NR661Capstone2

Capstone Portfolio Part 2 NR661 APN Capstone Practicum October 2020 Table of Contents Exemplar 1 3 Exemplar 2 8 Exemplar 3 14 Exemplar 4 18 Exemplar 5 22 Exemplar 6 25 Exemplar 7 29 Exemplar 8… 32 Exemplar 9 36 Exemplar 10 41 References 47 Appendix A: Table of Exemplars 59 Appendix B: Concept Map… 60 APN Capstone Portfolio Part 2 Chamberlain University has provided me the tools to successfully become a masters prepared Advanced Practice Nurse allowing me to build on my ever-growing professional knowledge base. Completing this portfolio allows me to consider my proficiency with the program outcomes (PO), the National Organization of Nurse Practitioner Faculties core competencies (NONPF) and the MSN Essentials. My collection of projects will display my growth both as a student and a professional throughout the program via the demonstrated Exemplars and how they relate with the MSN Essentials and Program Outcomes. Exemplar 1: NR503 Population Health, Epidemiology, & Statistical Principles: Analysis of MRSA Two type of MRSA exist; HA-MRSA (hospital acquired MRSA) and CA-MRSA (community acquired MRSA). HA-MRSA is the most common infection as MRSA is associated with invasive devices or procedures, surgeries, IV tubing or artificial joints (Mayo Clinic, 2018). CA-MRSA can occur amongst healthy people and often starts as a painful skin boil spread via skin-to-skin contact (Mayo Clinic, 2018). Populations at risk include members of sports teams, childcare workers and people who live in close contact in crowded conditions. MRSA is caused by staph bacteria that is normally found on skin or in the nose. This bacterium is typically harmless unless it enters the body via a wound but is generally a minor integumentary issue. Symptoms include skin that is warm to touch, swollen red abscesses that are painful and may be full of drainage while associated with a fever. Bacteria traveling past the skin can cause life-threatening infections within the bloodstream, bones, and surgical wounds (Mayo Clinic, 2018). Treatment is often problematic as MRSA has evolved due to years of needless antibiotics prescribed for colds and viral infections. Fortunately, MRSA still responds to certain antibiotics and sometimes a simple incision and drainage procedure of the abscess may be all that is required (Mayo Clinic, 2018). The CDC (2014) identify determinants of health as sex and age, individual behavior, social and physical environments. Poor personal hygiene (high risk for infection from one’s own colonized strain) and compromised skin and/or immunocompromised systems can also increase the risk. Many groups have a higher probability of infection including the elderly, children, IV drug users, athletes, military personnel, homosexual men, and patients with underlying diseases or indwelling medical devices (Otto & Chatterjee, 2013). CA-MRSA is onset of infection within 49 hours of hospital admission without previous history in the previous year whereas HA-MRSA is the onset of infection after 48 hours of hospital admission (Otto & Chatterjee, 2013). The epidemiological triad consists of the host, the agent, and environmental factors. According to Guillamet, et al. (2017), host factors also have the greatest influence the mortality rates (short, medium, and long-term) of patients with MRSA. Acute and chronic factors affect mortality including the age of the patient, comorbidities such as liver disease and length of therapy all have a major impact on the mortality rates of patients being treated for MRSA (Guillamet, et al., 2017). Age can determine if a patient (host) succumbs to the infection process. The older patient population are at a higher risk as their white blood cell response is not as vigorous with an aging immune system (Guillamet, et al., 2017). MRSA is opportunistic and a common cause for the progression of liver failure while triggering blood stream infections, pneumonia, and wound infections in liver transplant recipients (Righi, 2018). While there is a debate as to the appropriate length of treatment it has been determined that therapy greater than four weeks had “strong protective effects” (Guillamet, et al., 2017) for decreasing medium-term mortality rates. MRSA (agent) was once considered solely a hospital acquired pathogen but is now a significant community acquired infection (Guillamet, et al., 2017). Environmental factors include contaminated high-touch surfaces that have been in contact with a colonized or infected person in hospitals, emergency service vehicles, laboratories, public transportation, athletic centers, and home dwellings (Friedman, Waller & Papadopoulos, 2015). The AANP states that the Nurse Practitioner (NP) “assess, diagnose and treat acute and chronic diseases as well as counsel, coordinate care and educate patients regarding their illnesses,” (AANP, 2019). A NP educates patients on the importance of hand hygiene and proper cleaning agents (primary). NPs can screen via nasal swabs for bacteria in asymptomatic patients (secondary). NPs isolate patients and administer antibiotics when appropriate (tertiary). The ARCC Model allows NPs to incorporate best evidence into practice as a mentor for direct care nurses on MRSA infections producing a culture of change to EB care (Curley & Vitale, 2016). The authority to screen, treat, analyze, and report data gives NPs the ability to further prevent the spread of MRSA infections. AACN MSN Essentials Essential I (Background for Practice from Sciences and Humanities): Acknowledges the master’s prepared nurse incorporating evidence-based findings from nursing, genetics, biopsychosocial disciplines, q