| Course | NUR-7071 Adult Primary Care Part I |
|---|---|
| Module | Module 4 |
| Paper type | Case paper: COPD in primary care |
| Length | About 1,026 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7071 Module 4
Winded on the Stairs: Starting COPD Care With Spirometry and Two Bronchodilators
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7071: Adult Primary Care Part I
Mentor Name
Month Day, Year
Winded on the Stairs: Starting COPD Care With Spirometry and Two Bronchodilators
The Patient
Walter Kaminski, an invented 66-year-old retired machinist, has smoked roughly 20 cigarettes daily from age 21, roughly 45 pack-years. For two years he has been short of breath climbing the two flights to his apartment and has had a morning cough with clear sputum. Last February he had a chest cold that left him wheezing for two weeks; urgent care gave him prednisone and an antibiotic, and he was not hospitalized. He takes no inhalers. On examination his breath sounds are diminished, with a prolonged expiratory phase, and his oxygen saturation is 94 percent at rest.
Confirming the Diagnosis
Agustí et al. (2023) state that spirometry is required to diagnose COPD: persistent obstruction is confirmed when FEV1 divided by forced vital capacity stays under 0.70 after a bronchodilator in a person with symptoms and exposure. Mr. Kaminski's post-bronchodilator ratio was 0.62 and his FEV1 was 58 percent of predicted, placing him in GOLD grade 2, moderate airflow obstruction. A chest radiograph showed hyperinflation without masses, and blood eosinophils measured 150 per microliter.
Assessing Symptoms and Risk
The 2023 GOLD summary separates airflow grade from a symptom and exacerbation assessment. Symptoms are measured with the modified Medical Research Council dyspnea scale or the COPD Assessment Test. Mr. Kaminski scored 2 on the dyspnea scale, stopping for breath when walking at his own pace on level ground, and 18 on the assessment test. The 2023 report folded the old groups C and D into one group, E, defined by at least two moderate flares or any flare needing hospital care in the prior year. With one moderate exacerbation and high symptoms, Mr. Kaminski is in group B.
Choosing Initial Therapy
For group B, the 2023 summary recommends a long-acting beta agonist combined with a long-acting muscarinic antagonist, preferably in one inhaler, because the combination does more for lung function and breathlessness than one drug by itself. For group E, the same dual therapy is recommended, with an inhaled corticosteroid added for patients whose blood eosinophils are 300 or more. The summary discourages a long-acting beta agonist with an inhaled corticosteroid but without a muscarinic antagonist. Short-acting bronchodilators are prescribed for rescue in all groups.
When Inhaled Steroids Help
Lipson et al. (2018) compared once-daily triple therapy, fluticasone furoate with umeclidinium and vilanterol, against two dual combinations in 10,355 people whose COPD caused symptoms and who had flared in the previous year. Triple therapy brought the yearly rate of moderate or severe flares down to 0.91, compared with 1.07 for the steroid with a beta agonist and 1.21 for the two bronchodilators, but pneumonia was more common in the groups receiving an inhaled steroid. Later analyses linked the steroid's benefit to higher eosinophil counts. For a patient like Mr. Kaminski, with one exacerbation and eosinophils of 150, the trial supports starting without a steroid and reconsidering if flares become frequent.
| Source | Key point | Application to Mr. Kaminski |
|---|---|---|
| Agustí et al. (2023) | Spirometry confirms COPD; group B starts dual long-acting bronchodilators | Ratio 0.62, group B, dual inhaler |
| Lipson et al. (2018) | Triple therapy cut exacerbations but raised pneumonia | No steroid now with eosinophils of 150 |
| McCarthy et al. (2015) | Patients walk farther and feel better after rehabilitation | Referral to a hospital program |
Pulmonary Rehabilitation
McCarthy et al. (2015) reviewed 65 randomized trials with 3,822 participants and found that pulmonary rehabilitation, including exercise training for at least four weeks, improved quality of life and exercise capacity in people with COPD, with gains in walking distance and in fatigue, dyspnea and mastery scores larger than the minimum differences patients notice. The reviewers judged that more trials pitting rehabilitation against usual care were not needed. Mr. Kaminski was referred to a hospital program twice a week for eight weeks; Medicare covers it for patients with his severity.
Oxygen and Activity
His resting oxygen saturation of 94 percent does not call for supplemental oxygen. A six-minute walk test in the clinic showed saturation staying above 90 percent, with breathlessness limiting him before his oxygen level did. That result will also serve as a baseline for judging the benefit of rehabilitation.
Plan
Umeclidinium-vilanterol was started, one inhalation daily, with albuterol for rescue. I watched him use both inhalers and taught him to rinse his mouth only if a steroid is later added. We agreed on a written action plan: increase albuterol and call the clinic the same day if his breathing or sputum worsens for more than a day.
Smoking Cessation
Quitting is the single change that slows his lung function decline. Mr. Kaminski has tried twice to quit on his own. He agreed to start varenicline one week before a quit date, combined with counseling through the state quitline, and we will check on him by phone in two weeks.
Vaccines and Screening
He received influenza and pneumococcal vaccines and is due for an updated COVID-19 vaccine and a respiratory syncytial virus vaccine, recommended for adults his age with chronic lung disease. At 66 with 45 pack-years and current smoking, he meets the US criteria for yearly low-dose CT screening for lung cancer, and a referral was made after discussing benefits and harms.
Follow-Up
He will return in four to six weeks to check inhaler technique, symptoms and smoking, and his assessment scores will be repeated. Should flares become frequent, two moderate ones in a year or one needing a hospital stay, he would move to group E and an inhaled steroid would be reconsidered, guided by eosinophils.
Limits
The IMPACT trial enrolled patients with more frequent exacerbations than Mr. Kaminski and was sponsored by the manufacturer. Rehabilitation programs have waiting lists and travel costs. The patient is invented.
Conclusion
Agustí and colleagues guided the diagnosis by spirometry, the assignment to group B and the choice of two long-acting bronchodilators, Lipson and colleagues showed when an inhaled steroid adds benefit and at what risk and McCarthy and colleagues showed that rehabilitation improves how patients feel and function. Dual bronchodilators, rehabilitation, a serious quit attempt, vaccines and lung cancer screening give Mr. Kaminski a full plan rather than an inhaler alone.
References
Agustí, A., Celli, B. R., Criner, G. J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M. K., Martinez, F. J., Montes de Oca, M., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D. D., Singh, D., Stockley, R., López Varela, M. V., . . . Vogelmeier, C. F. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary. European Respiratory Journal, 61(4), Article 2300239. https://doi.org/10.1183/13993003.00239-2023
Lipson, D. A., Barnhart, F., Brealey, N., Brooks, J., Criner, G. J., Day, N. C., Dransfield, M. T., Halpin, D. M. G., Han, M. K., Jones, C. E., Kilbride, S., Lange, P., Lomas, D. A., Martinez, F. J., Singh, D., Tabberer, M., Wise, R. A., & Pascoe, S. J. (2018). Once-daily single-inhaler triple versus dual therapy in patients with COPD. New England Journal of Medicine, 378(18), 1671-1680. https://doi.org/10.1056/NEJMoa1713901
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015(2), Article CD003793. https://doi.org/10.1002/14651858.CD003793.pub3
NUR 7071 Module 4 instructions, in plain terms
Respiratory care appears in TESU's catalog description of NUR-7071 alongside health promotion and screening, and with the course outline unavailable outside the classroom, this fourth paper is modeled as a COPD case. Present an adult with exposure history, symptoms and post-bronchodilator spirometry, then confirm the diagnosis and assign the airflow grade and symptom-exacerbation group using current GOLD criteria. Justify initial inhaled therapy, explain when an inhaled steroid would be added and refer for pulmonary rehabilitation. Include smoking cessation with medication, vaccines, lung cancer screening eligibility and a written action plan. Set follow-up and criteria for changing therapy. Some sections focus on an exacerbation visit instead. Check whether your instructor uses the current GOLD report or an earlier edition.
Inside the NUR 7071 Module 4 example
Walter Kaminski, an invented 66-year-old machinist with 45 pack-years, is short of breath on stairs and had one flare last year. Spirometry shows a ratio of 0.62 and FEV1 of 58 percent, and his symptom scores place him in GOLD group B. The GOLD summary, the IMPACT trial and the Cochrane review are tied to decisions in a table. A dual bronchodilator is started, an inhaled steroid is deferred because his eosinophils are 150 and he is referred for rehabilitation. Smoking cessation with varenicline, vaccines, lung cancer screening, follow-up, limits and a conclusion follow. Oxygen is ruled out with a six-minute walk test.
Where the marks sit in the NUR 7071 Module 4 rubric
COPD case papers earn credit when the diagnosis rests on post-bronchodilator spirometry and the patient is placed in the correct airflow grade and group under the current GOLD report. Readers look for initial therapy that matches the group, a clear rationale for adding or withholding an inhaled steroid based on exacerbations and eosinophils and a referral to rehabilitation. Smoking cessation with medication and counseling, vaccines and lung cancer screening eligibility show complete prevention. An action plan for flares and criteria for changing therapy at follow-up show the student is managing a chronic disease, not a single visit. Using a walk test as a baseline for rehabilitation shows thinking ahead. Recording a baseline walk distance gives rehabilitation a measurable starting point.
NUR 7071 Module 4 help from the desk
COPD papers often skip spirometry or use outdated groupings. Confirm the diagnosis with a post-bronchodilator ratio, assign the airflow grade and the current symptom-exacerbation group and choose therapy for that group. Explain why you added or withheld an inhaled steroid, refer for rehabilitation and treat tobacco use with medication and counseling. Check vaccines and lung cancer screening eligibility, and write an action plan. Tell us your module prompt and the patient's spirometry and history, and a free first draft can be prepared from them. If the patient has already quit smoking, note relapse prevention instead. Naming who will help him quit, such as the state quitline, shows the plan is practical.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7071 Module 4 questions, answered
Where can I find a free NUR 7071 Module 4 sample paper?
The COPD case paper, from spirometry to dual bronchodilators and rehabilitation, is posted here.
How is COPD diagnosed?
Spirometry after a bronchodilator with an FEV1/FVC under 0.70, in someone with symptoms and exposure.
What changed in the 2023 GOLD groups?
Groups C and D were merged into group E for patients with frequent or hospitalized exacerbations.
When should an inhaled steroid be added in COPD?
GOLD suggests it for group E patients with blood eosinophils of 300 or more; IMPACT showed fewer exacerbations but more pneumonia.
Does pulmonary rehabilitation help COPD?
McCarthy and colleagues found patients walked farther and reported better quality of life, by margins they could feel.