NR661 APN Capstone Practicum/NR661 Capstone2

APN CAPSTONE PORTFOLIO PART 2 1




Capstone Portfolio Part

2 NR661 APN Capstone

Practicum




NR661 Capstone2

, APN CAPSTONE PORTFOLIO PART 2 2

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




NR661 Capstone2

, APN CAPSTONE PORTFOLIO PART 2 3

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




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, APN CAPSTONE PORTFOLIO PART 2 4

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




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