NBNS2113 Respiratory Nursing Assignment Sample: COPD and NIPPV | OUM
For information and reference only – not to be submitted as your own work.
This sample shows how a strong answer to Part I of the Open University Malaysia (OUM) NBNS2113 Respiratory Nursing assignment (September 2026 semester) can be organised. The case concerns a 67-year-old man with chronic obstructive pulmonary disease (COPD), repeated admissions and a deterioration into acute respiratory failure that needs non-invasive positive pressure ventilation (NIPPV). Browse similar briefs on the OUM question hub (add the NBNS2113 question link when it is live). For the marking logic behind this layout, read the companion NBNS2113 COPD and NIPPV assignment guide.
Only an extract is shown. The real answer must run to 2,500 to 3,000 words excluding references, use APA 7, and follow your own brief and rubric exactly.
Part I.1 Factors behind recurrent exacerbations
An exacerbation is an acute worsening of breathlessness, cough or sputum beyond normal day-to-day variation, and it usually needs a change in treatment. Recurrent admissions in one patient rarely have a single cause. The strongest answers group the factors, link each to the patient’s profile, and show the nursing relevance. The table below is a model layout, not a complete list.
| Factor | How it drives exacerbations | Nursing relevance |
|---|---|---|
| Respiratory infection | Viral and bacterial infections increase airway inflammation and mucus, the commonest trigger of acute worsening (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2025). | Early recognition of sputum change and fever; check vaccination status. |
| Poor adherence and inhaler technique | Incorrect technique reduces drug delivery to the lung, so controller therapy fails even when it is prescribed. | Observe a return demonstration at every contact; use teach-back. |
| Continued smoking | Ongoing exposure sustains inflammation and accelerates lung function loss. | Brief advice at each visit and referral to cessation support. |
| Comorbidities | Heart failure, diabetes and depression worsen symptoms and complicate recovery. | Holistic assessment rather than a lung-only focus. |
| Air pollution and haze | Particulate exposure during haze episodes irritates already damaged airways. | Advise on haze alerts, masks, indoor air and medication supply. |
| No pulmonary rehabilitation | Deconditioning increases breathlessness and fear of exertion. The Malaysian guideline notes limited programme availability (Academy of Medicine Malaysia et al., 2009). | Identify local programmes and referral routes. |
| Weak self-management | Late response to early warning signs delays treatment and leads to emergency attendance. | Written action plan reviewed with patient and family. |
| Frailty and social factors | Weakness, malnutrition and living alone reduce coping capacity. | Involve family, dietitian and community nursing. |
In your own paragraph, pick the two or three factors that best fit the synopsis and argue why they matter most for this patient. A list of eight factors with one line each earns far less than a short, reasoned prioritisation.
Part I.1 Strategies to prevent exacerbations and readmission
Each strategy should state who does what, when, and what outcome it targets. Link every row to a guideline or a systematic review.
| Strategy | Nursing action | Intended outcome | Support |
|---|---|---|---|
| Vaccination | Check and offer influenza and pneumococcal vaccines before discharge. | Fewer infective triggers. | Malaysian CPG; GOLD (2025) |
| Inhaler technique | Teach, observe, correct, and repeat at follow-up. | Reliable drug delivery. | GOLD (2025) |
| Pulmonary rehabilitation | Refer after the acute episode; support attendance. | Better exercise tolerance, fewer readmissions. | Puhan et al. (2016) |
| Smoking cessation | Brief advice, counselling, pharmacotherapy referral. | Slower decline, fewer episodes. | Malaysian CPG; GOLD (2025) |
| Written action plan | Co-create with the patient: what to do at the first sign of worsening. | Earlier treatment. | GOLD (2025) |
| Post-discharge follow-up | Early contact by telephone or clinic; medication reconciliation. | Catch relapse before readmission. | GOLD (2025) |
A Cochrane review concluded that pulmonary rehabilitation started soon after an exacerbation reduces hospital readmissions and improves quality of life (Puhan et al., 2016). The Malaysian guideline recommends rehabilitation for symptomatic patients with moderate to very severe disease (Academy of Medicine Malaysia et al., 2009). Note that this guideline dates from 2009, so use it for local context and pair it with the current GOLD report for up-to-date recommendations.
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Part I.2 Nursing role during acute deterioration
When the patient deteriorates, the nurse is usually first to detect it. Structure this section around ABCDE assessment, because markers look for a systematic, prioritised approach rather than a list of tasks.
- Airway and breathing: check patency, respiratory rate, accessory muscle use, speech in full sentences, and oxygen saturation. Sit the patient upright, supported by pillows.
- Controlled oxygen: in patients at risk of hypercapnic failure, aim for 88 to 92 per cent saturation, using a fixed-performance device such as a Venturi mask (O’Driscoll et al., 2017). Uncontrolled high-flow oxygen can worsen carbon dioxide retention.
- Circulation: pulse, blood pressure, capillary refill, ECG if tachycardic or irregular.
- Disability and exposure: new drowsiness or confusion may signal rising carbon dioxide; check blood glucose and temperature.
- Escalate early: use the local early warning score, call for senior review, and document times and responses.
Interpreting the arterial blood gas
The following values are illustrative, not from the brief. Suppose the gas on controlled oxygen shows pH 7.28, PaCO2 8.9 kPa and bicarbonate 32 mmol/L. The low pH with raised PaCO2 indicates respiratory acidosis. The raised bicarbonate suggests chronic retention with renal compensation, so this is acute-on-chronic. The BTS/ICS guideline advises starting NIV when pH is below 7.35 and PaCO2 above 6.5 kPa persist despite optimal medical therapy (Davidson et al., 2016). In an answer, state the thresholds, interpret the example, then explain what the nurse does next: inform the medical team, prepare equipment, and explain the plan to the patient.
Part I.2 Nursing care during NIPPV
NIPPV delivers pressure support through a mask, usually a full face mask first (Davidson et al., 2016). Present the care as a table linked to problems and rationales.
| Care domain | Nursing action | Rationale |
|---|---|---|
| Mask fit and skin | Size correctly, protect pressure points with a dressing, inspect the nasal bridge each shift. | Leaks reduce effectiveness; pressure injury is common. |
| Settings (IPAP/EPAP) | Check prescribed pressures against the machine; watch tidal volume, leak and chest rise. | Inspiratory support lowers work of breathing; EPAP keeps airways open. |
| Gas exchange | Continuous SpO2 with a 88 to 92 per cent target; arterial gas after the first one to two hours or sooner if worsening. | Early response predicts success or failure. |
| Aspiration and gastric distension | Upright position, monitor abdomen, reduce swallowed air, check nausea. | Vomiting into a tight mask is dangerous. |
| Communication and anxiety | Explain each step, agree a hand signal, give reassurance and a call bell. | Anxiety causes poor tolerance and mask removal. |
| Nutrition, hydration, oral care | Plan breaks, offer small feeds, mouth care, humidification. | Prevents dry mucosa and fatigue. |
| Weaning | Gradual increases in time off the mask once gases and effort improve. | Avoids sudden relapse. |
| Escalation criteria | Report worsening pH, rising respiratory rate, falling consciousness, exhaustion. | NIV should not delay intubation when it is more appropriate (Davidson et al., 2016). |
Closing paragraph (extract)
Recurrent exacerbations in this patient reflect interacting clinical, behavioural and environmental factors, which is why prevention must be coordinated across hospital and community. During acute deterioration, systematic assessment, controlled oxygen, timely blood gas interpretation and careful NIPPV management protect the patient while the cause is treated. Nursing leadership at each step, from the first observation to the discharge plan, shapes whether the next admission is avoided.
Need help structuring your own NBNS2113 answer? See our nursing assignment help page or the OUM assignment helper service.
About the expert
Amira Binti Kamarulzaman holds a Bachelor’s degree in Biotechnology from Universiti Putra Malaysia. Her profile lists about five years as a research scientist and about three years as an academic writer, with subjects including genetics, microbiology and molecular biology. Her profile shows 2,234 completed orders.
References
Academy of Medicine Malaysia, Malaysian Thoracic Society, & Ministry of Health Malaysia. (2009). Clinical practice guidelines: Management of chronic obstructive pulmonary disease (2nd ed.). https://moh.gov.my/moh/attachments/3963.pdf
Davidson, A. C., Banham, S., Elliott, M., Kennedy, D., Gelder, C., Glossop, A., Church, A. C., Creagh-Brown, B., Dodd, J. W., Felton, T., Foëx, B., Mansfield, L., McDonnell, L., Parker, R., Patterson, C. M., Sovani, M., Thomas, L., & BTS/ICS Acute Hypercapnic Respiratory Failure Guideline Development Group. (2016). BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax, 71(Suppl 2), ii1-ii35. https://doi.org/10.1136/thoraxjnl-2015-208209
Global Initiative for Chronic Obstructive Lung Disease. (2025). Global strategy for the prevention, diagnosis and management of COPD: 2026 report. https://goldcopd.org/2026-gold-report-and-pocket-guide/
O’Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 72(Suppl 1), ii1-ii90. https://doi.org/10.1136/thoraxjnl-2016-209729
Puhan, M. A., Gimeno-Santos, E., Cates, C. J., & Troosters, T. (2016). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (12), Article CD005305. https://doi.org/10.1002/14651858.CD005305.pub4
