DNP 606 Module 4 Case Study 2: Pediatric Septic Shock Example

Reviewed by Ingrid Vasterling, MSN, RN Arizona State University Updated October 2026

This DNP 606 Module 4 sample is case study 2 in Principles of Pediatric Acute Care I, offered to ASU DNP students on the pediatric acute care track. ASU DNP 606 wants each faculty case answered in a fixed order: what is known and missing, prioritized problems led by health maintenance, a short differential and a team plan. This composite case follows the infectious disease week: a 3-year-old girl with fever, cool extremities and low blood pressure after several days of urinary symptoms. The answer applies the 2024 Phoenix sepsis criteria, names missing data, lists four differentials and sets out a first-hour plan of cultures, antibiotics, measured fluid boluses, vasoactive support and PICU transfer based on the pediatric Surviving Sepsis guideline.

CourseDNP 606 Principles of Pediatric Acute Care I
ModuleModule 4
Paper typePediatric acute care case study
LengthAbout 556 words, 5 pages
FormatAPA 7 student paper
SchoolArizona State University
ProgramDoctor of Nursing Practice
UpdatedOctober 2026

Free sample paper for DNP 606 Module 4

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The First Hour Matters: A Pediatric Acute Care Case Study of Septic Shock in a 3-Year-Old

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 606: Principles of Pediatric Acute Care I

Instructor Name

Month Day, Year

What this page is doingThe title points to the time pressure that drives sepsis care, which the plan is organized around.
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The First Hour Matters: A Pediatric Acute Care Case Study of Septic Shock in a 3-Year-Old

Case

A 3-year-old girl with no chronic conditions has had three days of fever and painful urination, and today became sleepy and stopped drinking. In the emergency department, her temperature is 39.8 C, heart rate 182, respiratory rate 40 and blood pressure 68/34. Capillary refill is 4 seconds, her extremities are cool and mottled, and she responds only to voice. Lactate is 5.8 mmol/L. Urinalysis shows pyuria and nitrites.

1. Summary

Key issues. She has a suspected infection, most likely a urinary source, with cardiovascular dysfunction (hypotension for age and a lactate above 5) and altered mental status. Under the 2024 Phoenix criteria, sepsis in children is suspected infection with a Phoenix Sepsis Score of at least 2, and septic shock is sepsis with at least one cardiovascular point, such as severe hypotension for age or a lactate above 5 (Schlapbach et al., 2024). She meets the criteria for septic shock.

Missing information. Weight, immunization status, allergies, prior urinary infections or urinary tract anomalies, glucose, complete blood count, electrolytes, renal function, coagulation studies, blood and urine cultures, and response to the first fluid bolus.

What this page is doingApplying the current sepsis definition with the patient's actual numbers shows the reader why this is septic shock, not just a febrile child, and makes the urgency of the plan clear.
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2. Problem List

1. Health maintenance: immunization status to confirm.

2. Septic shock with cardiovascular and neurologic dysfunction.

3. Suspected pyelonephritis as the source.

4. Risk of acute kidney injury and electrolyte disturbance.

5. Family distress.

3. Differential Diagnosis

1. Septic shock from pyelonephritis: most likely, given urinary symptoms, pyuria, nitrites and shock.

2. Septic shock from another source, such as pneumonia or meningitis: altered mental status calls for careful assessment and consideration of lumbar puncture once she is stable.

3. Hypovolemic shock from poor intake: contributes, but does not explain fever and a high lactate alone.

4. Toxic shock syndrome: less likely without a rash, recent surgery or tampon use, but worth considering if she worsens rapidly.

4. Plan of Care

First hour. Call for help and assign roles. Give oxygen and obtain intravenous or intraosseous access. Draw blood cultures and labs, check glucose and start broad-spectrum antibiotics within one hour, as the pediatric Surviving Sepsis guideline recommends for septic shock (Weiss et al., 2020).

Fluids. In a setting with intensive care available, give balanced crystalloid in measured boluses, reassessing heart rate, blood pressure, capillary refill, mental status, liver edge and lung sounds after each one, and stop if signs of fluid overload appear (Weiss et al., 2020). Aggressive boluses are not automatically safe: in the FEAST trial in African children with severe febrile illness in a setting without intensive care, bolus fluids increased 48-hour mortality compared with no bolus (10.6% and 10.5% vs 7.3%) (Maitland et al., 2011).

Vasoactive support. If shock persists after fluid, start epinephrine or norepinephrine, which the guideline prefers to dopamine; peripheral infusion can begin while central access is arranged.

Consults and monitoring. PICU transfer; nephrology if kidney injury develops; urology imaging after recovery; pharmacy to adjust antibiotics to culture results.

Complementary approaches. Comfort measures for the child and family, such as a parent at the bedside and child life support, once she is stable.

Education and trust. Explain to her parents in plain language what sepsis is, what each treatment does and what the next hours will look like, and update them often. Acknowledge their fear and invite questions.

What this page is doingThe plan follows the guideline's first-hour sequence, then uses the FEAST trial to explain why fluids are given in measured steps with reassessment, which shows the reader evidence-based judgment rather than a memorized bundle.
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References

Maitland, K., Kiguli, S., Opoka, R. O., Engoru, C., Olupot-Olupot, P., Akech, S. O., Nyeko, R., Mtove, G., Reyburn, H., Lang, T., Brent, B., Evans, J. A., Tibenderana, J. K., Crawley, J., Russell, E. C., Levin, M., Babiker, A. G., & Gibb, D. M. (2011). Mortality after fluid bolus in African children with severe infection. New England Journal of Medicine, 364(26), 2483-2495. https://doi.org/10.1056/NEJMoa1101549

Schlapbach, L. J., Watson, R. S., Sorce, L. R., Argent, A. C., Menon, K., Hall, M. W., Akech, S., Albers, D. J., Alpern, E. R., Balamuth, F., Bembea, M., Biban, P., Carrol, E. D., Chiotos, K., Chisti, M. J., DeWitt, P. E., Evans, I., Flauzino de Oliveira, C., Horvat, C. M., ... Bennett, T. D. (2024). International consensus criteria for pediatric sepsis and septic shock. JAMA, 331(8), 665-674. https://doi.org/10.1001/jama.2024.0179

Weiss, S. L., Peters, M. J., Alhazzani, W., Agus, M. S. D., Flori, H. R., Inwald, D. P., Nadel, S., Schlapbach, L. J., Tasker, R. C., Argent, A. C., Brierley, J., Carcillo, J., Carrol, E. D., Carroll, C. L., Cheifetz, I. M., Choong, K., Cies, J. J., Cruz, A. T., De Luca, D., ... Tissieres, P. (2020). Surviving Sepsis Campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatric Critical Care Medicine, 21(2), e52-e106. https://doi.org/10.1097/PCC.0000000000002198

What the DNP 606 Module 4 instructions ask for

Case study 2 follows the infectious disease week in the posted syllabus, which covers healthcare-associated and opportunistic infections, resistant organisms, sepsis and septic shock. Like the other two cases, it is set by faculty, carries 20 points and goes in through a Canvas essay quiz. The answer again opens with the key data and what is still unknown, then lists problems with health maintenance first, offers three or four ranked diagnoses with reasons, and lays out a team plan that names drugs, any complementary measures, consults, teaching and ways to earn the family's trust, closing with peer-reviewed APA sources. Use current definitions and guidelines, since pediatric sepsis criteria changed in 2024.

How the DNP 606 Module 4 example is put together

The answer restates the composite case and follows the five required parts. The summary applies the 2024 Phoenix criteria to the child's numbers to show that she has septic shock and lists the information still needed. Health maintenance heads the problem list. Each of four differentials has a reason and a test or finding that would confirm or exclude them. The plan of care is organized by time and task: first-hour actions, fluids with reassessment and the FEAST trial as a caution, vasoactive support, consults, comfort measures and family communication. Three sources support it: the Phoenix criteria, the pediatric Surviving Sepsis guideline and the FEAST trial. The family communication paragraph is specific about what parents are told and when they are updated.

Reading the DNP 606 Module 4 grading rubric

Faculty will likely check that the summary identifies shock and its severity with current criteria, that the problem list is prioritized and begins with health maintenance, that differentials are realistic and that the plan reflects current guidelines, including time to antibiotics, fluid strategy and vasoactive choice, with consults, education and APA references. Answers earn more when they explain why each step is taken, for example fluid reassessment after each bolus. Using the most recent definition shows current knowledge. Family communication that is specific and honest meets the trust-building element of the format. Faculty may also look for awareness that fluid strategy depends on the setting, which is why the FEAST trial is worth citing.

DNP 606 Module 4 help: mistakes that cost marks

One frequent error is using older SIRS-based sepsis criteria. Check that your definition reflects the 2024 Phoenix criteria. Another is giving fluid without describing reassessment. Include time targets for antibiotics. The desk can review a draft of your sepsis case if you send the case text with it. Confirm every medication and fluid volume with a pediatric reference. Keep the answer organized under the five required headings. Write the time target next to each first-hour action, so faculty can see you know the sequence. Note what you would reassess after each bolus. Label each section with the rubric's own words.

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 Arizona 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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DNP 606 Module 4 questions, answered

Where can I find a free DNP 606 Module 4 sample paper?

This page has the full DNP 606 case study 2 sample on pediatric septic shock, applying the 2024 Phoenix criteria and the Surviving Sepsis guideline.

What are the Phoenix sepsis criteria?

2024 criteria defining pediatric sepsis as suspected infection with a Phoenix Sepsis Score of at least 2, and septic shock as sepsis with cardiovascular dysfunction.

How fast should antibiotics be given in pediatric septic shock?

The pediatric Surviving Sepsis guideline recommends antibiotics within one hour of recognizing septic shock.

Why are fluid boluses given carefully in children with sepsis?

Fluid overload can harm, and a large trial in a setting without intensive care found boluses increased mortality, so each bolus is followed by reassessment.

Which vasoactive drug is preferred in pediatric septic shock?

The guideline prefers epinephrine or norepinephrine to dopamine for fluid-refractory shock.