| Course | NUR-7072 Adult Primary Care Part II |
|---|---|
| Module | Module 1 |
| Paper type | Case paper: ear, nose and throat care |
| Length | About 1,055 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 7072 Module 1
Day Six or Day Twelve: Timing the Antibiotic Decision in Acute Sinusitis
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7072: Adult Primary Care Part II
Mentor Name
Month Day, Year
Day Six or Day Twelve: Timing the Antibiotic Decision in Acute Sinusitis
The Patient
Megan Fischer, an invented 38-year-old high school teacher, has had a blocked nose for six days, along with thick yellow discharge, pressure across her cheeks and a mild headache. Her symptoms began with a sore throat after several students were out sick. Her temperature has stayed at or below 100.2, and she reports no change in vision, puffiness around the eyes, severe headache or stiff neck. She has seasonal allergies and no history of chronic sinus disease. She asked for amoxicillin because "it always clears it up." Her examination showed swollen nasal mucosa with purulent discharge and mild tenderness over the maxillary sinuses, with normal ears, throat and neck.
Viral or Bacterial?
Rosenfeld et al. (2015) note that most acute rhinosinusitis is viral and resolves without antibiotics, often within 7 to 10 days. They recommend diagnosing acute bacterial rhinosinusitis only when purulent nasal discharge with obstruction or facial pain, pressure or fullness persists for 10 days or more without improvement, or when symptoms worsen within 10 days after an initial improvement, a pattern sometimes called double worsening. Color of the discharge alone does not distinguish bacterial from viral infection. They also advise against imaging for uncomplicated acute rhinosinusitis, reserving it for suspected complications or alternative diagnoses.
Chow et al. (2012), in the Infectious Diseases Society of America guideline, list three patterns pointing to a bacterial cause: symptoms that linger at least 10 days without getting better, a severe start with high fever of 39 C or more and pus-like discharge or facial pain lasting the first three or four days in a row, and a turn for the worse after early improvement. On day 6 with mild fever and steady symptoms, Ms. Fischer met none of these criteria. Her illness was most likely viral.
How Much Antibiotics Help
Lemiengre et al. (2018) reviewed 15 randomized trials involving 3,057 adults with acute rhinosinusitis diagnosed clinically or by imaging. Antibiotics modestly increased the chance of cure at 7 to 14 days: about 19 people needed to be treated for one additional person to be cured. Adverse effects, mostly gastrointestinal, were more common with antibiotics, with about one person in eight harmed for each additional person treated. The authors concluded that because most patients improve on their own, antibiotics offer little benefit for uncomplicated cases and that potential benefit must be weighed against side effects and resistance.
| Source | Key point | Application to Ms. Fischer |
|---|---|---|
| Rosenfeld et al. (2015) | Diagnose bacterial sinusitis at 10 days or with double worsening; no routine imaging | Day 6: viral; no imaging |
| Chow et al. (2012) | Three bacterial patterns; amoxicillin-clavulanate first line | Criteria met only on day 12 |
| Lemiengre et al. (2018) | Antibiotics help about 1 in 19 and harm about 1 in 8 | Watchful waiting is reasonable |
The First Visit
I explained that her pattern fit a viral infection and that antibiotics would not shorten it. To address her real concern, getting through the school week, we focused on symptom relief: rinsing her nose with saline morning and evening, an intranasal corticosteroid spray, which both guidelines support and which also treats her allergies, and acetaminophen or ibuprofen for pain. Chow and colleagues advise against routine antihistamines and decongestants. I gave her clear return criteria: symptoms lasting past day 10 without improvement, worsening after getting better, fever of 102 or higher or any swelling around the eyes, vision change, severe headache or stiff neck.
The Second Visit
Ms. Fischer returned on day 12. Her congestion and facial pressure had improved slightly around day 8 and then persisted, with ongoing purulent discharge; she still had no complications. She now met the guideline definition of acute bacterial rhinosinusitis. Rosenfeld and colleagues allow either watchful waiting or initial antibiotic therapy for uncomplicated cases, provided follow-up is assured. We reviewed the Cochrane numbers together. She chose treatment because she was missing class time, so she was prescribed a five- to seven-day course of amoxicillin-clavulanate at 875/125 mg every 12 hours, consistent with Chow and colleagues' preference for this agent over amoxicillin alone in adults. She has no penicillin allergy; for patients who do, doxycycline is the recommended alternative, while macrolides and trimethoprim-sulfamethoxazole are not recommended because of resistance.
Allergies in the Background
Ms. Fischer's seasonal allergies may have prolonged her congestion and made the viral illness feel worse. Continuing the intranasal steroid after the infection resolves, especially through her allergy season, may reduce future episodes of blocked sinus drainage. Saline irrigation can also continue as a simple daily habit during spring and fall.
Antibiotic Stewardship
The first visit was a stewardship decision as much as a clinical one. Unneeded antibiotics cause side effects, alter the gut microbiome and drive resistance in the community. Acknowledging her past experience, explaining the timeline and offering real symptom relief let her leave without a prescription she would otherwise have expected.
When to Worry
Complications of sinusitis are rare but serious. Redness or puffiness of the eyelids, seeing double, blurred or lost vision, a crushing headache, confusion or neck stiffness suggest orbital or intracranial spread and require same-day evaluation, often with imaging and specialist referral.
Follow-Up
She will call if she has not improved within 72 hours of starting antibiotics, at which point the diagnosis would be reconsidered and the antibiotic changed. Recurrent episodes, four or more a year, or symptoms lasting beyond 12 weeks would prompt evaluation for recurrent or chronic rhinosinusitis and referral to otolaryngology.
Documenting the Decision
The record for each visit noted the duration of symptoms, the criteria checked, the reason antibiotics were or were not given and the return instructions, which protects the patient and makes the reasoning clear to any clinician who sees her next.
Limits
Trials in the Cochrane review used varied diagnostic criteria, and few enrolled patients confirmed to have bacterial infection. Guideline thresholds such as 10 days are pragmatic rather than exact. The patient is invented.
Conclusion
Rosenfeld and colleagues and Chow and colleagues provided the timing rules that separate viral from bacterial sinusitis, and Lemiengre and colleagues showed that antibiotics help few patients while harming more. Symptom care and clear return criteria on day 6, and a shared decision for amoxicillin-clavulanate when bacterial criteria were met on day 12, gave Ms. Fischer the right treatment at the right time.
References
Chow, A. W., Benninger, M. S., Brook, I., Brozek, J. L., Goldstein, E. J. C., Hicks, L. A., Pankey, G. A., Seleznick, M., Volturo, G., Wald, E. R., & File, T. M. (2012). IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases, 54(8), e72-e112. https://doi.org/10.1093/cid/cis370
Lemiengre, M. B., van Driel, M. L., Merenstein, D., Liira, H., Mäkelä, M., & De Sutter, A. I. (2018). Antibiotics for acute rhinosinusitis in adults. Cochrane Database of Systematic Reviews, 2018(9), Article CD006089. https://doi.org/10.1002/14651858.CD006089.pub5
Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., Orlandi, R. R., Palmer, J. N., Patel, Z. M., Peters, A., Walsh, S. A., & Corrigan, M. D. (2015). Clinical practice guideline (update): Adult sinusitis. Otolaryngology-Head and Neck Surgery, 152(2 Suppl.), S1-S39. https://doi.org/10.1177/0194599815572097
What the NUR 7072 Module 1 instructions ask for
Otolaryngologic care opens the list of systems in TESU's catalog description of NUR-7072, and because TESU keeps the module outline for enrolled students, this opening paper takes the form of an acute sinusitis case. Present an adult with upper respiratory symptoms, their duration and examination findings, then apply guideline criteria to decide whether the illness is viral or bacterial and whether imaging is needed. Report evidence on how much antibiotics help, explain symptom care and return criteria and, if bacterial criteria are met, justify the antibiotic, dose and duration and name an alternative for penicillin allergy. Address stewardship and warning signs of complications. Some sections ask for a pediatric otitis media case instead. Ask whether a single visit or a follow-up visit should be described.
How the NUR 7072 Module 1 example is put together
Megan Fischer, an invented 38-year-old teacher, arrives on day 6 of sinus symptoms asking for amoxicillin. Rosenfeld and colleagues' timing rules and Chow and colleagues' three bacterial patterns show her illness is likely viral, and the Cochrane review's numbers on benefit and harm are set out with the guidelines in a table. Saline, an intranasal steroid and analgesics are offered with clear return criteria. On day 12 she meets bacterial criteria and chooses amoxicillin-clavulanate after a shared discussion. Sections on stewardship, warning signs of complications, follow-up, limits and a conclusion follow. Her seasonal allergies get their own section, explaining why the nasal steroid continues.
Reading the NUR 7072 Module 1 grading rubric
Sinusitis papers score well when duration and pattern, rather than the color of nasal discharge, drive the diagnosis and when imaging is avoided in uncomplicated cases. Readers look for accurate use of the 10-day and double worsening criteria, honest numbers on antibiotic benefit and harm and symptom care that addresses the patient's real concerns. When antibiotics are given, the first-line agent, dose, duration and penicillin allergy alternative should match the guideline. Clear return criteria and attention to orbital and intracranial warning signs show safe practice, and explaining the stewardship reasoning shows professional responsibility. Considering contributing conditions such as allergic rhinitis shows complete care. Documenting the reason for each decision at each visit shows medicolegal awareness.
NUR 7072 Module 1 help: mistakes that cost marks
Sinusitis papers often prescribe on the first visit because the discharge is yellow or the patient asks. Use duration and pattern to decide whether the illness is bacterial, explain why imaging is not needed and offer symptom relief that works. If bacterial criteria are met, compare waiting with treatment using real numbers, then choose the guideline's first-line agent and an allergy alternative. Give return criteria and warning signs in writing. Send your module prompt and the visit details for a free first draft built around that visit. Mention any allergies or chronic conditions that may be prolonging symptoms. If your instructor wants a SOAP note, keep the same reasoning in the assessment and plan sections.
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.
More NUR 7072 and M.S. in Nursing, Family Nurse Practitioner sample papers
- NUR 7072 Module 2: GERD and Dyspepsia Case Paper: Empiric PPI Trial, H. pylori Testing and PPI Safety
- NUR 7072 Module 3: Migraine Case Paper: Red Flags, Acute Treatment and When to Start Prevention
- NUR 7072 Module 4: Low Back Pain Case Paper: Red Flags, Risk Stratification and Nonpharmacologic First-Line Care
- NUR 7072 Module 5: Hypothyroidism Case Paper: Diagnosing Overt Disease and Starting Levothyroxine
- NUR 7072 Module 6: Urinary Tract Infection Case Paper: Diagnosing Cystitis in Women and Choosing First-Line Antibiotics
- NUR 7074 Module 3: Contraception Paper: Medical Eligibility, LARC Counseling and Respecting Choice for a Teen
- NUR 7070 Module 6: Procedures Paper: A Changing Mole, Dermoscopy and Excisional Biopsy
- NUR 7071 Module 2: Cholesterol Case Paper: Risk Estimation, Risk Enhancers and Starting a Statin
NUR 7072 Module 1 questions, answered
Where can I find a free NUR 7072 Module 1 sample paper?
The acute sinusitis case paper, from a viral first visit to an antibiotic decision on day 12, is on this page.
When is sinusitis considered bacterial?
When symptoms persist 10 days without improvement or worsen after initial improvement, or with severe onset and high fever.
Do antibiotics help acute sinusitis?
Lemiengre and colleagues found about 19 people must be treated for one extra cure, while about 1 in 8 has side effects.
What is the first-line antibiotic for adult bacterial sinusitis?
The IDSA guideline prefers amoxicillin-clavulanate for 5 to 7 days, with doxycycline for penicillin allergy.
Is imaging needed for acute sinusitis?
No; Rosenfeld and colleagues advise against it unless complications or another diagnosis are suspected.