

What is the Calgary family assessment model?

developmental stages, structural, developmental, functional

What is ethnicity?

a family's cultural, historical, linguistic and ethnic origin

What is race?

influences individual members and group identification

What is social class?

shaped by education, income and occupation

What is religion and spirituality?

can influence their ability to cope with or manage an illness or health concern

What is environment?

the larger community, neighbourhood and home contexts

What is gender?

a set of beliefs or expectations of masculine and feminine behaviours and experiences

What is rank order?

order of children by age and gender

What are subsystems?

smaller groups of relationships within a family

What is a functional assessment?

how family members interact and behave towards each other

- instrumental functioning

- expressive functioning

What is instrumental functioning?

the normal activities of daily living

What is expressive functioning?

the ways in which people communicate

- emotional communication

- verbal communication

- nonverbal communication

- circular communication

- problem solving

- roles

What is developmental assessment?

interactions between an individuals development and the phase of the family developmental lifestyle

1) family life stages

2) tasks

3) attachments

What is the McGill/Developmental Model?

family as a subsystem, health as the focus of worth, learning the process through which the health behaviours are acquired

What is the effect of smoking on surgery?

smokers are at an increased risk for post op complications

- increased mucous thickness

- greater difficulty clearing airways

What is the effect of alcohol/substance abuse on surgery?

predispose the patient to adverse reactions of anesthetic, cross-tolerant, withdrawal

What is the effect of obesity on surgery?

reduce respiratory and cardiac function, increased risk of embolus, pneumonia, poor wound healing, dehiscence

What is the effect of immunocompetence on surgery?

excess thinning of skin, destruction of collagen, impaired vascularization, infection, poor wound healing

What is the effect of malnourishment on surgery?

poor tolerance of anesthesia, delayed blood clotting mechanism, infection, poor wound healing

What is the effect of young age in surgery?

less BV, dehydration, over hydration, airway management, temperature management

What are respiratory complications of surgery?

airway obstruction, hypoxemia, hypoventilation, atelectasis (collapsed lung)

What are cardiovascular complications of surgery?

hypotension, hypertension, dysrhythmia, fluid retention, DVT, syncope

What are the neurological complications of surgery?

delirium, delayed awakening

What are the GI/GU complications of surgery?

nausea and vomitng, post operative ileus, paralytic ileus, low urine output, urinary retention

What are integument complications of surgery?

surgical site infections

What are psychological complications of surgery?

anxiety, depression, confusion, delirium, disturbed sleep pattern, body image

What is delirium?

state of acute mental confusion

What is delirium characterized by?

acute onset, fluctuating course, altered LOC

What are predisposing factors?

present at the time of admission, demographic, cognitive status, functional status, coexisting conditions

What are precipitating factors?

noxious insults related to hospitalization, surgery, drugs, incurrent illness

What is hypoactive delirium?

decreased alertness, decreased psychomotor activity

What is hyperactive delirium?

Agitation, restlessness and hallucinations

What is mixed delirium?

alternating periods of hyperactive and hypoactive

What is dementia?

impaired memory, slow gradual decline, chronic, decreased orientation, decreased ability to perform ADL's

What is vascular dementia?

cause by stroke or chronically damaged/narrowed brain blood vessels

What are signs and symptoms of vascular dementia?

difficulty concentrating and analyzing situations, unsteady gait, restlessness, agitation, incontinence

What are risk factors for vascular dementia?

aging, increased BP, atherosclerosis, diabetes

What is Parkinson's dementia?

a progressive neurodegenerative disease of the CNS

What are signs and symptoms of Parkinson's dementia?

dysphagia, difficulty concentrating, confusion

What is the progression of Parkinson's dementia?

gradual onset, ongoing progression

What is Alzheimer's disease?

abnormal protein deposits form plaques and tangles in the brain (connections b/w cells die off)

What are signs and symptoms of Alzheimer's disease?

memory loss, disorientation, reduced cognition, decline in social skills

What are risk factors for Alzheimer's disease?

older population, genetic, hospitalization, medical conditions

What are treatments for Alzheimer's disease?

creating a safe and supportive environment, cholinesterase inhibitors

What is lewy body dementia?

protein deposits in nerve cells, accumulation of Lewy bodies results from the loss of neutrons that create ACTH and dopamine

What are signs and symptoms of Lewy body dementia?

cognitive fluctuations, hallucinations, motor disturbances

What are risk factors for Lewy body dementia?

60+, male, family history

What is fronto-temporal dementia?

degeneration of the frontal, temporal, or both sides (tau protein)

What are signs and symptoms of fronto-temporal dementia?

behavioural: loss of inhibitions, depression, compulsivity, loss of empathy

language: aphasia, loss of semantics

What is the progression of fronto-temporal dementia?

gradual decline, stepwise, rare, more common younger

What is Huntington's dementia?

A progressive brain disorder caused by a single defective gene on chromosome 4

What are signs and symptoms of Huntington's dementia?

involuntary jerking, slow abnormal eye movement, impaired gait, difficulty with speech and swallowing

What are cognitive changes of Huntington's dementia?

disorganized thinking, behavioural/emotional instability, lack of awareness

What are behavioural changes of Huntington's dementia?

depression, irritability, social withdrawal, insomnia, fatigue

What is prediabetes?

blood sugars that are higher than normal, can turn into type 2

What are risk factors for prediabetes?

high BP, high cholesterol, high BMI, sleep apnea, psychiatric disorders

What is gestational diabetes?

occurs during the 2nd or 3rd trimester of pregnancy

What is metabolic syndrome?

cluster of metabolic disorders, abdominal obesity, increased TG levels, decreased HDL levels, hypertension, increased glucose levels, insulin resistance

What is type 2 diabetes?

insulin resistance or dysfunctional secretions

What are risk factors for type 2 diabetes?

40+, family history, history of prediabetes, heart disease, hypertension, high cholesterol, overweight, sleep apnea

What are signs and symptoms of type 2 diabetes?

non specific manifestations, fatigue, weight gain, tingling/numbness, prolonged wound healing

What is type 1 diabetes?

the pancreas does not produce any insulin, rapid onset, acute manifestations

What are signs and symptoms of type 1 diabetes?

polyuria, polydipsia, polyphasic, weight loss, weakness, fatigue

What is nephropathy?

microvascular complications associated with damage to the SBV's that supply the glomeruli of the kidney

What is neuropathy?

nerve damage that occurs because of the metabolic derangements associated with diabetes

What is retinopathy?

microvascular damage to the blood vessels of the retina

What is hypoglycaemia?

extremely low blood glucose levels

What are risk factors for hypoglycaemia?

alcohol intake without food, loss of weight without change in dose, taking too much meds/insulin, pregnancy

What are symptoms of hypoglycaemia?

cold/clammy skin, headache, hunger, nervousness, tachycardia, confusion, nausea, numbness/tingling

What is hyperglycaemia?

high blood glucose levels