Synthesis Paper topic... do you have any ideas?

Specialties NICU

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I'm at a blank. I'm in neonatal nurse practitioner school, and need to decide on a topic for my synthesis paper. It needs to be somewhat narrow (we were told congenital diaphragmatic hernia was too broad), but broad enough that I can find enough articles to write the paper-- I'm at a blank. Please help if you have any good ideas! Thanks!

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Specializes in Nursing Professional Development.

Well ... what interests you? What led you to pursue the NNP role? Are there certain aspects of the NNP that particularly interest or appeal to you? Are there certain types of babies that fascinate you? Are there certain aspects of the care that particularly interest you?

Perhaps if you told us a little bit about your preferences and interests, we could help you narrow in on a focus that will appeal to you.

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My favorite system is respiratory; the fact that so many hospitals are using NCPAP on TINY patients fascinated me-- when I first started nursing, I was told these tiny infants didn't have the musculature to breathe on their own. And now they do, with the aid of NCPAP? I wonder if the early NCPAP really does anything to prevent BPD on ELBW infants. Bronchopulmonary dysplasia interests me, and I was thinking of doing something about prevention of BPD; there are some studies showing a link with vitamin A deficiency. I also wonder about the permissive hypercapnia-- is it really okay, or are we doing damage we haven't thought of?

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Specializes in Neonatal ICU (Cardiothoracic).

Khakisack,

I tried to pm you, but it must be disabled on your account. I NEED information from someone like you who is in an NNP program. Please PM me so we can chat!!

Stephen

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Specializes in Nursing Professional Development.

Ok. That's a good start. You're starting to focus in on something -- the causes of BPD and actions that might be taken to prevent it. That could be a paper topic. Go to the library and research the causes of BPD. See what literature is available that explain the causes ... what studies have been done on various modes of respiratory therapy and their influence on the development of BPD ... etc.

After you have surveyed the literature, then choose a particular emphasis for your paper based on the results of your lit survey. For example, if you try to discuss "everything ever written about BPD -- causes, incidence, treatments, long-term outcomes, etc. -- your instructor may feel that is too broad. You might want to focus in on one or two aspects only, such as the causes and the measures that have been tried to reduce the incidence. If you choose that focus, you won't elaborate on the management of patients with BPD etc. After reviewing the literature, you might choose another specific -- such as the role of barotrauma in the development of BPD and efforts to reduce barotrauma ... or oxygen saturation levels ... or ETCPAP vs NCPAP ... or methods of delivering NCPAP ... etc.

BTW ... I couldn't tell if you were joking about the rationale for CPAP or not. You do know it has nothing to do with muscles, right? If you weren't joking, you might want to start by getting a basic understanding of RDS and the rationale for CPAP before tackling a more complex topic such as BPD.

Good luck with your paper.

llg

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Specializes in Neonatal ICU (Cardiothoracic).

BTW ... I couldn't tell if you were joking about the rationale for CPAP or not. You do know it has nothing to do with muscles, right? If you weren't joking, you might want to start by getting a basic understanding of RDS and the rationale for CPAP before tackling a more complex topic such as BPD.

Wow, maybe I don't know either.....! I thought that CPAP improved oxygenation and CO2 removal by providing a constant PEEP which slightly distends the alveoli, preventing atelectasis, and improving oxygen transport across the pulmonary membranes. I thought that if the baby is unable to adequately move air due to underdeveloped diaphragmatic musculature, no amount of positive pressure ventilation is going to work. Mechanical ventilation would be the choice then. I'm not saying that 26-27 weekers can't do fine on vapotherm or NCPAP, but they usually get pretty tired. I guess I'll have to reread my textbook.....

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Specializes in NICU, Infection Control.

I think the additional pressure makes it much easier to breathe, less work for chest muscles.

In the "olden" days (before surfactant), you would watch the baby get more and more fatigued. The natural course of the disease is to get progressively worse for the 1st 48 hours--if you could keep the baby going for that long, w/o major complications like IVH, pneumothorax, and all the stars were in alignment, the baby would start getting better.

It used to be such a bad disease--it would just hurt to look at the baby trying to reinflate those alveoli w/each breath. Between surfactant, early nutrition, vapotherm and the like, it's still no fun, but what an improvement!

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Hey Steve-- I tried to PM you; don't know if you got it. Anyhow, if you didn't, just email me at my name (khakisack) at gmail.com

Thanks!

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