1- After Each question, write down references2- 300 minimum wo.docx

1- After Each question, write down references
2- 300 minimum words for each question, you can go up to 700
words.
3- 2-3 references for each question
4- References should be within 5 years
5- I am in acute care nurse practitioner program.
Chamberlain College of Nursing NR449 Evidence-Based
Practice
NR449 RUA Topic Search Strategy.docx Revised 07/25/16 1
Required Uniform Assignment: Topic Search Strategy
PURPOSE
The Topic Search Strategy Paper is the first of three related
assignments which are due in Unit 3. The purpose of
this initial paper is to briefly describe your search strategies
when identifying two articles that pertain to an
evidence-based practice topic of interest.
COURSE OUTCOMES

This assignment enables the student to meet the following
course outcomes.
CO 1: Examine the sources of knowledge that contribute to
professional nursing practice. (PO #7)
CO 2: Apply research principles to the interpretation of the
content of published research studies. (POs #4 and
#8)
DUE DATE
Refer to the course calendar for due date. The college’s Late
Assignment policy applies to this activity.
POINTS POSSIBLE
This assignment is worth 160 points. The college’s Late
Assignment policy applies to this activity.
REQUIREMENTS
You will be assigned a group in unit 2 (located in the team
collaboration tab) to formulate an evidence-based
practice topic of interest that will be used to complete the unit 3
and unit 5 independent assignments, as well as
the group PowerPoint presentation in unit 7.
The paper will include the following.
a. Clinical Question
a. Describe problem
b. Significance of problem in terms of outcomes or statistics
c. Your PICOT question in support of the group topic
d. Purpose of your paper
b. Levels of Evidence
a. Type of question asked

b. Best evidence found to answer question
c. Search Strategy
a. Search terms
b. Databases used (you may use Google Scholar in addition to
the library databases; start with
the Library)
c. Refinement decisions made
d. Identification of two most relevant articles
d. Format
a. Correct grammar and spelling
b. Use of headings for each section
c. Use of APA format (sixth edition)
d. Page length: three to four pages
PREPARING THE PAPER
1. Please make sure you do not duplicate articles within your
group.
2. Paper should include a title page and a reference page.
Practice
NR449 RUA Topic Search Strategy.docx Revised 07/25/16 2

DIRECTIONS AND ASSIGNMENT CRITERIA
Assignment
Criteria
Points % Description
Clinical Question 45 28 1. Problem is described. What is the
focus of your group’s work?
2. Significance of the problem is described. What health
outcomes result from your problem? Or what statistics
document this is a problem? You may find support on
websites for government or professional organizations.
3. What is your PICOT question?
4. Purpose of your paper. What will your paper do or describe?
This is similar to a problem statement. “The purpose of this
paper is to . . .”
Levels of
Evidence
20 13 1. What type of question are you asking (therapy,
prognosis,
meaning, etc.)?
2. What is the best type of evidence to be found to answer that
question (e.g., RCT, cohort study, qualitative study)?
Search Strategy 65 41 1. Search topic(s) provided. What did
you use for search terms?
2. What database(s) did you use? Link your search with the

PICOT question described above.
3. As you did your search, what decisions did you make in
refinement to get your required articles down to a reasonable
number for review? Were any limits used? If so, what?
4. Identify the two most relevant and helpful articles that will
provide guidance for your next paper and the group’s work.
Why were these two selected?
Format 30 18 1. Correct grammar and spelling
2. Use of headings for each section: Clinical Question, Level
of
Evidence, Search Strategy, Conclusion
3. APA format (sixth
ed.)
4. Paper length: three to four pages
Total 160 100
Practice
NR449 RUA Topic Search Strategy docx Revised 07/25/2016 3

GRADING RUBRIC
Assignment
Criteria
Outstanding or Highest
Level of Performance
A (92–100%)
Very Good or High Level of
Performance
B (84–91%)
Competent or Satisfactory
Level of Performance
C (76–83%)
Poor, Failing or
Unsatisfactory Level of
Performance
F (0–75%)

Clinical Question
45 points
ALL elements present
1. Problem is presented clearly.
2. Significance of problem
is described completely.
3. PICOT question is presented.
4. Purpose of paper is stated.
42–45 points
All but one element present
38–41 points
ALL but two elements present
34–37 points

Three or more elements missing
2. Significance of problem is
described completely.
0–33 points
Levels of Evidence
20 points
1. Accurately identifies type of
question being asked.
2. Accurately identifies best type
of evidence available to
answer question being asked.
19-20 points
1. Accurately identifies type of
2. Inaccurately identifies best
type of evidence available to
answer question being asked.

17-18 points
1. Incompletely or inaccurately
identifies type of question
being asked.
2. Incompletely or inaccurately
identifies best type of
evidence available to answer
16 points
1. Does not identify type of
2. Does not identify best type of
evidence available to answer
0–15 points
Search Strategy
65 points
ALL elements present
1. Search topic(s) and terms

provided.
2. Includes database(s) used for
search and links to PICOT
question.
3. Explains process of refining
search to locate evidence.
4. Identifies and defends the
choice of the two most
relevant articles to provide
guidance for your next paper
and the group’s work.
60-65 points
All but one element present
provided.
question.

55-59 points
ALL but two elements present
provided.
question.
49-54 points
Three or more elements missing
provided.
question.

0–48 points
Practice
NR449 RUA Topic Search Strategy.docx Revised 07/25/2016
4
Format
30 p
o
i
n
t
s
1. Grammar and mechanics are
free of errors.
2. Headings are free of errors
and include all of the
following.

b. Level of Evidence
c. Search Strategy
d. Conclusion
3. APA format is used
without errors.
4. Total length: Three to four
pages, excluding references
and title page.
28–30 points
1. Grammar and mechanics
have no more than one
type of error.
2. Headings are free of
errors and include three
of the following.
c. Search Strategy
d. Conclusion
without errors.
4. Total length: Three to four
pages, excluding
references and title page.

26–27 points
1. Grammar and mechanics
have no more than two types
of errors.
2. Headings are free of
errors and include two of
the following.
b. Level of
Evidence
c. Search Strategy
d. Conclusion
without errors.
4. Total length: less than three
or more than four pages,
excluding references and
title page.
23–25 points
1. Grammar and mechanics have
three or more types of errors.
2. Headings have errors, are
missing, or include just one of
the following.

c. Search Strategy
d. Conclusion
without errors.
4. Total length: less than three
or more than four pages,
excluding references and title
page.
0–22 points
Total Points Possible = 160 points
DQ-1
Linezolid is a bacteriostatic oxazolidinone antibiotic which is
highly effective against gram-positive cocci, and also is
effective against methicillin-resistant gram-positive bacteria as
well as vancomycin-resistant enterococcal infections (Rebai,
Fitouhi, Daghmouri, & Bahri, 2019). This makes Linezolid an
effective second-line antibiotic when methicillin and penicillin
class antibiotics are not effective (Rebai, Fitouhi, Daghmouri, &
Bahri, 2019). Another point to remember with Linezolid is that
it is also effective at penetrating past the blood-brain barrier
and into the cerebral spinal fluid (Rebai, Fitouhi, Daghmouri, &
Bahri, 2019). Linezolid has not been approved for the treatment
of gram-negative infections, catheter-related bloodstream
infections, or catheter site infections (Azzouz & Preuss, 2019).
Linezolid is a synthetic drug whose mechanism of action

involves inhibiting bacterial protein synthesis by interfering
with translation (Azzouz & Preuss, 2019). Linezolid binds to
site 23s ribosomal RNA of the 50s subunit, which then prohibits
bacteria from forming a functional 70s which causes failure in
the bacterial multiplication process (Azzouz & Preuss, 2019).
This failure to multiply is what helps curb the extent of the
infection and ceases it from spreading, but does not kill already
established microorganisms in the body (Azzouz & Preuss,
2019).
Linezolid is also a reversible, non-selective monoamine oxidase
inhibitor which leads to increased concentration of
neurotransmitters such as epinephrine, norepinephrine,
dopamine, and serotonin in the central and sympathetic nervous
systems (Azzouz & Preuss, 2019). This is important to keep in
mind when ordering this antibiotic for a septic patient on
vasopressors as it can have a cumulative effect if the patient is
on levophed or an epinephrine drip (Azzouz & Preuss, 2019).
Also, use caution in patients with hypertension as it can cause
the GI tract to increase systemic absorption of large amounts of
tyramine from the diet and could cause life-threatening
hypertension (Azzouz & Preuss, 2019).
Monitoring for patients with linezolid includes vital signs,
blood glucose, weekly CBC and BNP (Azzouz & Preuss, 2019).
Common side effects of taking linezolid include
thrombocytopenia, low hemoglobin, leukopenia, headache,
nausea, diarrhea, elevated pancreatic enzymes, elevated LFTs,
and neuropathy (Azzouz & Preuss, 2019). There is also caution
in the use of linezolid in patients on an insulin drip or
hypoglycemic drugs which could lead to serotonin syndrome,
drugs, seizures, lactic acidosis (Azzouz & Preuss, 2019).
Contraindications include do not use linezolid within two weeks
of MAO inhibitors, avoid tyramine containing foods, and use
caution with serotonergic and adrenergic drugs (Azzouz &
Preuss, 2019). Avoid aged cheese, cured or smoked meats, draft
beer, fava beans, and soy products (Azzouz & Preuss, 2019).
Toxicity can occur in some patients but is rare, and there is no

antidote for linezolid, just supportive symptomatic treatment
(Azzouz & Preuss, 2019). Toxicity examples would be
exacerbations of adverse reactions (Azzouz & Preuss, 2019).
For example, if thrombocytopenia occurs, then the prescriber
would order a platelet transfusion (Azzouz & Preuss, 2019).
References:
Azzouz A. & Preuss C.V. (2019). Linezolid In: StatPearls.
Treasure Island (FL): StatPearls Publishing. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK539793/
Rebai, L., Fitouhi, N., Daghmouri, M. A., & Bahri, K. (2019).
Linezolid for the treatment of post neurosurgical infection
caused by methicillin-resistant Staphylococcus. Surgical
Neurology International, 10, 1–5. https://doi-
org.lopes.idm.oclc.org/10.25259/SNI_455_2019
DQ-2
Amoxicillin is a penicillin-type beta-lactam antibiotic that
interferes with cell wall bacterial synthesis on both gram-
negative and gram-positive bacteria (Yangyang et al., 2019).
For this reason, Amoxicillin is one of the most used broad-
spectrum antibiotics for fighting infections (Yangyang et al.,
2019). Amoxicillin is also effective at permeating tissues of the
human body, making it more effective than some other
penicillin class antibiotics (Yangyang et al., 2019). Amoxicillin
is effective and has antibacterial and bactericidal activity as
well as a relatively low cost, contributing to amoxicillin’s
frequent uses (Yangyang et al., 2019).
The mechanism of action includes the beta-lactam binding to
penicillin-binding proteins, inhibiting transpeptidation, leading
to activation of autolytic enzymes in the bacterial cell wall
(Akhavan & Vijhani, 2019). This process leads to the lysis of
the bacterial cell wall, destroying the invading organism
(Akhavan & Vijhani, 2019). Amoxicillin also has an additional
amino group to the penicillin portion, helping to prevent
bacterial resistance to amoxicillin (Akhavan & Vijhani, 2019).
Amoxicillin is given orally in two ways; immediate-release and

extended-release (Akhavan & Vijhani, 2019). The importance of
these two types of releases is that amoxicillin is time-dependent
in order to maintain serum levels in the body and continue its
effectiveness (Akhavan & Vijhani, 2019). This around the clock
dosing provides less variability in peaks and troughs of the
serum levels (Akhavan & Vijhani, 2019).
Amoxicillin is excreted by the kidneys, so in patients with a
renal history, some dose adjustments may be required to prevent
toxicity (Akhavan & Vijhani, 2019). Amoxicillin is also
dialyzable and should be given after hemodialysis (Akhavan &
Vijhani, 2019).
Adverse effects of amoxicillin include nausea, vomiting, and
diarrhea but is normally well tolerated (Akhavan & Vijhani,
2019). There can also be a superinfection in which an organism
is allowed to grow without competition from the originally
targeted organism that can be caused by amoxicillin
administration such as C-Diff colitis (Akhavan & Vijhani,
2019).
A severe adverse reaction can occur with amoxicillin as a type
1, 2, 3, or 4 hypersensitivity reaction and may cause
anaphylaxis requiring hospitalization (Akhavan & Vijhani,
2019). For this reason, it is important to screen the patient for
any sensitivities or allergies to antibiotics of the penicillin,
cephalosporin, or carbapenem class and amoxicillin would be
contraindicated in these patients (Akhavan & Monitoring for
amoxicillin includes attention to hypersensitivity reactions of
any kind while taking amoxicillin (Akhavan & Vijhani, 2019).
Also, monitoring for diarrhea would be an indication for
continued closer monitoring of diarrhea for fever, abdominal
cramping, and foul-smelling stool as this may be the onset of a
C-Diff infection and would require immediate intervention and
antibiotic change (Akhavan & Vijhani, 2019). In some cases,
amoxicillin may be prescribed for prolonged use, and in these
cases, hepatic and renal monitoring would be indicated to
prevent toxicity or organ damage (Akhavan & Vijhani, 2019).
References:

Akhavan, B.J., & Vijhani P. (2019). Amoxicillin In: StatPearls.
Treasure Island (FL): StatPearls Publishing. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK482250/
Yangyang, Z., Xing, X., Maoda, P., Min, Z., Kaizhou, X., … &
Jinyu, W. (2019). Depletion of Residual Amoxicillin and Its
Major Metabolites in Muscle, Liver and Kidney of Chicken.
Pakistan Veterinary Journal, 39(1), 19–24. https://doi-
org.lopes.idm.oclc.org/10.29261/pakvetj/2018.120
Vijhani, 2019).
DQ-3
Antibiotic stewardship and handwashing campaigns reduce C.
difficile infection without reported harms. There are an
estimated 350,000 C. difficile infection related hospitalizations
in the United States every year with approximately nine percent
ending in death. The number of patients discharged from the
hospital with any C. difficile related diagnosis has more than
doubled since the 1990s ( Butler et al.,2016). The Agency for
Healthcare Research and Quality (AHRQ) review update
included 93 articles published between 2010 and April 2015.
Based on a systematic review that included one randomized
controlled trial (RCT) and five interrupted time series studies,
antibiotic stewardship is associated with decreased C. difficile
infection. AHRQ review found high strength of evidence based
on four RCTs that oral vancomycin has higher initial C. difficile
infection cure rates compared with metronidazole (83.9% vs.
75.7%; number needed to treat = 12; 95% confidence interval, 7
to 35) (Butler et al.,2016).
An antimicrobial medication that inhibits bacterial protein
synthesis is vancomycin. The bactericidal action of vancomycin
results primarily from inhibition of cell-wall biosynthesis
(production of a chemical compound by a living organism). In
addition, vancomycin alters bacterial-cell-membrane
permeability and RNA synthesis(Micromedex, 2020). The key
role of the bacterial ribosome makes it an important target for
antibacterial agents such as vancomycin. A large number of

clinically useful antibiotics target this complex translational
ribonucleoprotein machinery. The majority of these compounds,
mostly of natural origin, bind to one of the three key ribosomal
sites: the decoding (or A-site) on the 30S, the peptidyl
transferase center (PTC) on the 50S, and the peptide exit tunnel
on the 50S. Antibiotics that bind the A-site, such as the
aminoglycosides like vancomycin, interfere with codon
recognition and translocation. Peptide bond formation is
inhibited when small molecules like oxazolidinones bind at the
peptidyl transferase center. Finally, macrolides tend to block
the growth of the amino acid chain at the peptide exit tunnel
(McCoy & Xie, 2011). Patient’s receiving vancomycin
monitoring include obtaining cultures and WBC count to
monitor for efficacy. Physical findings : Symptomatic
improvement, including resolution of fever, is indicative of
efficacy. Assessment of serum vancomycin trough
concentrations is recommended for monitoring efficacy.
Troughs should be obtained just prior to the next dose under
steady state conditions (approximately just before the fourth
dose) and then repeated as clinically necessary. To avoid the
development of resistance, target serum vancomycin trough
concentrations above 10 mg/L (7 mcmol/L) are recommended.
For complicated infections, such as endocarditis, osteomyelitis,
meningitis, bacteremia, and hospital acquired pneumonia caused
by Staphylococcus aureus, goal serum vancomycin trough
concentrations of 15 to 20 mg/L (10 to 14 mcmol/L) are
recommended to increase penetration, increase likelihood of
achieving target serum concentrations, and improve clinical
outcomes. Trough concentrations (not peak) are the most
accurate measure to monitor for efficacy. Trough monitoring is
recommended for patients receiving aggressive dosing (to attain
trough levels of 15 to 20 mg/L or 10 to 14 mcmol/L), in patients
at high risk for nephrotoxicity (receiving concomitant
nephrotoxins), patients with unstable renal function, and
patients receiving prolonged courses of treatment (more than 3
to 5 days). However, for lower intensity dosing (target troughs

less than 15 mg/L or 10 mcmol/L) and short course therapy,
frequent monitoring (more than 1 trough before the fourth dose)
is not recommended(Micromedex, 2020).
Toxicity: Close monitoring of serum concentrations of
vancomycin is recommended in neonates and children. Monitor
renal function for nephrotoxicity during and after completion of
therapy, especially in patients over 65 years of age. Monitor
serum vancomycin concentrations following oral administration,
especially in patients with inflammatory disorders of the
intestinal mucosa, renal insufficiency and/or colitis, and those
receiving concomitant therapy with an aminoglycoside
antibiotic. Contraindications: Assess WBC count periodically to
screen for neutropenia in patients on prolonged therapy with
vancomycin or those who are receiving concomitant drugs that
may cause neutropenia. Monitor auditory function, especially in
patients who receive excessive IV doses, have underlying
hearing loss, or who receive concomitant therapy with another
ototoxic agent such as when both Vancomycin and Amikacin is
ordered. Cholera Vaccine live reduced immune response to the
cholera vaccine. Antibiotics which possess activity against
Vibrio cholerae organisms may interfere with the
immunological response to the live cholera vaccine. Do not
administer the vaccine and antibiotics concomitantly; do not
administer the vaccine in patients who have received oral or
parenteral antibiotics within 14 daysprior to vaccination. CAM:
Vancomycin and St John’s wort has not been tested to determine
interaction(Micromedex, 2020).
Reference
Butler, M., Olson, A., Drekonja, D. (2016). Early diagnosis,
prevention, and treatment of Clostridium difficile. Retrieved
from Agency for Healthcare Research and Quality; March 2016.
https://ahrq-ehc-application.s3.amazonaws.com/media/pdf/c-
difficile-update_research.pdf.
McCoy, L.S, Xie,Y. (2011). Antibiotics that target protein
synthesis. Retrieved from Wiley Interdiscip Rev RNA. 2011
Mar-Apr;2(2):209-32. doi: 10.1002/wrna.60.

Micromedex. (2020). Vancomycin Hydrochloride. Retrieved
from www.micromedexsolutions.com,SSL+evidencexpert.

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