| Course | DNP 619 Principles of Pediatric Acute Care II |
|---|---|
| Module | Module 4 |
| Paper type | Moderated case discussion with final summary |
| Length | About 516 words |
| Format | Discussion post with APA 7 citations |
| School | Arizona State University |
| Program | DNP |
| Updated | October 2026 |
Free sample paper for DNP 619 Module 4
Student-Led Discussion Board 2: Sores in the Mouth and a Spreading Rash
Mycoplasma or Medication? Moderating a Case of Mucositis With Few Skin Lesions in an Eight-Year-Old
The Case as Posted on Sunday
Welcome to Board 2. Our composite patient is J.S., an 8-year-old boy with five days of fever and cough. Two days ago he developed painful sores in his mouth and red eyes, and today a few target-like spots appeared on his trunk. He has taken ibuprofen for fever for four days. He is refusing to drink. Vital signs: temperature 102.2 °F, heart rate 128, respiratory rate 28, SpO2 94%.
Roles: Ava, history; Daniel, examination; Sofia, problem list; Marcus, differential diagnosis; all, systems-based plan.
What Each Role Added, With My Replies
History (Ava): No new medications other than ibuprofen; a classmate at school had "walking pneumonia"; no prior reactions. I replied that both an infection and a drug are possible triggers here, and the timing matters for each.
Exam (Daniel): Hemorrhagic crusting of the lips, extensive oral erosions, bilateral nonpurulent conjunctivitis, and fewer than ten scattered targetoid lesions with less than 2% skin detachment; crackles at the right base. I noted that severe mucositis with sparse skin involvement is the pattern recent literature associates with infection-triggered disease.
Problem list (Sofia): Health maintenance: immunizations up to date; acute: mucocutaneous eruption, dehydration, pneumonia, eye involvement; psychosocial: parental anxiety.
Differential (Marcus): Stevens-Johnson syndrome from ibuprofen, reactive infectious mucocutaneous eruption from Mycoplasma pneumoniae, herpetic gingivostomatitis, Kawasaki disease. I asked how he would separate them; he pointed to the pneumonia, the predominance of mucositis and the absence of Kawasaki's extremity and lymph node findings.
Moderator's Final Summary
Assessment: Chest radiograph showed right lower lobe infiltrate, and Mycoplasma testing was positive. The picture fits a reactive infectious mucocutaneous eruption, the term proposed for infection-triggered blistering mucocutaneous disease in children. Pediatric reviews emphasize that SJS in children is more often triggered by infection than by drugs, and that distinguishing infection-triggered from drug-induced cases matters for initial management and for avoiding an unnecessary drug-allergy label (Ramien, 2022).
Systems-based plan:
Infection: Treat Mycoplasma with a macrolide.
Mucosa and hydration: Intravenous fluids, topical oral anesthetic rinses before meals, and soft or liquid diet; nasogastric feeding if intake remains poor.
Eyes: Urgent ophthalmology consultation, because ocular involvement can cause lasting damage; lubricants and other treatment as directed.
Skin: Gentle care of lesions; monitor for spreading detachment, which would change the diagnosis and level of care.
Medications: Stop ibuprofen out of caution while the trigger is clarified; use acetaminophen for fever. Document carefully so he is not mislabeled as drug-allergic if the evidence supports infection.
Immunomodulators: Evidence for systemic therapies in pediatric SJS and TEN is limited, and guidelines differ; a systematic review of pediatric guidelines found that recommendations are often extrapolated from adults (Creighton et al., 2026). Decisions should involve dermatology, and a recent national guideline offers a detailed framework for supportive and specialist care (Heuer et al., 2024).
Disposition and follow-up: Admit for hydration and eye care; follow up with ophthalmology and dermatology, since recurrence and long-term effects are more common in children.
Thank you for a thoughtful discussion that showed how much the trigger matters.
References
Creighton, R., Gupta, S., Langille, C., & Sutherland, A. (2026). Diagnosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis in pediatric patients: A systematic review of clinical guidelines and consensus statements. Pediatric Dermatology, 43(3), 579-589. https://doi.org/10.1111/pde.70149
Heuer, R., Paulmann, M., Annecke, T., Behr, B., Boch, K., Boos, A. M., Brockow, K., French, L. E., Gille, J., Gundlach, V., Hartmann, B., Höger, P., Hofmann, S. C., Klein, T., Lehnhardt, M., Liß, Y., Maier, P., Mandel, P., Marathovouniotis, N., ... Nast, A. (2024). S3 guideline: Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis), Part 1: Diagnosis, initial management, and immunomodulating systemic therapy. Journal der Deutschen Dermatologischen Gesellschaft, 22(10), 1448-1466. https://doi.org/10.1111/ddg.15515
Ramien, M. L. (2022). Stevens-Johnson syndrome in children. Current Opinion in Pediatrics, 34(4), 341-348. https://doi.org/10.1097/MOP.0000000000001146
Reading the DNP 619 Module 4 assignment instructions
Board 2 falls in Week 8, the dermatology week just before spring break, and it runs on the same weekly clock as the other student-led boards: the case and role list go up on Sunday, classmates add their pieces by Friday, and the moderator's wrap-up is due Saturday. Like Boards 1 and 3, it carries 10 points, and every post needs APA citations to evidence-based sources. Skin cases work well here because photographs or careful descriptions give classmates something concrete to reason about. A VoiceThread or other creative format is allowed only with faculty approval, so ask early if you plan one. Choose a case with a real diagnostic question.
Inside the DNP 619 Module 4 example
The opening post gives enough clinical detail, vital signs, timeline and a medication history, to make the differential genuinely open. Contributions are summarized by role, and the moderator's replies add teaching points. The final summary resolves the case with test results and current terminology from a pediatric review, then organizes the plan by system, including the eyes. A brief note on limited evidence for immunomodulators shows honest appraisal. Three sources support the summary. Replies to each classmate add a teaching point, and the summary explains why the final diagnosis was preferred over the drug-induced alternative. Eye care receives its own line in the plan. The summary resolves the diagnostic question with test results. Classmates' contributions are credited by role, which shows the moderator read each one carefully.
Reading the DNP 619 Module 4 grading rubric
Faculty grade the second board on the quality of the case, how clearly roles are assigned, how well the moderator engages each classmate, and whether the final summary reaches a diagnosis and an evidence-based plan organized by system, with APA references. Moderators who build an open diagnostic question into the case, rather than a case with an obvious answer, usually generate the richest discussion. Using current pediatric terminology and recent reviews shows reading beyond the textbook. Attention to complications such as eye involvement demonstrates a complete plan. Posting on time on Sunday and Saturday is also part of the grade.
DNP 619 Module 4 help: mistakes that cost marks
Moderators often post cases that point to one obvious answer, which leaves little to discuss. Build in a real diagnostic question. Another weakness is a summary that does not explain why the final diagnosis was chosen. Organize the plan by system and include consults. Note when evidence is limited. Reply to every classmate. If you would like help preparing a moderated case, send it to the desk. Include enough history, such as recent infections and medications, for classmates to weigh competing triggers. Post the case and roles by Sunday night. Resolve the differential clearly in your summary. Keep your replies short but specific.
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 619 Module 4 questions, answered
Where can I find a free DNP 619 Module 4 sample paper?
The second student-led discussion is above in full: a child with mucositis and few skin lesions, roles and replies, and a summary distinguishing infection-triggered eruption from drug-induced necrolysis.
Is Stevens-Johnson syndrome in children usually caused by drugs?
Pediatric reviews note that it is more often triggered by infections, such as Mycoplasma pneumoniae, than by drugs.
Why does the trigger matter in pediatric mucocutaneous eruptions?
It changes initial management and helps avoid labeling a child allergic to a drug that did not cause the reaction.
Why is ophthalmology consulted in SJS?
Eye involvement can cause lasting damage, so early specialist care is important.
When is DNP 619 Student-Led Board 2 due?
The syllabus places it in Week 8, the dermatology week.