| Course | NU653 AGACNP Acute Care Diagnosis and Management Clinical II |
|---|---|
| Unit | Unit 3 |
| Paper type | Revised case presentation script |
| Length | About 630 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU653 Unit 3
Not a Viral Rash: A Four-Minute Revised Case Presentation of Drug Reaction With Eosinophilia and Systemic Symptoms From Allopurinol
[Student Name]
Purdue University Global
NU653: AGACNP Acute Care Diagnosis and Management Clinical II
Unit 3 Revised Case Presentation
[Instructor Name]
[Date]
The patient is composite; values, doses and dates are bracketed. Timing marks show where the four minutes go.
Script
[0:00 to 0:20] Mrs. [F.], whom I presented on Tuesday as a viral rash, has drug reaction with eosinophilia and systemic symptoms, most likely from allopurinol started [five] weeks ago, and today's discharge is canceled.
[0:20 to 0:45] What made a virus reasonable on Tuesday: several people in her church choir had a febrile illness last week, and she arrived with a fever of [101.8] F and a widespread red rash, with a normal white count on the first draw.
[0:45 to 1:30] New this morning: eosinophils [2,100] per microliter; atypical lymphocytes on the smear; ALT [412] and AST [288] units per liter, up from normal on admission; creatinine [1.5], up from her baseline of [1.2]. On examination her face is swollen, she has tender lymph nodes in her neck and groin, and the rash now covers more than half her body. Her temperature last night was [102.6].
[1:30 to 2:20] Assessment. Rash, fever, eosinophilia, atypical lymphocytes, lymph nodes and liver involvement, five weeks after a new drug, is the pattern of drug reaction with eosinophilia and systemic symptoms, and a virus does not explain the eosinophils or the timing. Her RegiSCAR score is [6], definite. In the RegiSCAR registry, allopurinol was the second most common culprit after antiepileptic drugs, and the median time from starting the drug was 22 days (Kardaun et al., 2013). Her only new drug in the past three months is allopurinol, started at [300 mg] daily for gout with a creatinine clearance of about [38].
[2:20 to 3:20] Plan. One, stop allopurinol today and list it as a severe reaction, never to be restarted. Two, prednisone [1 mg/kg] daily because of liver involvement, with a slow taper over at least [six to eight] weeks, since early tapering is associated with relapse. Three, liver tests, creatinine and blood count daily; troponin and a urinalysis today to look for heart and kidney involvement. Four, dermatology consultation today. Five, no new drugs unless essential, because patients with this reaction can react to other drugs during the illness.
[3:20 to 4:00] Disposition: inpatient on the medical ward for at least [five to seven] days. I have spoken to her son, who was planning to take her home today.
Prepared Answers
Could this still be viral? A viral illness can cause fever, rash and raised liver enzymes, and that is why it was a reasonable first reading. It does not usually cause eosinophilia of [2,100] or facial swelling, and the timing after a new drug fits a drug reaction. Reactivation of human herpesvirus 6 is described in this syndrome, but it is part of the reaction rather than an alternative to it.
What about her gout? Urate-lowering therapy is paused until the reaction settles. The ACR gout guideline advises starting allopurinol at no more than [100 mg] daily, lower in chronic kidney disease, and testing for HLA-B*58:01 before starting it in patients of Southeast Asian or African American descent, because that allele is associated with severe allopurinol reactions (FitzGerald et al., 2020). Her starting dose was higher than the guideline advises for her kidney function. Rheumatology will advise on an alternative once she has recovered.
Why not stop at Tuesday's diagnosis? Because the eosinophil count and liver tests were not yet available on Tuesday. The first diagnosis was reasonable with the data in hand; keeping it after this morning's results would not have been.
References
FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello-Petersen, R., Guyatt, G., Abeles, A. M., Gelber, A. C., Harrold, L. R., Khanna, D., King, C., Levy, G., Libbey, C., Mount, D., Pillinger, M. H., Rosenthal, A., Singh, J. A., Sims, J. E., Smith, B. J., Wenger, N. S., . . . Neogi, T. (2020). 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care & Research, 72(6), 744-760. https://doi.org/10.1002/acr.24180
Kardaun, S. H., Sekula, P., Valeyrie-Allanore, L., Liss, Y., Chu, C. Y., Creamer, D., Sidoroff, A., Naldi, L., Mockenhaupt, M., & Roujeau, J. C. (2013). Drug reaction with eosinophilia and systemic symptoms (DRESS): An original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. British Journal of Dermatology, 169(5), 1071-1080. https://doi.org/10.1111/bjd.12501
The Purdue Global NU653 Unit 3 instructions
The Unit 3 assignment asks you to present a patient again after new information has changed the diagnosis. You open with the revised diagnosis, briefly explain why the first one was reasonable, present the new data, give the reasoning for the change, set out the revised plan and prepare for likely questions. Most prompts set a time limit of three to five minutes. The script should be written for speaking, with the most important sentence first. Sources are expected for the diagnostic criteria and the key treatment decisions, and the plan must say what the revision cancels as well as what it starts. Mark where the time goes, since a script without timing tends to run long.
Inside the NU653 Unit 3 example
The example is a timed script with marks showing where each part of the four minutes goes. The headline carries the whole revision in one sentence. The recap keeps only what made a virus reasonable. New findings come in one run so the listener hears the whole picture before any interpretation. The assessment uses the RegiSCAR score and registry data on culprits and timing. The plan is numbered, from stopping the drug to limiting new drugs. Three prepared answers address whether it could still be viral, what happens to her gout and why the first diagnosis was not wrong at the time.
Reading the NU653 Unit 3 grading rubric
The Unit 3 rubric weighs the clarity of the revised diagnosis, the fairness of the recap, the reasoning, the plan and delivery within time. Clarity earns full points when the first sentence states the new diagnosis and its consequence. The recap is judged on whether it explains the first diagnosis without dwelling on it. Reasoning counts when criteria and evidence connect the findings to the diagnosis. The plan must include stopping the culprit and documenting the reaction. Delivery is judged on timing. Prepared answers that show the presenter understands the uncertainty often earn extra credit. Keeping to the time limit matters as much as content, and graders often time the script. Scripts that say what the revision cancels, not only what it starts, show the full effect of the new diagnosis.
NU653 Unit 3 help from the desk
The most common error is presenting the case again from the beginning, so the new diagnosis arrives at minute three. Another is presenting the new data one value at a time with interpretation after each, which makes the picture hard to see. Students sometimes forget to cancel the old plan, such as the discharge. Some presentations stop the drug but do not record it as an allergy, which risks a rechallenge. The gout itself is often forgotten. And a presenter who blames the first team for the viral diagnosis loses the listener; explain why it was reasonable, then why it no longer fits.
Get an NU653 Unit 3 example written to your instructions
Revised presentations are delivered live in some sections and submitted as scripts in others, with time limits that vary. Share the format, the limit, the composite case and what changed in it, plus the rubric. A first script, free and returned within 24-48h, puts the new diagnosis in its opening sentence and times every section. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU653 papers and MSN samples
- NU653 Unit 1: Re-Presenting a Changed Diagnosis
- NU653 Unit 2: Serial Progress Notes, Encephalitis
- NU653 Unit 4: Written Plan Defense
- NU653 Unit 5: Seminar Reflection
- NU653 Unit 6: Family Update Summary
- NU653 Unit 7: Case Conference Review
- NU653 Unit 8: Consultation Note
- NU653 Unit 9: Reflective Narrative
- NU653 Unit 10: Learning Objectives Update
- NU652 Unit 3: Revised Differential, Red Leg
- NU651 Unit 3: Sickle Cell Crisis Progress Note
- NU650 Unit 3: Level of Care, Alcohol Withdrawal
- NU648 Unit 3: Adverse Drug Event Analysis
NU653 Unit 3 questions, answered
How much of the original presentation should the revision repeat?
Very little. Your listeners heard the first version, so the revision keeps only the facts that explain why the original diagnosis was reasonable and what now contradicts it. The sample keeps two sentences of recap; your preceptor or instructor may want a fuller summary if the audience is new, and the script adjusts to that.
Can the script be adapted for a live seminar?
Yes. The script includes timing marks and short sentences meant to be spoken aloud. For a live version, the sample can also add a one-slide summary or a card of key values, depending on what your section uses. The order stays the same either way: headline, brief recap, new data, assessment, plan.
Where can I find a free NU653 Unit 3 sample paper?
The full NU653 Unit 3 revised case presentation is on this page, a timed script with the headline, recap, new data, assessment, plan and prepared answers. A free script for your own revised diagnosis can be written from your case.
How long after a drug does DRESS usually start in NU653 Unit 3?
In the RegiSCAR registry the sample cites, the median time from starting the drug was 22 days. The sample's patient began allopurinol five weeks before, which fits, and allopurinol was the second most common culprit in that registry.
Why does the NU653 Unit 3 plan continue steroids for weeks?
Because early tapering is associated with relapse in drug reaction with eosinophilia and systemic symptoms. The sample starts prednisone for liver involvement and plans a slow taper over at least six to eight weeks.