DNP 619 Module 5 Disaster Crush Injury Case Study Example

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

This DNP 619 Module 5 sample is the second case study in Principles of Pediatric Acute Care II at ASU, due in the disaster management week. ASU DNP 619 asks for the same structure as the first case: summary with missing information, a problem list beginning with health maintenance, differentials and an interprofessional plan with education and trust-building. The composite patient is an 11-year-old rescued after 20 hours under a collapsed building with a crushed right leg. The answers explain how muscle breakdown releases potassium and myoglobin, why kidney injury and cardiac arrest are the main threats, what current pediatric crush data show about predicting dialysis, and how to plan care when a disaster strains every resource.

CourseDNP 619 Principles of Pediatric Acute Care II
ModuleModule 5
Paper typePediatric acute care case study
LengthAbout 599 words, 5 pages
FormatAPA 7 student paper
SchoolArizona State University
ProgramDNP
UpdatedOctober 2026

Free sample paper for DNP 619 Module 5

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Twenty Hours Under the Rubble: A Pediatric Case Study of Crush Syndrome After a Building Collapse

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 619: Principles of Pediatric Acute Care II

Instructor Name

Month Day, Year

What this page is doingThe title gives the time trapped, a detail that frames the risks, and names the syndrome the case teaches.
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Twenty Hours Under the Rubble: A Pediatric Case Study of Crush Syndrome After a Building Collapse

Summary

A.H., an 11-year-old boy, was extracted from a collapsed apartment building after about 20 hours, with his right leg pinned under concrete. He arrives at a pediatric hospital receiving many casualties. He is alert but in pain. Heart rate 138, blood pressure 92/54, respiratory rate 26, SpO2 97%. His right thigh and calf are swollen and tense, with weak distal pulses. He has passed a small amount of dark brown urine. Initial labs: potassium 6.4 mmol/L, creatinine 1.2 mg/dL, creatine kinase 48,000 U/L, phosphorus elevated, bicarbonate 16 mmol/L.

Missing information: other injuries, weight, tetanus status, family members' whereabouts, preexisting conditions, and ECG findings.

Problem List

1. Health maintenance: tetanus immunization status unknown; family separation.

2. Crush syndrome with rhabdomyolysis.

3. Hyperkalemia with risk of arrhythmia.

4. Acute kidney injury with metabolic acidosis.

5. Hypovolemia.

6. Possible compartment syndrome of the right leg.

7. Psychological trauma.

Differential Diagnosis

1. Crush syndrome: systemic effects of muscle injury after compression, the leading diagnosis given the history and labs.

2. Hypovolemic shock from hemorrhage due to unrecognized internal injury; must be excluded with a trauma survey.

3. Acute kidney injury from hypovolemia alone, without significant rhabdomyolysis; unlikely given the creatine kinase level.

4. Compartment syndrome as a local complication contributing to ongoing muscle injury.

Pathophysiology in Brief

Prolonged compression damages muscle cells. When pressure is released, potassium, phosphate, myoglobin and acids flood the circulation, and fluid shifts into injured muscle, causing hypovolemia. Myoglobin damages kidney tubules, especially in acidic, low-flow conditions, and hyperkalemia can cause sudden arrhythmia. Crush-related kidney injury in children has a rapid onset and life-threatening systemic complications (Sever & Bakkaloğlu, 2025).

Plan of Care

Immediate: Cardiac monitoring and a 12-lead ECG. Treat hyperkalemia urgently with calcium to stabilize the heart, insulin with glucose and inhaled beta-agonist to shift potassium, and plan removal.

Fluids: Aggressive isotonic fluid resuscitation to restore volume and maintain urine output, adjusted to weight and monitored closely for overload.

Kidney: Track urine output and serial creatinine, potassium and phosphorus. Plan early for kidney replacement therapy. In children after the 2023 earthquakes in Türkiye, nearly a quarter of those with crush syndrome required kidney replacement therapy; creatine kinase, the percentage of body area crushed and phosphorus predicted the need for it, while time under rubble did not (Atmis et al., 2023). Another pediatric cohort proposed a renal score built on eGFR, creatine kinase, time under rubble, amputation or fasciotomy and urine volume to flag children likely to need dialysis (Karakaya et al., 2023).

Limb: Urgent surgical evaluation for compartment syndrome, with serial checks of pain, pulses and sensation every hour.

Infection: Tetanus prophylaxis, wound care and close watch for infection in damaged muscle, which is common after prolonged entrapment.

Consults: Pediatric nephrology, orthopedic or trauma surgery, critical care, social work, child life and mental health.

Disaster considerations: Pediatric dialysis capacity may be limited in a disaster, so early transfer decisions matter (Sever & Bakkaloğlu, 2025).

Patient and caregiver education: Explain each treatment simply to A.H., with child life support. Help reunite him with family through the hospital's family reunification process.

Strategies to build trust: Keep one consistent nurse when possible, tell him what will happen before procedures, and give him small choices. Children who survive disasters often show signs of acute stress, such as nightmares, clinging or withdrawal, so screening and early psychological first aid belong in the plan. As his kidneys recover, the team will plan rehabilitation for the injured leg and a follow-up schedule for kidney function after discharge.

References

Atmis, B., Bayazit, A. K., Cagli Piskin, C., Saribas, E., Piskin, F. C., Bilen, S., Ozgur Horoz, O., Ekinci, F., Turker, I., Telefon, H. A., Unal, I., Yilmaz, H. L., Narli, N., & Yildizdas, D. (2023). Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week. European Journal of Pediatrics, 182(12), 5591-5598. https://doi.org/10.1007/s00431-023-05250-3

Karakaya, D., Yılmaz, A. Ç., Güngör, T., Kenan, B. U., Çelikkaya, E., & Çakıcı, E. K. (2023). Is the renal score predictive for kidney replacement therapy in pediatric patients with crush syndrome? Pediatric Nephrology, 39(1), 291-296. https://doi.org/10.1007/s00467-023-06090-x

Sever, L., & Bakkaloğlu, S. A. (2025). Disasters and crush syndrome-related acute kidney injury: What pediatric nephrologists should know. Pediatric Nephrology, 41(9), 2727-2739. https://doi.org/10.1007/s00467-025-07095-4

What the DNP 619 Module 5 instructions ask for

The second faculty-assigned case arrives in Week 12, when the course turns to disaster management and clinical practice, and it is submitted in Canvas as an essay worth 20 points. The required parts match Case Study 1, so the rubric and the feedback from that first case are the best guide. Because disaster cases mix trauma, kidney, electrolyte and psychosocial problems, reread the disaster chapter and the renal content before starting. Plan to name what you do not know, since missing information is part of the summary. Your references should be peer-reviewed, with lay sources reserved for family teaching. Faculty choose the case.

How the DNP 619 Module 5 example is put together

The sample presents the case with the laboratory values that drive decisions, then follows the required headings. A short pathophysiology section links muscle injury to the dangers of hyperkalemia and kidney injury. The plan puts the immediate threat, hyperkalemia, first and then addresses fluids, kidneys, limb, infection, consults, disaster-specific constraints, education and trust. Recent pediatric data from a major earthquake inform the kidney plan. Missing information includes family whereabouts, reflecting disaster realities. The disaster setting shapes the plan, from limited dialysis capacity to family reunification, which shows how context changes pediatric care. Pediatric cohort data inform the kidney plan. Pathophysiology is kept brief but tied directly to each treatment decision that follows. Trust-building strategies are concrete and suited to a frightened child.

Reading the DNP 619 Module 5 grading rubric

The second case is graded on the same elements as the first, a full summary, a problem list led by health maintenance, reasoned differentials, a prioritized team plan and recent peer-reviewed sources. Graders look for plans that address the most immediate threat first and that consider the disaster setting, such as limited dialysis and family reunification. Linking pathophysiology to treatment shows depth. Child-centered communication strategies complete the plan. Plans that order interventions by urgency, starting with the heart, demonstrate the prioritization expected in acute care. Disaster-specific considerations add depth. Linking each lab value to a decision shows clinical reasoning. Faculty also check that each lab value informs a decision.

DNP 619 Module 5 help: mistakes that cost marks

The most common weakness in crush cases is focusing on the limb and missing hyperkalemia. Address the heart first. Another is forgetting the disaster context, including resource limits and family separation. Use pediatric-specific evidence where it exists. Include the required health maintenance item at the top. Keep the plan prioritized. Students working on Case Study 2 can share their draft with the desk. Check potassium and the ECG before anything else when a crushed limb is released, and say so in your plan. Use pediatric data where available. Include tetanus and family reunification in the plan. Cite pediatric data where it exists, since adult crush injury studies may not apply to children's fluid and electrolyte needs.

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 5 questions, answered

Where can I find a free DNP 619 Module 5 sample paper?

The disaster case study is shown above in full: crush syndrome in an 11-year-old after a building collapse, with summary, problem list, differentials, pathophysiology and a prioritized interprofessional plan.

What is crush syndrome?

The systemic effects of muscle injury after prolonged compression, including hyperkalemia, acidosis, hypovolemia and acute kidney injury from myoglobin.

What is the first priority in crush syndrome?

Treating hyperkalemia and preventing arrhythmia, along with fluid resuscitation.

What predicts dialysis in children with crush syndrome?

In one earthquake cohort, creatine kinase, the percentage of body area crushed and phosphorus predicted kidney replacement therapy.

When is DNP 619 Case Study 2 due?

The syllabus lists it in Week 12, the disaster management week.