This NURS N8284 sample answer shows one way to structure the NURS N8284 respiratory nursing care case study at DkIT using a fictional, anonymised patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Every detail about the patient, ward and hospital is invented for illustration. Your own case must come from a real patient you nursed on placement, with pseudonyms throughout. For a step-by-step method, read our guide on how to approach a respiratory nursing case study.

Planning table

Section	Suggested words (of 2,000)	What markers look for
1. Introduction and presentation of the individual	150	Pseudonym, consent, confidentiality, relevant history, why the case was chosen
2. Understanding the respiratory condition	400	Epidemiology, aetiology, pathophysiology linked to this patient’s signs
3. Assessment, planning, implementation, evaluation	600	Roper, Logan and Tierney (RLT) activities of living, focused respiratory assessment, three prioritised problems, evaluation
4. Pharmacological management	300	Drug action, dose route, side effects, nursing responsibilities, evidence
5. Prevention, education and ongoing care	300	Self-management, vaccination, smoking cessation, pulmonary rehabilitation, referral
6. Conclusion	100	Summary only, no new information
7. Reference list	Excluded from count	Accurate DkIT Harvard citations that match the list

The mark split for each section is on the question page, so check your brief for the exact weightings and deadline before you allocate words.

1. Introduction and presentation of the individual

This case study examines the care of “Mr Brennan” (pseudonym), a 71-year-old retired man admitted to “St Declan’s Ward” in “Riverside Hospital” (both pseudonyms) with an acute exacerbation of COPD. Verbal consent was obtained and all identifying details have been removed in line with the Nursing and Midwifery Board of Ireland (NMBI) Code (NMBI, 2021). The Roper, Logan and Tierney model structures the assessment because its activities of living capture how breathlessness affects daily life, not only physiological measures (Roper, Logan and Tierney, 2000).

Mr Brennan has a 40 pack-year smoking history, stopped smoking four years ago and lives alone. He presented with three days of increased breathlessness, a productive cough with green sputum and reduced exercise tolerance. His observations on admission are illustrative only: respiratory rate 28 breaths per minute, oxygen saturation 86% on air, pulse 104 beats per minute and temperature 37.9 degrees Celsius.

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2. Understanding the respiratory condition

COPD is a common, preventable and treatable condition characterised by persistent respiratory symptoms and airflow limitation, caused by airway and alveolar abnormalities usually following significant exposure to noxious particles or gases (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2025). Tobacco smoke is the main cause in Ireland, although occupational dusts and fumes also contribute. The HSE model of care identifies COPD as a major cause of unscheduled hospital admission and describes an integrated pathway between hospital and community (Health Service Executive (HSE), 2019).

Pathophysiology linked to the patient

Chronic inflammation narrows the small airways, increases mucus production and, in emphysema, destroys alveolar walls and reduces elastic recoil. Expiratory airflow is limited and air becomes trapped, so the lungs hyperinflate and the work of breathing rises (GOLD, 2025). During an exacerbation, infection or irritants increase airway inflammation, mucus and bronchoconstriction. This explains Mr Brennan’s wheeze, purulent sputum, use of accessory muscles and low saturation, because ventilation-perfusion mismatch lowers arterial oxygen.

Patients with COPD are at risk of hypercapnic respiratory failure if given high-concentration oxygen, mainly through worsening ventilation-perfusion mismatch. For this reason, the nurse targets a saturation range of 88 to 92% until blood gases show the risk of acidosis is excluded (O’Driscoll et al., 2017).

3. Assessment, planning, implementation and evaluation

Focused respiratory assessment

An ABCDE approach was used first. Airway was patent; breathing was fast, shallow and effortful with prolonged expiration and expiratory wheeze; circulation showed tachycardia. Sputum colour, peak of breathlessness, speech in full sentences and the early warning score were recorded. An arterial blood gas and chest X-ray were requested by the medical team.

RLT activities of living (summary)

Activity of living	Finding for Mr Brennan (fictional)	Nursing implication
Maintaining a safe environment	Lives alone, fear of falling when breathless	Falls risk assessment, discharge planning
Breathing	Dyspnoea, wheeze, purulent sputum, saturation 86%	Priority problem, see below
Eating and drinking	Reduced appetite, tires while eating	Small frequent meals, dietitian referral, weigh weekly
Mobilising	Walks about 20 metres before stopping	Graded mobilisation with physiotherapy
Sleeping	Wakes breathless, uses three pillows	Upright positioning, review night-time symptoms
Working and playing	Anxious, has stopped his gardening	Explore goals, reassurance, rehabilitation referral

Three prioritised nursing problems

Problems were prioritised using an airway, breathing, circulation logic, so physiological safety comes before education and psychosocial needs. The table is illustrative.

Priority and problem	Goal	Key interventions and rationale	Evaluation
1. Impaired gas exchange and ineffective breathing pattern related to airway inflammation and mucus	Saturation 88 to 92% within one hour; respiratory rate below 24 within 24 hours	Controlled oxygen via Venturi mask, upright positioning, nebulised bronchodilators, hourly observations, escalation by early warning score (O’Driscoll et al., 2017; GOLD, 2025)	By 24 hours, saturation 91% on 28% oxygen, respiratory rate 22; goal met
2. Ineffective airway clearance related to thick sputum and fatigue	Patient expectorates effectively and speaks in full sentences by day 3	Hydration, active cycle of breathing techniques with physiotherapy, sputum sample before antibiotics, record colour and volume	Sputum lighter and easier to clear by day 3; goal met
3. Anxiety and knowledge deficit about the condition, related to repeated breathlessness	Patient names two self-management actions before discharge	Calm presence, pursed-lip breathing, inhaler technique teaching with teach-back, written action plan	Demonstrated technique correctly; named two actions; goal partly met, to reinforce at follow-up

Person-centred practice meant asking Mr Brennan what mattered most. He wanted to return to his allotment, so goals were framed around that outcome. This reflects the NMBI principle of respecting the person’s dignity and autonomy (NMBI, 2021). Evaluation drew on observations, the patient’s own account and multidisciplinary review.

Students who struggle to turn placement notes into a prioritised plan can look at our nursing and healthcare assignment support.

4. Pharmacological management

Treatment followed national and international guidance, and doses are those prescribed in the fictional chart. Always check current local policy and the British National Formulary (BNF) before citing a dose.

Salbutamol and ipratropium (bronchodilators)

Salbutamol is a short-acting beta-2 agonist that relaxes bronchial smooth muscle and gives rapid relief. Ipratropium is a short-acting antimuscarinic that blocks acetylcholine-mediated bronchoconstriction. GOLD recommends short-acting bronchodilators as the initial treatment of an exacerbation (GOLD, 2025). Nurses monitor for tremor, tachycardia and hypokalaemia with salbutamol, and for dry mouth or urinary retention with ipratropium (Joint Formulary Committee, 2026). When nebulisers are driven by oxygen in a patient at risk of hypercapnia, the delivery time should be limited, or air-driven devices used, as recommended in the oxygen guideline (O’Driscoll et al., 2017).

Prednisolone (systemic corticosteroid)

Oral corticosteroids reduce airway inflammation, shorten recovery time and improve lung function. GOLD suggests 40 mg prednisone-equivalent daily for five days (GOLD, 2025), and a randomised trial found that a five-day course was non-inferior to 14 days for later exacerbation outcomes (Leuppi et al., 2013). Nursing responsibilities include giving the dose with or after food, monitoring blood glucose, mood changes and fluid balance, and explaining that short courses do not normally need tapering.

Antibiotic therapy

Mr Brennan had increased sputum purulence and dyspnoea, which supports antibiotic use under both GOLD and National Institute for Health and Care Excellence (NICE) guidance (GOLD, 2025; NICE, 2018). The nurse checks allergies, takes cultures before the first dose, reviews the antimicrobial prescription at 48 to 72 hours and records any diarrhoea. Following local antimicrobial stewardship protects against resistance.

5. Prevention, education and ongoing care

Preventing the next exacerbation is the nurse’s main long-term contribution. Mr Brennan received teaching on inhaler technique, recognising early warning signs (more breathlessness, change in sputum colour) and when to contact his GP or the community COPD team. Influenza and pneumococcal vaccination, continued smoking abstinence and a referral to pulmonary rehabilitation were discussed in line with GOLD (2025) and the HSE model of care (HSE, 2019).

Written action plans, early supported discharge and follow-up within a short period after admission reduce the risk of readmission, although the evidence is stronger for rehabilitation than for any single education session (GOLD, 2025). The nurse also liaises with the general practitioner, public health nurse and occupational therapy to ensure that a man who lives alone is safe at home.

For further examples of how nursing briefs are structured, see our DkIT NURS N8174 older adult and palliative care brief.

6. Conclusion

This case study applied the Roper, Logan and Tierney model to a fictional man with an exacerbation of COPD. Three prioritised problems, gas exchange, airway clearance and anxiety with limited knowledge, were addressed through evidence-based nursing and drug therapy. The care aligned with national and international guidance and the NMBI Code, and preventive education was central to reducing readmission.

If you would like a bespoke case study written to your own brief and referencing style, you can submit your assignment details for a quote.

References

Global Initiative for Chronic Obstructive Lung Disease (2025) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. Available at: https://goldcopd.org/2025-gold-report/ (Accessed: 5 November 2026).

Health Service Executive (2019) End to end COPD model of care. Dublin: HSE National Clinical Programme for Respiratory. Available at: https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/copd/moc/end-to-end-copd-model-of-care-december-2019.pdf (Accessed: 5 November 2026).

Joint Formulary Committee (2026) British National Formulary. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/ (Accessed: 5 November 2026).

Leuppi, J.D., Schuetz, P., Bingisser, R., Bodmer, M., Briel, M., Drescher, T. et al. (2013) ‘Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial’, JAMA, 309(21), pp. 2223-2231.

National Institute for Health and Care Excellence (2018) Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NG115). London: NICE. Available at: https://www.nice.org.uk/guidance/ng115 (Accessed: 5 November 2026).

Nursing and Midwifery Board of Ireland (2021) Code of professional conduct and ethics for registered nurses and registered midwives. Dublin: NMBI.

O’Driscoll, B.R., Howard, L.S., Earis, J. and Mak, V. (2017) ‘BTS guideline for oxygen use in adults in healthcare and emergency settings’, Thorax, 72(Suppl 1), pp. ii1-ii90.

Roper, N., Logan, W.W. and Tierney, A.J. (2000) The Roper-Logan-Tierney model of nursing: based on activities of living. Edinburgh: Churchill Livingstone.

Prepared by

Ireland Assignment Helper Editorial Team

This model answer was prepared by our editorial team in response to a real assignment brief we received. It shows one way to approach the task and is meant as a study guide, not for submission.