APN Capstone Portfolio Part 2 /NR661 APN Capstone Practicum part 2. Download to Score A

APN Capstone Portfolio Part 2 /NR661 APN Capstone Practicum part 2 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, quality, and organizational sciences for the persistent expansion of nursing care. This outcome has evidence-based support and demonstrates my comprehension of the evolving relationship between mind and body. NONPF Core Competencies Core Competency #3 (Quality): I have met this competency by referring to and utilizing clinical practice guideline that are evidence-based within the clinical setting while caring for my patients. This competency helped me recognize the immense impact evidence- based research has on my delivery of care and health outcomes. Chamberlain Program Outcomes PO #2 (Care Focused): This project demonstrated the necessity to effectively work within an interdisciplinary team to provide and result in positive health outcomes for the patient. It is our responsibility to maintain constant communication with our patients regarding their course of treatment and all involving specialties to promote self-care and provide the patient with a sense of control over their health care decisions. PO #5 (Extraordinary Nursing): This paper supports the use of this PO through the nurse practitioner’s leadership skills through patient advocacy, advocacy of the patient via a holistic and safe approach. By following this outcome, in clinical practice, my preceptor and I involved the patient and families in the treatment and decision-making process to make the most ethical and evidence-based decisions possible. Connect Our patients hold and expect us, as Nurse Practitioners, to a higher standard of practice. PO #3 is demonstrated by this. Evidence-based research fuels evidence-based practices propelling practitioners to provide safer, higher quality medical care than before. As future NPs it is paramount that we translate what we have learned via our day- to-day lives, masters level assignments and clinical rotations and transform that knowledge into research and theory-based practices. Reflection Program Outcomes, NONPF Core Competencies and MSN Essentials were learned. Although I was a student, my patients at once looked to me for safe and effective guidance. Because they bestowed their trust immediately upon our meeting, I was forced to make ethical determinations with every question, assessment, diagnosis, and therapy discussed. One example that occurred with virtually every patient I encountered was the possibility of polypharmacy and associated adverse reactions due to comorbidities and/or additional providers the patient may have. It was imperative that I performed a medication reconciliation with each patient to make sound decisions for them as not to cause possible life-threatening adverse reactions. It is my duty to advocate for the best health outcome possible and reduce the number of hospitalizations for my patients. Exemplar 2: NR503 Population Health, Epidemiology, & Statistical Principles Adult ADHD Attention-deficit/hyperactivity-disorder (ADHD) is a neurodevelopmental disorder society most associated with children. ADHD, however, often continues into adulthood and is frequently not recognized and diagnosed as symptoms may not become obvious. In addition, some treatments for treating adult ADHD is the same for the pediatric population, some medications are not, and vice versa (Mayo Clinic, 2017). How prevalent is ADHD in the adult population and can it be accurately diagnosed? Adult attention-deficit/hyperactivity-disorder (ADHD) functionally impairs adults in their daily life and can negatively affect friends and family around them. Adults who displayed signs and symptoms of ADHD by the age of 12 would be considered as having adult ADHD, even if they were not diagnosed as a child (Ginsberg, et al., 2014). It is estimated that 4% of adults have ADHD (Parekh, 2017). Males are more likely to be diagnosed with ADHD three times more than females as 12.9 percent of men versus 4.9 percent of women will be diagnosed with this disorder over their lifetime, and 4 percent of American adults live with ADHD (Holland, Riley & Krucik, 2017). Possible causes include a genetic component as individuals who have a parent or close family member also diagnosed with ADHD. It is believed that there is a minimum of two genes involved with ADHD. Environment (lead exposure) and problems during development are also believed to cause the development of ADHD (Mayo Clinic, 2017). Adult ADHD can present with many symptoms. Impulsiveness, disorganization and problems prioritizations, trouble multi-tasking, poor time management, having a hot temper as well as difficulty coping with stress are a few for adults living with ADHD (Mayo Clinic, 2017). Adult ADHD is also more difficult to accurately diagnose as it typically accompanied by other comorbidities such as anxiety disorders, learning disabilities, sleep disorders, substance abuse, disorders and mood and other psychiatric disorders, which can make diagnosing and treatment for ADHD more challenging (Leahy, 2018). Since the comorbidities mask the signs and symptoms of adult ADHD, it is often underdiagnosed and therefore inappropriately treated (Ginsburg, et al., 2014). Symptoms may decrease as people age; however, many adults continue to have significant signs that continue to negatively impact different areas of their day-to-day lives. It has been determined by the National Comorbidity Study (Paris, Baht & Thombs, 2015) that 4.4 percent of adults within the United States meet the diagnostic criteria for attention-deficit hyperactivity disorder, however, it may not reflect what percentage of these individuals are negatively impacted by ADHA and/or who would benefit from treatment. Because adult ADHD was not recognized as a valid disorder until the 1990’s in the Unites States, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) adjusted the criteria for ADHD in adults in the 2010’s (Faraone, 2017), I found limited research containing up-to-date and relative information regarding current prevalence and incidence rates (within the last five years). This included current prevalence and incidence rates of adult ADHD in the United States, let alone in Florida. It appears that research adult ADHD may only be growing out of its infancy according to current data. The National Institute of Mental Health (2017) states that the “overall prevalence of current adult ADHD is 4.4%. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSMV-IV) categorized the developmental differences in the prevalence of DSM-IV ADHD and its subtypes ADHD -C (the combined type), ADHD-H (hyperactive impulsive type) and ADHD-I (inattentive type) (Willcutt, 2012). Nationwide, with a Confidence Interval (CI) of 95% for individuals 19 years and older, it was concluded that there was a prevalence of 5.0% of individuals who had Total ADHD. With the same CI of 95%, research determined the following for ADHD-C, ADHD-H and ADHD-I, respectively; 1.1%, 1.6% and 2.4%. This was further broken down according to male and female participants (please see chart). Physicians, however, are required to report medications in E-FORSCE, Florida’s Prescription Drug Monitory Program (PDMP). E-FORSCE was created in 2009 by the Florida Department of Health. Its purpose is to monitor all prescriptions and disbursements by health care practitioners, pharmacies, and pharmacists of Schedule II (including Adderall and similar stimulant medications that treat ADHD), III, IV and V drugs (E-FORSCE, 2018). It is an initiative “to encourage safer prescribing of controlled substances and to reduce drug abuse within the state of Florida (E-FORSCE, 2018). Patients may also have a strong genetic connection to ADHD as genetic research is discovering that if a direct member of the family has been diagnosed with ADHD, such as the father, then there is a greater likelihood that a child born of that parent will also have ADHD as a child,