| Course | DNP 643 Developmentally Based Care of the Well Child |
|---|---|
| Module | Module 3 |
| Paper type | Case study response with peer reply |
| Length | About 488 words |
| Format | Discussion post with APA 7 citations |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 643 Module 3
Case Study 3: The Screener Said Refer
The Screener Said Refer: A Failed Vision Screen, Amblyopia Risk and Why Timing Matters for a 3-Year-Old
The Case
T., a 3-year-old boy, comes for his well visit. He is healthy, active and developing normally, and his parents have no concerns about his vision. He watches cartoons from across the room and recognizes small toys. An instrument-based photoscreener used in the clinic returns a "refer" result for anisometropia, a difference in refractive power between the two eyes. Red reflexes appear symmetric to the examiner, and the cover test is hard to perform because he will not hold still.
Case Study Response
What the Result Means
Amblyopia is reduced vision in one or both eyes caused by abnormal visual input during the years when the visual system is developing. Its main risk factors are strabismus, anisometropia, significant refractive error in both eyes and anything that blocks the visual axis, such as a cataract or ptosis. Because the better eye compensates, a child with unilateral amblyopia usually behaves as if he sees normally, which is why parents rarely notice. Bright Futures places objective vision screening at the 3-year visit (Hagan et al., 2017). Instrument-based screening detects risk factors rather than amblyopia itself, and the AAP recommends it from age 1 to 3 as an alternative to chart-based testing for children too young to cooperate (Donahue et al., 2016).
Assessment
T.'s symmetric red reflex and normal behavior do not rule out anisometropia, which is often invisible on routine examination. I would attempt a cover-uncover test with an interesting target and, if he cooperates, a picture-based acuity test with each eye. A positive screen for an amblyopia risk factor warrants referral even when the office examination looks normal.
Plan
Refer to a pediatric ophthalmologist or optometrist experienced with young children for a cycloplegic refraction and full eye examination (Donahue et al., 2016). If anisometropia is confirmed, the first treatment is glasses with the full correction, which alone improves vision in many children. If a vision difference remains, the weaker eye is strengthened by patching the stronger eye for part of the day or by atropine drops that blur it; a randomized trial found both approaches produced similar improvement in moderate amblyopia (Pediatric Eye Disease Investigator Group, 2002). I would place a reminder to confirm the appointment occurred.
Why Timing Matters
Treatment is most effective in early childhood, when the visual pathways are still adaptable. Detection at 3 gives T. the best chance of normal vision in both eyes. Waiting for school screening at 5 or 6 can reduce the response to treatment.
Reply to a Classmate (On Doubtful Parents)
Priya, you asked how to respond when parents say their child sees fine. I find it helps to explain that the strong eye hides the weak one, then cover each eye during a game in the office so parents can watch the difference themselves. Did you find that a demonstration changed their minds?
References
Donahue, S. P., Baker, C. N., Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, & American Academy of Ophthalmology. (2016). Procedures for the evaluation of the visual system by pediatricians. Pediatrics, 137(1), Article e20153597. https://doi.org/10.1542/peds.2015-3597
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Pediatric Eye Disease Investigator Group. (2002). A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Archives of Ophthalmology, 120(3), 268-278. https://doi.org/10.1001/archopht.120.3.268
Reading the DNP 643 Module 3 assignment instructions
Case Study 3 comes in Week 7, the module on preschoolers aged 3 to 5, just before the second immersion and OSCEs. It opens on Sunday like the others, with the written answer due midweek and a response to a peer at the end of the week. Preschool cases in this course often turn on screening results and development rather than illness, so expect to show that you know which screens are due at the age, what an abnormal result does and does not mean and how to make sure a referral actually happens. Because the week is crowded with immersion preparation, draft the response early. Name the screening tool and its result exactly as the case gives them, since the interpretation depends on both.
How this DNP 643 Module 3 example is built
Four short sections answer the case after a brief summary. The first explains what amblyopia is, why children do not notice it and what instrument-based screening detects, citing the AAP clinical report. The second sets out what the office examination can and cannot show and why a positive screen still needs referral. The third gives the referral, the confirming examination and the stepwise treatment from glasses to patching or atropine, with a randomized trial for the last step and a reminder to close the loop. The fourth explains why the preschool years matter for treatment response. A reply to a classmate offers a demonstration that helps parents understand why their child needs care. Three sources support the response.
Reading the DNP 643 Module 3 grading rubric
The third case earns up to 10 points. In screening cases, faculty look for correct interpretation of the result, an understanding of what the screen detects, an office assessment that is realistic for a 3-year-old, a referral with the right urgency and a plan to confirm it was completed, treatment options described accurately and family guidance, supported by APA references and followed by a useful reply. Responses lose credit when an abnormal screen is dismissed because the child seems fine, when treatment is described vaguely and when follow-up is left to the family alone. The case studies together outweigh each exam in the course grade.
DNP 643 Module 3 help from the desk
A normal-looking examination, or parents who notice nothing wrong, does not outweigh an abnormal screen. Explain why. Describe amblyopia as a problem of visual development, not of the eye itself. Name the specialist, the examination they will do and how you will know the appointment happened. Cite the AAP clinical report for screening and a trial or review for treatment. In your reply, offer a way to explain the result to doubtful parents. If you want your draft checked against the case questions, the desk can do that when you send the case as posted. Remember that the sooner treatment begins in the preschool years, the better the response, so urgency belongs in your plan.
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 643 Module 3 questions, answered
Where can I find a free DNP 643 Module 3 sample paper?
This page has a full DNP 643 Module 3 sample: a preschool case study response on a failed vision screen and amblyopia risk in a 3-year-old, with a classmate reply.
What is amblyopia?
Reduced vision from abnormal visual input during early childhood, most often caused by strabismus or a difference in refraction between the eyes; it is treatable when found early.
When should instrument-based vision screening be used?
The AAP supports instrument-based screening from about 1 to 3 years and as an alternative to chart testing for children who cannot yet cooperate.
Is patching or atropine better for amblyopia?
For moderate amblyopia, a randomized trial found similar improvement with patching and atropine drops, so the choice often depends on the child and family.
What does Week 7 of DNP 643 cover?
Care of the preschooler from 3 to 5 years, with a discussion board, Case Study 3 and Quiz 3 due.