writing test...mansoura, public health nurse, 125 canterbury road, ringwood, victoria 3134...

Writing Test 3

Writing Test

Time allowed: Writing : 40 Minutes

Read the case notes below and complete the writing task which follows.

Hospital Royal Perth Hospital

Patient Details Alfred Billy 52 Years old Marital status: married Wife to be contacted if there is any sort of emergency: Maria Jennifer, Arillon City Arcade 207 Murray Street Perth

Admission Date 21/03/2010

Discharge Date 5/05/2010

Diagnosis Skin cancer – BCC (Basal Cell Carncinoma) (neck) Nodular basal-cell carcinoma

Past Medical No prior hospitalization, no history

History Medications

Social Truck Driver

History/Supports Lives with her wife Habit of consuming liquor for th past 30 years Cigarette Smoker Skin dark Religion: Protestant

Medical Progress Skin biopsy is taken for pathological study CCB - removal of

Pain reliever panadein forte 500mg

Nursing No complications noted

Management Perfectly well at the time of discharge No complain of any pain

Discharge Plan Daily obs Medicine to be taken for one more week

Writing Task

You are the charge nurse on the hospital ward where Mr. Alfred Billy has recently had his operation. Using the information provided in the case notes, write a referral letter to the Community Nurse Head at Care Well Hospital, Birmingham, who will be attending to Mr. Alfred Billy, following his discharge.

In your answer:

Expand the relevant case notes into complete sentences.

Do not use note form.

The body of the letter should be approximately 200 words.

Use correct letter format.

OET Preparation: Writing

Writing Test: Nurses

Time allowed: 40 minutes

Red the case notes below and compete the writing task which follows.

Notes:

Ms. Amy Vineyard is a patient in your care at the St Kilda Women’s Refuge Centre. She is 6 weeks pregnant with her first child. She presented two days ago, requesting help for her substance abuse problems. She reports a desire to reduce or cease her alcohol consumption and a desire to reduce a cease her drug use. No desire has been indicated to decrease or stop cigarette use. She now wishes to be discharged but will require ongoing support throughout her pregnancy.

Discharge summary:

Name: Ms. Amy Vineyard

Age: 21

Admission: 6/1/09

Diagnosis: pregnant substance abuse

Discharge: 8/1/09

Plan:

• Community mental Health Nursing required daily next 2 weeks minimum.• Pt wishes to continue living with a friend on her sofa.• Psychiatric support needed for depression.• Methadone program Alcoholics Anonymous meetings• 1 Trimester Ultrasound at 2 weeks;• maternal health clinic appointment needed.

Reason for admission:

• Pt. self admitted due to concern about pregnancy. Confirmed pregnancy test the daysbefore (5/1/09)

• Reported pain in lower back• weight loss (6kg over 2 months)

• some memory loss• tingling in feet, difficulty sleeping, excessive worry and hallucinations• feeling depressed-history of depression• no pain in hips or joints• no decrease in appetite• no double vision

Treatment

• pt. monitored and blood tests for HIV/AIDS and STDs• counseled re nutrition and pregnancy• counseled re HIV/AIDS and STDs risk• discussed possibility of rehabilitation clinic for ‘driving out’

Lifestyle:

• Nicotine daily 30-40 cigarettes• started smoking at 15 y. o.• Drugs used cannabis, amphetamines, cocaine, heroin• started all above at 16 y. o.• injects heroin, occasionally shares infecting equipment• Alcohol 8 units/day __ max. units/day- 15• started drinking at 16 y. o.• lives with a friend, Sophie, on her sofa.• no contact with parents

History:

• suicidal thoughts, self harm in past• never seen a psychiatrist

Writing Task

Using the notes, write a letter about Ms. Vineyard’s situation and history to new community health nurse. Address your letter to Ms. Lucy 8an, Registered Nurse, Community Health Centre, St Kilda.

Sample Writing Task: Nurse Time allowed: 40 minutes

Read the case notes below and complete the writing task which follows: You are Sonya Matthews, a qualified nursing sister working with the Blue Nursing Home Care Agency. Bob Dawson is a patient in your care. Read the case notes below and complete the writing task which follows. Name: Bob Dawson Address: 141 Montague, West End 4101 Phone: (07) 3442 1958 Date of Birth: 25 September 1924 Social Background Married – wife Elizabeth aged 83. Lives in own home – Both receive age pensions Bob is World War11 Veteran with Gold Health Card entitlement Medical History: Cerebrovascular accident (CVA) 4 years ago Rehabilitation generally successful - Mentally alert, slight speech impairment, - residual weakness left side - walks with limp – balance slightly impaired. 18 /5/08 Had fall descending stairs. Badly grazed left knee. GP has requested daily visits by Blue Nursing Home Care to dress wound and assist with showering. 19.5.08 Grazed knee redressed – no sign of infection Bob managing to get around the house slowly with aid of his wife. Reports that apart from “usual aches and pains” he is doing well. 23.5.08 Knee healing well. Suggested use of a walker or walking stick to assist with mobility. Bob said he had a walking stick but it was useless. Wife says he had never learned to use it properly. She asked if I would contact their local physiotherapist to see if Bob could receive a home visit to assess further assistance to improve his mobility.

WRITING TASK Using the information in the case notes, write a letter to Ms Marcia Devonport, West End Physiotherapy Centre, 62 Vulture Street, West End, Brisbane 4101 on behalf of Mrs Elizabeth Dawson requesting a home visit to provide advice and assistance with improving her husband’s mobility. Do not use note form in the letter. Expand on the relevant case notes to explain his background and medical history and the assistance requested. The letter should be 15-20 lines long. No more than the first 25 lines will be assessed.

Sample Writing Task: Nurse


Read the case notes below and complete the writing task which follows:

You are Sonya Matthews, a qualified nursing sister working with the Blue Nursing Home Care Agency. Bob Dawson is a patient in your care. Read the case notes below and complete the writing task which follows.

Name: Bob Dawson Address: 141 Montague, West End 4101 Phone: (07) 3442 1958 Date of Birth: 25 September 1924

Social Background Married – wife Elizabeth aged 83. Lives in own home – Both receive age pensions Bob is World War11 Veteran with Gold Health Card entitlement

Medical History: Cerebrovascular accident (CVA) 4 years ago Rehabilitation generally successful - Mentally alert, slight speech impairment, - residual weakness left side - walks with limp – balance slightly impaired.

18 /5/08 Had fall descending stairs. Badly grazed left knee. GP has requested daily visits by Blue Nursing Home Care to dress wound and assist with showering.

19.5.08 Grazed knee redressed – no sign of infection Bob managing to get around the house slowly with aid of his wife. Reports that apart from “usual aches and pains” he is doing well.

23.5.08 Knee healing well. Suggested use of a walker or walking stick to assist with mobility. Bob said he had a walking stick but it was useless. Wife says he had never learned to use it properly. She asked if I would contact their local physiotherapist to see if Bob could receive a home visit to assess further assistance to improve his mobility.

CASE STUDY No.1 - Mavis Brampton [5 mins reading / 40 mins writing] This patient has been in your care and is now going home from the Northern Community Hospital, Moreland, 3051.

Patient: MAVIS BRAMPTON - 72 years old Admitted: 10 January 2011 To be discharged: 15 January 2011 Diagnosis: Pleurisy

BACKGROUND: Mrs Brampton has been widowed 25 years. Has been an active member of thecommunity all her life. Is the current President of PROBUS in her area. She with her husband ran the Sydney Road Newsagency until his death at which time she retired. Attends the local Community Centre three times a week to play Bingo. Has been a smoker all her life (since 18 years of age). Current smoking 10 a day.

NURSING NOTES: • 10 Jan 2011 Overweight: BMI 29 Had CXR; IV Amoxycillin with supplementary O2• Advised to give up smoking.• BP 170/90 Pulse 92 Slightly raised temperature: 39oC Breathless

12 Jan 2011 On low-dairy diet Advised about Nicotine patches.• Productive cough – sputum culture done Pravastatin 20mg/day and Celecoxib

100mg/day13 Jan 2011

• Deep breathing exercises started. Is keeping to a non-smoking regime.• Using Nicotine patches and Zyban (150mg b.i.d).• To be discharged 15 Jan 2011.

DISCHARGE PLAN: • Support Mrs Brampton - needs monitoring for medication compliance• Needs help with nutritious meals (Meals on Wheels) and house keeping (Council

Home Help) - Assistance with shopping• Monitor her quit-smoking plans - watch for side effects from Zyban such as dry

mouth and difficulty in sleeping. If side effects occur Zyban should be stopped.Zyban to be withdrawn after 2 months. Nicotine patches to continue untilsmoking addiction is under control.

WRITING TASK: Write a letter of referral to Brunswick Family Care Clinic, 44 Decarle Street, Brunswick, Vic 3056 requesting monitoring and ongoing care be arranged for Mrs Brampton. Community Nurse to make sure Mrs Brampton continues her cessation of smoking – with the help of Nicotine patches and Zyban. Zyban tablets to cease as soon as side effects occur (if any). Both Zyban and Nicotine to cease as soon as craving for cigarettes has stopped. Letter should be 180 to 200 words long / only the first 25 lines will be considered.

CASE STUDY No.1 - Beverley Williams Born 1943 PATIENT This patient has been in your care for the past 10 years. During the past 8 years Mrs Williams has developed diabetes. It is not well controlled. You are now referring her on to a Public Health Nurse for a health education program. HISTORY � Type II Non Insulin Dependent Diabetes – onset 8 years ago � Prescribed tablets soon after diagnosis � No problems with sugars or infections � Has monitored urine with sticks at home � Not always well controlled � Does not care about diet regime � High BP for past 5 years – on medication � Overweight for past 30 years (BMI 32) � Vision OK � Has worn spectacles for past 20 years � Grandmother had Diabetes; died of gangrene of the foot � Husband is also Diabetic DIABETIC HABITS � No special diet � Tries not to have sugar � Buys diabetic cordial � Tastes food while preparing meals in kitchen � Eats cream cakes at afternoon tea time � Loves fruit � Unaware of consequences of careless diet � Has trouble losing weight � Very little exercise – walks around the neighbourhood occasionally � Likes a glass of wine with evening meal RELATIONSHIPS � Has four children – all adults – all married � Gets on well with husband � Likes visiting her daughter in the country � Has active social life – visit friends regularly TREATMENT PLAN � Monitor urine – monitor blood sugar levels with glucometer � Needs to be educated re Diabetes and importance of special diet � Needs to attend formal diabetic education program (daytime classes at Hospital) � Increase Daonil from 15 to 20mg per day � Needs vision checked every two to three months � Needs to lose weight – has increased 3.5kg in last 6 months � Suggest a suitable exercise program ? Swimming WRITING TASK Using the information in the case notes, write a letter of referral to: Ms Michella Mansoura, Public Health Nurse, 125 Canterbury Road, Ringwood, Victoria 3134 Australia. DO NOT use note form – use complete sentences. Expand the relevant notes in the treatment plan requesting that Ms Mansoura take over the management of this patient. Letter should be no more than 25 lines long.

Sample Writing Task 2: Dylan Charles Read the case notes below and complete the writing task that follows.

Time allowed : 40 minutes

You are a Maternal and Child Health Nurse working at the Romaville Community Child

Health Service.

Today’s date: 15 January 2012

Patient History

• Baby boy: Dylan Charles

• DOB: 04/12/11

• Born: Romaville Maternity Hospital

• First baby of Raymond and Sylvia Charles

• Address: 19 Mayfield St, Romaville

• Discharged 8/12/11

Family History

• Mother: Aged 24 First Child

• Father: Aged 25 Soldier Currently away from home on duty

Birth Histor

• Normal vaginal birth at term

• Birth weight: 3400gm

• Apgar score at 5 min: 9

• No antenatal or postnatal complications

15/01/12 Subjective

• Silvia and baby attended for routine 6 week check-up. Silvia says she is concerned

about constipation: once every three days, hard stool. Mother is asking about stool

softener or prune juice for baby.

• Breast fed for first three weeks after birth.

• Baby became unsettled during summer heatwave in December.

• Silvia got sick and had a fever for a few days. Mother-in-law (Mary Charles) came to

visit and advised changing baby to formula feeds. Mary advised extra powder in formula

feeds to improve weight gain.

• Silvia worried she does not have enough breast milk and now gives extra formula feeds

as well as breast feeding. Dylan difficult to bottle feed.

• Silvia wishes to breast feed properly as she believes it would be the best thing for her

son.

• Mary Charles plans to stay with the family for at least a further month to help with

baby. Tensions developing between mother and mother-in-law over what is best feeding

method for Dylan.

Objective

• Reflexes normal

• Slightly lethargic

• No abdominal tenderness

• Heart Rate: 174

• Respirations: 56

• Temperature: 37.1

• Weight: 4200gms

• 3 wet nappies in last 24 hours

• Urine dark

Assessment

• Mild constipation and dehydration

Plan

• Increase breast feeds

• Refer to breast feeding support service

• Check formula is correctly prepared

• If continuing formula feeds, advise to supplement with water (boiled and cooled)

• Advise on keeping baby cool in hot weather

• Return for review in 48 hours.

Writing Task

Please write a referral letter to the Lactation Consultant at the Breast Feeding Support

Centre, 68 Main Street, Romaville.

• In your letter expand the relevant case notes into complete sentences

• Do not use note form

• The body of your letter should be approximately 180~200 words

• Use correct letter format.

Mr Gerald Baker is a 79-year-old patient on the ward of a hospital in which you are Charge Nurse.

Patient Details:

Marital Status: Widower (8 years)

Admission Date: 3 September 2010 (City Hospital)

Discharge Date: 7 September 2010

Diagnosis: Left Total Hip Replacement (THR)

Ongoing high blood pressure

Social Background: Lives at Greywalls Nursing Home (GNH) (4 years)

No children

Employed as a radio engineer until retirement aged 65

Now aged-pensioner

Hobbies: chess, ham radio operator

Sister, Dawn Mason (66), visits regularly; v supportive

– plays chess with Mr Baker on her visits

No signs of dementia observed

Medical Background: 2008 – Osteoarthritis requiring total hip replacement surgery

1989 – Hypertension (ongoing management)

1985 – Colles fracture, ORIF

Medications: Aspirin 100mg mane (recommenced post-operatively)

Ramipril 5mg mane

Panadeine Forte (co-codamol) 2 qid prn

Nursing Management and Progress:

daily dressings surgery incision site

Range of motion, stretching and strengthening exercises

Occupational therapy

Staples to be removed in two wks (21/9)

Also, follow-up FBE and UEC tests at City Hospital Clinic

Assessment: Good mobility post-operation

Weight-bearingwithuseofwheelie-walker;walkslengthofwardwithoutdifficulty

Post-operative disoriention re time and place during recovery, possibly relating to anaesthetic – continued observation recommended

Dropped Hb post-operatively (to 72) requiring transfusion of 3 units packed red blood cells; Hb stable (112) on discharge – ongoing monitoring required for anaemia

Discharge Plan: Monitor medications (Panadeine Forte)

Preserve skin integrity

Continue exercise program

Equipment required: wheelie-walker, wedge pillow, toilet raiser. Hospital to provide walker and pillow. Hospital social worker organised 2-wk hire of raiser from local medical supplier.

Writing task:

Using the information in the case notes, write a letter to Ms Samantha Bruin, Senior Nurse at Greywalls Nursing Home, 27 Station Road, Greywalls, who will be responsible for Mr Baker’s continued care at the Nursing Home.

In your answer:

• expandtherelevantnotesintocompletesentences

• donot use note form

• useletterformat

Thebodyofthelettershouldbeapproximately180-200words.

Practice writing sub-test No.008 for nursing

Read the case notes and complete the writing task which follows

Notes

Harry Kovacs is a 5 year old boy who is the son of one of your newly referred patients in the

community mental health centre where you are a mental health case manager.

Date of birth: 15 April 2006

Place of birth: Sydney Children’s Hospital, Sydney

School year: Kindergarten

Religion & ethnicity: Catholic & both parents Australian born Hungarian

Mother’s name: Elizabeth Kovacs

Mother’s community admission date: 16 May 2011

Diagnosis: Mother – Major depression with psychotic features

Son – ? Early onset separation anxiety disorder

Family/Psychosocial: * Elizabeth suffered PND – depressed since

*She sometimes hears voices calling her and sees ‘men’

running around her house – nil serious psychosis in

functional terms.

* Recently 1st psych admission for 6/52after high

lethality DSH attempt.

*Harry’s psychological status ok until DSH and

hospitalisation; after this +++ signs of separation

anxiety

*Father is self employed and works long hours 7/7. Rarely

sees Harry & dismissive of Harry’s emotional states, ‘He’s

like a bloody girl now!’ he told us.

*Harry loves soccer and playing with his dog, ‘Rusty’.

Medical History

Eczema

Serous otitis media – required grommets at 18 mths

Hearing NAD now.

Medication Nil meds

Case management care and progress:

* Elizabeth new to our area (from Parramatta) & referred to

us post D/C from Bankstown MH inpatient unit 2/52 ago

*We will provide her with long term MH case management.

*Harry now 1) cries and panics whenever Mum leaves his

sight 2) Socially withdrawn & refusing to attend

kindergarten 3) ↑ insomnia & nightmares 4) preoccupied

re Mum’s daily activities & that she might leave him again.

* This is greatly ↑pressure on Elizabeth when her MH

is already fragile.

* Father, John, uninterested in meeting in person or

discussing problems in detail.

*Harry attended initial assessment with Elizabeth and

separation anxiety behaviour very obvious

Referral plan: * Referral to early childhood mental health team for

assessment and management of Harry’s ? early onset

separation anxiety disorder.

*Request joint meeting with case manager and Elizabeth.

You are the Case Manager caring for Harry Kovac’s depressed mother but due to his psychological

issues need to write a referral for him to John Dyer, Clinical Psychologist on the Bankstown early

childhood mental health team at Bankstown Hospital.

In your answer:

Expand the relevant notes into complete sentences

Do not use note form

Use letter format

The body of the letter should be approximately 180-200 words.

Time allowed: 40 minutes Read the case notes below and complete the writing task which follows: Today's date: 9/7/08

Patient Details

Jim Middleton aged 84 was admitted to your ward following surgery for a left inguinal hernia. His doctor has advised he can be discharged within 48hrs if there are no complications following the surgery. Jim reports some pain on movement but has recovered well from the surgery and is keen to return home.

Name: Jim Middleton Date of Birth: 3 July 1924 Admitted: 7 July 2008 Planned Discharge Date: 9 July 2008 Diagnosis: Left inguinal hernia

Medical History

Hypertension diagnosed 1998 Medication Atacand 4 mg daily

Family History

Married 50 years to wife Olga DOB 8.2.32 - one son living in USA Jim is Second World war veteran - served two years in Borneo -Prison of War 16 months. Own their home with large garden which they maintain without assistance. Very independent and proud that they have never applied for a pension or home assistance. Have always managed quite well on their income from a number of investments. Olga told you she is worried as income from these investments has recently been significantly reduced due to severe stock market falls. She is concerned Jim will not be able to continue to maintain their garden and they will not be able to afford a gardener or any other help at this time.

Transport is also a problem as Olga does not drive. Not close to any public transport so will have to rely on taxis. Olga thinks they may now be eligible to receive a pension and other assistance from the Department of Veteran Affairs but doesn't know how to find out - doesn't want to worry Jim.

Olga is in good general health but becoming increasingly deaf - finds phone conversations difficult. She would appreciate a home visit. You agree to enquire on her behalf. Their address is 22 Alexander Street, Belmont, Brisbane 4153 Phone (07) 6946 5173

Discharge Plan

• Must avoid any heavy lifting• Should not drive for at least six weeks• Light exercise only• May take 2 Panadol six hourly for pain• Appointment made to see surgeon for post operation check at 10am on 11 August• Contact Department of Veterans Affairs re eligibility for pension and home help

WRITING TASK Using the information in the case notes, write a letter to The Director, Department of Veterans Affairs, GPO Box 777 Brisbane 4001. In your letter, explain why you are writing and the assistance they are seeking.

Do not use note form in the letter; expand the relevant case notes into full sentences. The letter should be 15-20 lines long. No more than the first 25 lines will be assessed.

TURN OVER 2

Mr Lionel Ramamurthy, a 63-year-old, is a patient in the medical ward of which you are Charge Nurse.

Hospital: Newtown Public Hospital, 41 Main Street, Newtown

Patient details

Name: Lionel Ramamurthy (Mr)

Marital status: Widowed – spouse dec. 6 mths

Residence: Community Retirement Home, Newtown

Next of kin: Jake, engineer (37, married, 3 children

3

Medical progress: Afebrile. Inflammatory markers back to normal. Slow but independent walk & shower/toilet. Dry cough, some chest & abdom. pain. Weight gain post r/v by dietitian.

Nursing management: Encourage oral fluids, proper nutrition. Ambulant as per physio r/v. Encourage chest physio (deep breathing & coughing exercises). Sitting preferred to lying down to ensure postural drainage.

Assessment: Good progress overall

Discharge plan: Paracetamol if necessary for chest/abdom. pain. Keep warm. Good nutrition – fluids, eggs, fruit, veg (needs help monitoring diet).

Writing Task:

Using the information given in the case notes, write a discharge letter to Ms Georgine Ponsford, Resident Community Nurse at the Community Retirement Home, 103 Light Street, Newtown. This letter will accompany Mr Ramamurthy back to the retirement home upon his discharge tomorrow.

In your answer:

• Expand the relevant notes into complete sentences


• Use letter format

The body of the letter should be approximately 180–200 words.

Patient Details

Patient: Maria Joseph is a 39 years old woman who has been a patient at a hosptical you are working in as a head nurse. Apart from usual childhood illness such as chicken pox, she had been healthy.

10 / 5 2011

Subjective: Frontal headache for 6 hrs. Mild assoc, suffering from nausea, no vomiting, patient with blurred vision but not aura. No other symptoms noticed. She has no family history of migraine.

Objective P96, BP 130/ 70. Normal Cervical Spine Movement, examination normal.

Assessment Probably due to excess tension or personal dilemma

Plan Advised to take rest. Given analgesia (paracetamol (500q4h))

14/5 /2011

Subjective Complained of continuous headaches (left sided and frontal), blurred vision, throbbing headache (left sided). Vomited 5 times during last three hours Complaining of slight paraesthesia.

Objective Distressed, P 103, BP 150/90, Normal peripheral nervous system

Assessment Severe Migraine Possibility

Plan: Stat- Pethidine 100 mg, intramuscular injection Maxolon 10 mg

15 / 5 / 2011

Home Visit

Subjective Fell down at home due to severe left sided headache, started some 5 hrs after reaching home. Injured her right arm, bruises on left leg. slurred speech, half unconscious.

Objective P 100, BP 150/90, extension 4/5 power, left leg knee flexion 4/5

Assessment Probable intracranial pathology, space occupying lesions.

Plan Urgent assessment in Emer. Dept.

Using the information given above write a letter to the neurologist, who will attend the patient in the emergency department.

In your answer:

Expand the information given in complete sentences Do not use note forms Use only letter format.


E:\Weebly\2013\Sarah\Mr Wilson - sample question.doc

Writing Sub-Test: Nursing Time allowed: Reading time: 5 minutes

Writing time: 40 minutes

Read the case notes and complete the writing task which follows.

Notes

Hospital: Lyell McEwin Hospital

Patient Details: Name: Martin Wilson Age: 62

Admission Date: 13 October 2009

Discharge Date: 24 October 2009

Diagnosis: Attempted suicide – overdose of Mogodol

Past Medical History: Heavy smoker (40 cigarettes/day) Bronchitis (multiple episodes) Underweight – 66kg, BMI 18 Psoriasis

Social History: Retired 2 years ago (bookkeeper with Holden Car Company) Lives with wife, Joan, and adult son in housing trust maisonette in Elizabeth. Wife works at Coles, son unemployed 2 married daughters and 5 grandchildren.

Regular social drinker Depression related to gambling addiction Began gambling 2 years ago Has lost a lot of money including superannuation funds and is in debt. Wife and family previously unaware of addiction – very angry but also upset about suicide attempt Patient remorseful and ashamed Wants to overcome addiction Used to be a keen lawn bowls player Has lost friends as result of gambling

E:\Weebly\2013\Sarah\Mr Wilson - sample question.doc

Nursing Management: Weak and depressed. Anti-depressants prescribed – Lovan 200g BP 130/95 Diagnosed with Type II diabetes. Diabetes education regarding diet and oral medications Wheelchair use from 20/10 Psoriasis on Torso and scalp – Diprosone OV cream 2x/day, Ionil T Shampoo Poor appetite Physically unfit

Discharge Plan: Encouragement to maintain anti-depressant medication routine as the SSRI is established. Mrs Wilson will help with supervision Monthly follow-up appointments with psychologist Dr Brian Murphy, Lyall McEwen Hospital Social worker appointment to be made for gambling addiction therapy Strong encouragement and assistance to join Gambling Addiction Action Group, Elizabeth Community Centre Contact with Quitline needs to be encouraged Wheel chair required for another week. Frame advised after this Maintain psoriasis treatment Maintenance of low GI diet for diabetes – involvement of wife necessary Encouragement in social sporting activities eg lawn bowls?

Writing Task

Using the information in the notes, write a letter to the social worker, Ms Jennifer Adams, at the Elizabeth Community Health Centre, 125 Munno Parra Avenue, Elizabeth, 5098 requesting follow-up care. Stress that Mr Wilson’s case needs urgent attention.

In your answer:

expand the relevant case notes into complete sentences do not use note form use letter format


Case Notes: Mr Benjamin is a 63 – year-old patient in Care Well Hospital where you are acting as a Charge Nurse.

Patient Details

Marital Status Widower (8 years)

Admission Date 5 September 2009 (Care Well Hospital)

Discharge Date 9 September 2009

Diagnosis THR – Total Hip Replacement Higher BP

Social Background Lives in Abrina Nursing Home 19-21 Victoria Street ASHFIELD NSW 2131 Had been there for 2 years before coming to Care Well (2 months ago) Has no children Worked in a bank as an accountant before quiting at age 60 No Pensioner Hobbies: reading, writing, chess Brother, Peterson, pay visits daily No severe signs of dementia are observed yet

Medical Background 2005 – Osteoarthritis requiring total hip replacement surgery

2003 – Blood Pressure (mangaement ongoing)

Medications Aspirin (100mg) Ramipril 5mg

Nursing Management Dressing Daily and Progress Recommend stretching exercises

Follow up FBE and UEC tests

Assessment Good Condition – post operation Walks with aid in the beginning but now walks perfectly with wheelie-walker Appeared disoriented during post operative recovery - possibly anesthetic Hb dropped (71) post operatively, transfused three units of packed RBCs Hb normal on discharge (112)

Discharge plan Pain reliever given Panadeine Forte (6tablets / day) Exercise recommended Equipment required: wheelie-walker, wedge pillow, toilet raiser. Hospital is providing Wheelie-walker and wedge pillow. With help from local medical supplier, raiser hired for 2 weeks.

Writing Task Using the information in the case notes, write a letter to Ms Susanna Bates, Senior Nurse at Abrina Nursing Home 19-21 Victoria Street ASHFIELD NSW 2131, who will be responsible for Benjamin's continued care at the Nursing Home.

In your answer:



Use letter format



Notes

Mr Dallas Walters is a patient on a renal ward where you are the charge nurse

Age: 51

Marital status: Married with 2 adult children

Religion & cultural background: Uniting Church & aboriginal background

Admission Date: 16th June 2011, Charles Gardiner Hospital

Discharge Date: 22nd June 2011

Diagnosis: Insertion of continuous ambulatory peritoneal dialysis

(CAPD) catheter for CRF

Family/Psychosocial: *On Disability Support Pension (DSP) for schizophrenia

*Mental status relatively stable with mild chronic delusions -

‘Aliens are spying on me 24/7’.

*Supportive wife = his carer; has mild intellectual disability

* Live in demountable home in Bunbury Caravan Park

*Pt loves fishing and AFL.

Medical History *Mild CRF for 4 years; recently worsened

*Type 2 diabetes. Stable/compliant with oral meds

*Removal cataract left eye & insertion of intraocular lens

*Quit smoking and drinking 4 years ago – previously heavy

for +++ years.

Medications To be forwarded by medical officer

Management and Progress during Hospitalisation:

*Uneventful procedure; catheter inserted successfully

*Prolonged admission as pt and wife slow to learn

management of CAPD

*Hyperkalaemic & needed cardiac monitoring for 2/7

But K+ = 4.0 on D/C (N = 3.5-4.8)

*S/B mental health liaison & their Reg. happy that nil acute

changes with pt’s psychosis

Discharge Plan: *+++ CAPD /CRF education for pt and wife

*Monitor for catheter infection or signs of

peritonitis

*Important to educate on minimising K+ in diet.

*Observe for signs of ↑psychosis & refer prn

*If necessary, get community aboriginal health worker

to reinforce CAPD/CRF education

Writing task

Using information provided in the case notes, write a letter of referral to the renal Clinical Nurse

Specialist (CNS) at the Bunbury Community Health Centre for ongoing community care of the patient.

In your answer:



Use letter format



Time Allowed

Reading time = 5 minutes

Writing time = 40 minutes


Notes

Mr Ming Zhang is a 24 year old male patient on the mental health ward where you are a charge

nurse.

Name: Ming Zhang

Age: 24

Cultural background: From China. Speaks ↓English. Needs interpreter.

Admission Date: 5th April 2011 Macquarie Hospital Rosella Ward

Discharge Date: 26th April 2011

Diagnosis: Major depression and deliberate self poisoning (DSP)

Social background: - Came to Australia as a labourer 5 years ago

-Permanent resident now

-Wife had affair and divorced pt 1yr ago.

-Depressed and unemployed since

-Lives in own house with NESB mother out from China.

-Mother doesn’t like pt taking psych meds due to her

Chinese medicine beliefs

-Pt hobbies are fishing & online trading

Psychiatric & Medical background: - Nil Hx of depression pre divorce

- 1st presented 1 yr ago with 1st episode DSP and major

depression

- Attended Chinese psychologist sporadically this year

- Current presentation is 2nd DSP and mental health

admission.

- Medical history of gout, previous hepatitis A, # L tibia, #

R humerus, # L clavicle (all separate occasions and

resolved; work related)

Medications: - Mirtazipine 30 mg nocte

Nursing Management and Progress: -Frequently S/B Chinese speaking transcultural mental

health worker and received 1:1 CBT counselling.

-++ insomnia & ↓mood

-Mirtazipine ↑from 15mg to 30mg 12/4/11

-Mother educated via interpreter re importance of

Antidepressant (AD) meds

-Nil suicidal ideation (SI) at present, please monitor closely

for SI in community

Assessment: Mood low but improved

Low risk of self harm with close follow up and support

Good response to CBT

Discharge Plan: - For case management via community mental health team

-Ideally assign pt to Chinese speaking clinician or use

interpreter service

-Continue CBT

-Observe response to ↑ AD Rx, monitor for side effects

-Encourage ↑ physical exercise & job hunting

-Avoid prescribing benzo meds as pt uses these to DSP

Writing task

You are the Charge Nurse on the mental health ward where Mr Ming Zhang will be discharged from

and need to write a nursing referral letter to the local community mental health team. Address the

letter to Team Leader, Ryde Community Mental Health Team.

In your answer:



Use letter format


Writing Sub-Test: Nursing Time allowed: Reading time: 5 minutes Writing time: 40 minutes

Read the case notes and complete the writing task which follows. Notes Hospital: The Royal Adelaide Hospital

Patient Details: Name: Mr Robert DOB: 02/06/52 Marital Status: Married Next to kin: Wife

Admission Date: 1 October 2011

Discharge Date: 26 November 2011

Reason for admission: Chronic cough, hoarseness, difficulty breathing upon exertion

Diagnosis: Squamous Cell Carcinoma of left lung confirmed by CT scan

Past Medical History: HT diagnosed June 2008 Frequent episodes of bronchitis Heavy smoker-40 years (1-1 ½ pack/day) Non- drinker

Social History: Lawyer Supportive wife 2 married daughters in regular contact. One is 6 months pregnant

Medical Progress: Resection of the lung

Chemotherapy and radiotherapy Ineffective treatment: metastases in liver and spine Cancer in terminal stages-Mr Jones wishes to return home

Nursing Management: Fluid management Oxygen therapy Patient comfortable

Pain management: Morphine sulfate 40mg 4 hourly / 20mg dose as needed.

Discharge Plan: Monitor pain status Manage symptoms

Check need for assistance with mobility / bathing

Daughters want father to stay in hospital for further treatment

- provide family with emotional support

Writing Task

Using the information given in the case notes, write a letter to Marry Watson, Palliative Care Manager, Royal District Nursing Service (RDNS) about the patient.

In your answer:

• expand the relevant case notes into complete sentences• do not use note form• use letter format


Today’s date: 05/04/12 You are Annie Smith, Cardiac Nurse, at the Prince Charles

Hospital, Brisbane. Your patient is Mr.Yanlin Ma who underwent emergency cardio-

thoracic surgery on the 31st March 2012. Patient details

• DOB: 12th March 1980

• Nationality: Chinese

• Marital Status: Single, no family in Australia

• International student on scholarship for Masters in Information Technology

Medical & Surgical History

• No known allergies

• No previous surgery

• Reports high blood pressure since late 2010

• Medications: Panadine Forte for headaches

• Alcohol use: does not drink

• Smokes 5-6 cigarettes per day

• Weight 105kg, Height 182cm

• Family history: Father died of aortic aneurysm at age 44

31/03/12

• Presented to Royal Brisbane and Women’s Hospital with severe chest and back pain

• CT scan showed severely dilated ascending aorta and type-A dissection

• Transferred to Prince Charles Hospital

• In acute pulmonary oedema on arrival

• Echocardiogram performed, showing aortic valve incompetence

• Open-chest surgery for repair of aortic aneurysm and aortic root replacement with

mechanical valve

Post-operation

• Hypertensive initially post-op

• Blood pressure stablised by day 3

• Satisfactory post-operative recovery

• Reviewed by physiotherapist – exercise program provided

• Started on Warfarin therapy

• Cardiac outpatient's appointment at 3 and 6 months post-op

• To be discharged 09/04/12

Plan

• Routine wound care

• Patient education on Warfarin therapy

• Monitor BP. To be maintained at 120/80 or below

Social

Mother has come to Australia urgently from China. First time in Australia, no

English

His lease on rental accommodation has recently expired

He will not complete this semester’s university assessment on time

His visa also expires at end of semester

Concerned about being able to lose weight and stop smoking

Writing Task

Write a referral letter to Ms Susan Williams, the hospital social worker, requesting her to

see your patient before discharge to assist with: accommodation; letters for university

and department of immigration; referral to programs for smoking cessation and weight

loss/exercise.

• Do not use note form in the letter

• Expand on the relevant case notes into complete sentences

• The body of the letter should be approximately 200 words long

• Use correct letter format

2 3

OCCUPATIONAL ENGLISH TESTWRITING SUB-TEST: NURSING

TIME ALLOWED: READING TIME: 5 MINUTES WRITING TIME: 40 MINUTES


Notes:

Patient: Mrs Beryl Casey (DOB: 21/11/1941) is a 72-year-old woman who is being discharged from hospital to a rehabilitation centre.

Marital status: Widowed (recently)

Family: 2 children – son lives locally & daughter interstate.

Social: Lives alone in 2-bedroom house with stairs to entrance. Son (married, 2 children – 6 & 8) lives 20 minutes away – visits twice a week.Enjoys gardening.

Medications: Anti-hypertensive (Ramipril) 10mg

Admission date: 4/02/14 at 1200hrsFaintedgettingoutofbed&felltothe oor.Foundbyson2hourslater.

Diagnosis: X-ray – fractured left neck of femur (# L NOF) post fall

Treatment: Left hemiarthroplasty (Austin Moore hip replacement); general anaesthesiaIncision closed with staples & 2x Exudrain

Post operation: Intravenous (IV) therapy: 3 units packed cells – with IV Lasix (furosemide) 40mgtherapy after each unit (intraoperative & post op)Maintained Vtherapyfor3 hrs,thenceasedandoral uidsencouragedIntravenous antibiotics (IVABs) – Cephazolin 1g t.d.s. for 3/7 – course completed

Vital signs: BP hypotensive – 95/60, other obs. within normal limitsAnti-hypertensive medication reviewd by Dr – Dose now Ramipril 5mg daily

Pain management: Patient-controlled analgesia (PCA) with Fentanyl for 36hrs –pain relief – satisfactory. Commenced oral analgesia 36hrs post op Panadeine or Panadol 4/24 prn, Max 4 doses/24hrs

Wound management:DressingTotalof 00mlhaemoserous uiddischargefromExudrainsover24hrsDrain tubes removed 48hrs post op (Day 2)Alternate staples removed Day 5 and dressing changed

Mobility & activities of daily living (ADLs):Day 2 Sitting out of bed (SOOB) short periods, full assistanceDay 3 Mobilising with pick-up frame (PUF) & 2-person assistDay 4 UneventfulDay 5 Mobilising short distances with PUF & 1-person assist

Abduction pillow when resting in bed (RIB)Anti-embolic stockings in situ for 14 daysADLs – full assistance

Day 6 Uneventful dayPreparing for discharge

Discharge plan:Day 7 (1100hrs) Discharge to the Rehabilitation Centre

Discharge medications – Ramipril 5mg daily, paracetamol 1g qid prnFamilytobenotifiedoftransferHospital transport arranged for 1100hrs

Day 8 Repeat check of hemoglobin (Hb) levels Monitor BP b.d., for 3/7, due to adjustment in anti-hypertensive medsAssess for rehab therapy (inpatient & on return home)

Day 10 Removal of remaining staples, wound can remain exposed afterwards

Writing Task:

Using the information given in the case notes, write a discharge letter to the Nursing Unit Manager, The Rehabilitation Centre, Waterford.

In your answer:• Expandtherelevantnotesintocompletesentences• Donot use note form• Useletterformat

Thebodyofthelettershouldbeapproximately180–200words.



Notes

Name: Mrs Jane LaPaglia

Age: 71

Cultural & religion data: Italian & Catholic, speaks functional English

Admission Date: 4th March 2011 – Prince Albert Hospital

Discharge Date: 28th April 2011

Diagnosis: Renal failure 2⁰ to dehydration, mild dementia, pneumonia

Social/Medical family: * Lives with 80 yr old husband/carer, Joe, in a 4 bdrm unit

*Joe not coping with pt’s or his own care needs.

*House filthy, both have poor hygiene and nutrition

*One son, Andrew, a mechanic, visits Tuesday and Sunday

*Interests include classical music, ballet and AFL.

Medical History and Medications:

See Dr’s notes (to be forwarded)


*Initially comatose, ventilated in ICU 7/7

*Given dialysis 3/52 which ↓ urea & creatinine, stable now

*Hospital acquired pneumonia 2/24 chest physio

for 2/52, still requiring O2 2 litres via nasal prongs but non

infective for 3/52.

*↑confusion post ICU but now back to usual mild level and

Is quite settled.

*Needs prompting to eat, drink, dress, walk, toilet

& tend to personal hygiene but can independently do these

*Family conference 25/3/11. Consensus decision: pt will

move to nursing home & Joe will live in adjoining hostel – nil

beds for either till 28/4/11.

Discharge Plan:

*Transfer to nursing home

*Husband will live in hostel next door, both accepting of this

*Continue O2 therapy as per O2 sats

*Encourage independence, pt capable of self-care with ++

prompting

*Ensure adequate hydration to prevent ↓renal function

*Repeat electrolyte, urea & creatinine blood test weekly

Writing task

You are the Charge Nurse on the medical ward where Ms LaPaglia has spent most of her hospital

stay as a patient.

Using the information in the case notes, write a referral letter to the Charge Nurse at Boronia

Nursing Home, Coogee where Mrs Jane LaPaglia will be discharged to from your ward.

In your answer:



Use letter format


Sample Writing Task: Nasser Ali Read the case notes below and complete the writing task which follows


Today’s date: 19/02/2012 You are Louise Nagatani, a registered nurse in the Coronary

Care Unit at a General Hospital. Nasser Ali is a patient in your care. Discharge

Summary

• Name: Nasser Ali

• Address: 1052 Moorvale Rd, Moorooka

• Phone: 046538762

• Date of Birth: 4 February 1964

• Date of admission: 09/02/2012

• Diagnosis: MI

• Date of discharge: 19/02/2012

• Name of surgery: CABG

Reason for admission

• Patient arrived at the hospital via ambulance 10 days ago suffering from acute

substernal chest pain radiating to left arm.

• He complained of severe chest pain, pain in jaws and left arm, diaphoresis, dizziness

and shortness of breath.

• Patient has been diagnosed with myocardial infarction. Condition has now stabilised,

however, he appears restless and worried about his condition.

• He is overweight and is a smoker.

• He has high blood pressure.

Treatment

• Sereptolunanse, anti-coagulants and anti-cholinergic drugs.

• Continuous ECG monitoring, angioplasty on 10/02/2012

• Post surgery physiotherapy

• Karvea 150 mg daily

• ½ Aspirin daily

Social History

• Family are refugees from Afghanistan arrived by boat in Australia in 2010.

• Marital status: Married, seven children. Aged 6 months to 22

• Next of kin: Fatima Ali (Wife)

• Employment o Nasser works as a Taxi Driver

o Fatima: Housewife

• Accommodation: Living in rental flat

• GP: No family doctor

• Language: Dari. Nasser attends TAFE English classes but only has basic English

conversational ability.

Discharge Plan

• Follow-up appointment made with cardiologist, Dr R Lang, Hospital Outpatients 2pm

26/2/2012

• Order medications from hospital pharmacy – Explain usage and stress the importance

of taking medication regularly as directed

• Arrange for dietician to provide dietary advice

• Discuss importance of giving up smoking and provide advice on available quit smoking

programs

• Advise patient to continue with the exercise program recommended by the hospital

physiotherapist , particularly deep breathing exercises with Triflo

• Arrange for a community social worker to provide a support service to the family to

ensure a smooth transition back to normal life.

WRITING TASK

Using the information in the case notes, write a letter to the social worker, Sarah

MacDonald Annerley Community Centre, 1122 Ipswich Rd Annerley, 4121 explaining the

patient’s situation and needs. In your answer:

• Expand the relevant case notes into complete sentences


• The body of the letter should not be more than 200 words

• Use correct letter format



Notes

Name: Phillip Satchell

Age: 73

Marital status: Wife deceased (2007)

Family: Two sons in their 40’s in Darwin.

First attended community centre: March 2007

Last visit to community centre: Feb 2011

Diagnosis: Multiple sclerosis, Type 2 diabetes, chronic L & R leg ulcers

Social/Medical Background: Current: lives alone in public housing in Orange

Future: will move to equivalent housing in Maroubra to Î

access for MS treatment.

Income: aged pension

Poor compliance with oral diabetic agents and diabetic diet

MS currently stable but frequent relapses

2-3/12 Staphylococcus Aureus infections

in leg ulcers; pus ++

Lonely and isolated, but nil mental illness; good relations

with sons but rarely see them. They run a pet shop business.

Nursing management and progress: Medications: IV antibiotics twice daily and metformin for

diabetes three times per day.

Twice daily dressings to L & R legs

Monitored blood sugar levels, medication compliance

and provided education re diabetes.

Constantly monitored for signs of MS relapse

Discharge plan

Switch to oral antibiotics but continue same diabetic medications and dressings.

Please refer to Prince of Wales Diabetic Clinic (medication review + Î education).

Via your doctors, facilitate referral to neurologist for MS follow up.

Support to link with community services to Î coping and social network.

Writing task

Using the information in the case notes, write a referral letter to the Community Nurse, Community

Health Centre, Maroubra, outlining relevant information and requesting continued community care.

In your answer:



Use letter format




Notes

Patient: Rosalind Hinds

Age: 6 days

Next of Kin: Genette Keating (Mother)

Date of birth: 22 April 2011

Discharge Date: 28 April 2011

Diagnosis: Low birth weight & opioid dependence

Family: Will live with mother at maternal grandmother’s house

Background: * Mother (22 yrs) heroin dependent 2 yrs.

*Mother, single and recently worked as a sex worker.

*Estranged from father of Rosalind as alleged domestic

violence towards her during pregnancy.

*Genette’s mother supportive.

*First child

*Department of Community Services involved but approve

discharge living situation as long as with grandmother

Medical History and Medications:

See Dr’s notes (to be forwarded)


* Both mother and baby completed heroin withdrawal

without complications

*Baby 2.0kg at birth; 2.3kg 28/4/11

*Bottle feeding erratically ? ↓appetite

*Poor bonding between mother and baby.

*Genette often needs prompting to care for baby.

*Drug and alcohol team involved in managing Genette’s

ongoing addiction issue.

Discharge Plan: *Daily visits until pt stable weight and feeding stable

*Ensure safe environment for baby and update

Department of Community Services if risks present

*Monitor mother’s coping and psychosocial state

*Educate mother and grandmother on infant care

*Liaise with drug and alcohol team to provide integrated

support for mother to ↓ risk of heroin use.

Writing task

You are the Charge Nurse on the maternity ward where Rosalind Hinds was born and need to write a

letter to the local community midwifery team outlining relevant information and requesting

discharge follow-up. Address the letter to Maitland Maternal and Child Health Centre, Maitland.

In your answer:



Use letter format


Sample Writing Task: Nurse



You are Sonya Matthews, a qualified nursing sister working with the Blue Nursing Home Care Agency. Bob Dawson is a patient in your care. Read the case notes below and complete the writing task which follows.

Name: Bob Dawson Address: 141 Montague, West End 4101 Phone: (07) 3442 1958 Date of Birth: 25 September 1924

Social Background Married – wife Elizabeth aged 83. Lives in own home – Both receive age pensions Bob is World War11 Veteran with Gold Health Card entitlement

Medical History: Cerebrovascular accident (CVA) 4 years ago Rehabilitation generally successful - Mentally alert, slight speech impairment, - residual weakness left side - walks with limp – balance slightly impaired.

18 /5/08 Had fall descending stairs. Badly grazed left knee. GP has requested daily visits by Blue Nursing Home Care to dress wound and assist with showering.

19.5.08 Grazed knee redressed – no sign of infection Bob managing to get around the house slowly with aid of his wife. Reports that apart from “usual aches and pains” he is doing well.

23.5.08 Knee healing well. Suggested use of a walker or walking stick to assist with mobility. Bob said he had a walking stick but it was useless. Wife says he had never learned to use it properly. She asked if I would contact their local physiotherapist to see if Bob could receive a home visit to assess further assistance to improve his mobility.

C:\Users\Gary\Desktop\Sarah\Shannon Warne - sample letter.doc

Occupational English Test

Writing sub-test: Nurses

Time allowed: Reading Time: 5 minutes Writing Time: 40 minutes


NOTES

Name: Shannon Warne

Age: 23 years

Marital status: Single

Admitted: April 6, 2007

Discharged: June 14, 2007

Diagnosis: Broken neck and fractured pelvis following car accident Probable permanent neurological damage affecting mobility, speech

and memory areas

Social background: 3rd year architectural studies student, Adelaide University Interests: hockey, cycling, photography Was living in share flat - now needs long term rehabilitation Parents willing to care for him; may eventually return home Currently eligible for disability pension

Nursing management and progress: Good progress Will require ongoing high level care Recently started using wheelchair Daily physiotherapy, hydrotherapy 2x / week and speech therapy 3x / week Bed sores but improving with increased mobility Frequent headaches Nurofen 200g max 4x a day

C:\Users\Gary\Desktop\Sarah\Shannon Warne - sample letter.doc

Discharge plan: Depression needs to be treated with activities and interests Contact university for possible continuation of studies externally Needs contact with people his own age – Community Access? No special dietary requirements

Writing task:

Write a letter to Su Yin Lee, Sister in Charge, Hampstead Rehabilitation Centre, 695 Hampstead Road, Greenacres 5029 using the information in the case notes to outline relevant information and request follow-up care.

Do not use note form in the letter; expand the relevant case notes into full sentences. The body of the letter should be approximately 180-200 words.

Writing Test 2

Read the case notes and complete the writing task which follows.

Patient History Shirley Decosta is a two week's old baby. Her mother has got discharge from maternity hospital Baby: Shirley Decosta, two week's old

Social History Mother: Ritz Decosta DOB: 9/8/1983 Husband: Joseph Decosta, 42 years Occupation: Taxi Driver Other Children: Shelley Decosta, 9 years

Nursing Notes Normal delivery Breast Feeding the baby Baby sleepy

Weight Taken At the time of birth: 3009 gm At the time of discharge: 3022 gm

Discharge Date 22 April, 2011

Using the information in the case notes, write a letter to Ms Susanna Bates, Child Health Nurse, at Royal Women Hospital, CNR Grattan & Flemming St, Parkville, VIC 3052, who will provide follow-up care in this case.

In your answer:



Use letter format


Patient name:—Stanley Williams. D.0.8- 20/3/1956 Patient History: Stanley Williams is a builder and regular patient your country medical center in Mildura, 350 km north of Melbourne. Presents occasionally with lower back pain-clears up with anti inflammatories. Had spinal x-ray 1 year ago—showed some narrowing of L4-5 and sign of osteoarthritis in L5-s1 Has NIDDM controlled by diet and exercise.

23/2/2007 Sudden onset lower back pain yesterday while working .Worse than usual back pain. Worse L. Side with radiation down back of L.thigh. Took Nurofen which settled pain but worse this morning. Couldn't go to work.

Puts on L.hip when walking, walks slowly. Tender around lower spine and spinal muscles. SLR positive on L.side at 45 degrees. Legs normal power and reflexes. Pain inhibiting lumbar flexibility and extension.

Assessment: Possible disc prolapse or nerve root irritation from facer joint disfunction.

Treatment: Bed rest 2 days, paracetamol and anti inflammatory 50 mg 2 X daily with food, hot water bottle on back, come back in 2 days.

25/2/2007 No change in pain or leg pain, neurological examination done normal. In pain but says it's no worse than before, still some difficulty with movement, L.side SLR 40-45 degrees.

Assessment: No improvement of symptoms but no worsening. Treatment-Continue treatment as before. NSAIDS increased to 3X daily .Return in 2 days for review.

27/2/2007 No change in back pain; radiating leg pain worse, more constant, esp. at night; urine test showed glycosuria 2 plus (usually none). Obviously in pain, difficulty with movement ,walks slowly. Still tender and with decreased motion. SLR 30 degrees. L.side. Random blood glucose taken-12 mmol.

Assessment- Symptoms worse. Inactivity making diabetes symptoms worse.

Treatment: Continue treatment as before. Review in 5 days. Paracetamol/codeine 30 mgX 6 hourly. Reason for diabetes symptoms worsening explained- diet modification recommended because of inactivity.

29/2/2007 Called urgently to patient's home, pain increased overnight in back and down L.leg; pain not controlled by any medications, lower L.leg has become numb.

Pain caused inability to get out of bed.SLR 10 degrees L.Ieg and 30-40 degrees R.leg.L.leg also no ankle reflex, decreased toes extension, decreased ankle flexion, decreased pin prick sensation in areas. Random blood glucose increased to 14 mmol.

Assessment: condition not relieved by medication. Signs indicate nerve root compression and disc prolapse.

Treatment: Ambulance transport to Royal Melbourne Hospital emergency department arranged, phoned orthopaedic registrar and arranged for hospitalisation and orthopaedic assessment.

Write a letter to Dr.Kate Murray, Royal Melbourne Hospital Royal Parl, 3004.

Patient Details

You are Joanna Andrew, a senior nurse working with the “Your Health Care Agency.” Stephen Mabel is the patient. Read the case notes below and complete the writing task which follows.

Name Stephen Mabel

Address 8 Stuart Street, Perth, WA 6000

Phone 0422 678 144

Date of Birth 18 June, 1972

Social Background

Married – Wife Sandra Mabel aged 39. Lives together Stephen Mabel works as an accountant in a company in Perth.

Medical History Faced Cerebrovascular accident (CVA) some 2 years ago. Agile, Mentally active, speech slightly slurred, complaining of severe illness, Walks with limp, impaired balance

12/7/2011

Felt extreme headache in the morning, fell off the stairs, badly injured right knee, GP requested Your Health Care Agency for daily visits, dressing and assisting in taking shower daily.

15/7/2011

Left leg knee – redressed, no infection noticed.

Stephen was able to walk little distances with help from his wife, Sandra. Complained of usual pain while walking, apart from this nothing and he is doing well.

19/7/2011

Kneed healed well.

Patient was suggested to walk, using walking sticks. Wife, Sandra, requested for more home visits in order to bring more improvement in his mobility.

WRITING TASK

Using the information given below in the case notes, write a letter to the Ms Physiotherapy Center 588 Hay Street Subiaco, ((08) 9388 2877) on behalf of the patient's wife, Sandra, requesting a home visit to help her husband in walking properly.

In your answer:

Expand the information given in complete sentences

Do not use note forms

Use only letter format.

The body of the letter should be approximately 180-200 words. .

reported that Alison is overeating, embarrassed about her eczema and missing her father, who she was very close to.

Based on this, I would appreciate it if you could investigate her case. Should you require any further information please do not hesitate to contact me.

Yours sincerely,

Charge Nurse Toohey Point State School

Word Count: 227 words

Writing Task 1 Nurses



Today's Date

09/09/12

Notes

You are Lee Wong a registered nurse in the Coronary Care Unit, St Andrews Hospital Brisbane. Bill O’Riley is a patient in your care.

Patient Details

Name: Bill O’Riley DOB 12 January 1959 Address 9476 Old Dam Road, Goondiwindi QLD 4390 Next of Kin Brother, Ernie O’Riley 72 Burke St, Cunnamulla QLD 4490

Admitted 2 September 2012 Diagnosis Obstructive coronary artery disease Operation Coronary artery bipass grafts (x 4) on 4th September 2011

Social History • Never married• Lives alone in own home just outside Goondiwindi• Fencing contractor

Medical History • Smokes 20 cigarettes/day• Alcohol: 2 x 300ml bottles beer / day• Ht 170cm Wt 99kg• Usual diet: sausages, deep fried chips, eggs, MacDonalds• Allergic reaction to nuts

Nursing Management and Progress • Routine post operative recovery• Advised to cease smoking, reduce alcohol• Low fat diet• Walking well• Wounds healing well• Routine visit from Social Worker

Discharge Plan • Returning Home to Goondiwindi • Appointment made for follow up visit to local GP Dr. Avril Jensen 2pm 15/9/12 • Local physiotherapist to continue rehabilitation exercise program

Writing Task

Mr. O’Riley has requested advice on low fat dietary guidelines and healthy simple recipes. Write a letter to the Community Information Section of the Heart Foundation, Gregory Terrace, Brisbane on the patient's behalf. Use the relevant case notes to explain Mr. O’Riley’s situation and the information he needs. Include Medical History, Body Mass Index and lifestyle. Information should be sent to his home address.

Task 2 Case Notes: Robyn Harwood

Time allowed: 40 minutes Today’s date: 12/07/11 You are Sonya Matthews, a registered nurse at the Spirit Hospital. Robyn Harwood is a patient in your care. Read the case notes below and complete the writing task which follows. Patient Details Name: Robyn Harwood Address: 8 Peach St, New Farm Phone: (07) 3397 2695 Date of Birth: 4 February 1950 Social Background Marital status: Widow. No children. Lives alone Next of kin: Megan Mack (Niece) Niece lives with husband in Sydney who works as software engineer for Google Australia. Sister died recently. No other relatives. Medical History Diabetes Mellitus Type 2 Metformin 500mg mane Diagnosis

Right partial rotator cuff tear Presented to Spirit hospital with pain and weakness in the right shoulder, especially when lifting arm overhead. Descending stairs at home and slipped, falling onto outstretched arm. Xray and MRI showed a partial rotator cuff tear. Orthopaedic surgeon discussed surgery. Patient prefers to try non-surgical treatment. Date of admission: 30-06-2011 Date of discharge: 12-07-2011

Treatment

Ibuprofen orally QID Cortisone injections Daily physiotherapy

Nursing Care Needs

Needs blood glucose level monitoring 4 hourly May be elevated because of cortisone Needs assistance with shower and housework Orthopaedic review on 01/08/11

WRITING TASK Using the information in the case notes, write a letter to the Nursing Director Ms. Jenny Attard of the Community Home Care Agency, requesting visits from the home care nurse.

Task 3 Case Notes: Henry O'Keefe


Today's Date 13/3/12

Read the case notes below and complete the writing task which follows: You are a nurse with the Blue Skies Home Nursing Centre. You visited this patient at home today for the first time following a referral from the Spirit Public Hospital. He was discharged from hospital on 17/03/12.

Name: Henry O’Keefe Address: 12 Donaldson Street, Greenslopes 4121 Phone: (07) 3941 2267 Date of Birth: 2 February 1929 Admitted: 14/3/12 Diagnosis: Malignant Melanoma Left Shoulder

Medical History

Large lesion successfully removed 14/3/12 Discharged 17/3/12 Needs assistance with showering and to dress wound prior to removal of sutures at Mater Public Hospital on 24/3/12

Family History

Married aged pensioner. Lives in housing commission home with wife Dorothy also an aged pensioner. No children

18/3/12 1st Home visit

Showered patient. Wound dressed – healing satisfactory no sign of infection Balance a little shaky - complaining of increased arthritic pains in hands and legs. Currently taking Glucosamine & Chondroitin Supplement recommended by GP. Pain relieved with 2 Panadol 3 times daily. Confused about why he had operation. Dorothy concerned about future. Tells you she will be 83 in August. Says Henry has not been himself since the surgery. Keeps forgetting things. She finds it difficult to manage the house and garden. Neighbours are helping with shopping. Kitchen and bathroom disordered - trouble finding clean towels – dishes piled in sink, bed unmade.

19/3/12

Henry showered and wound dressed. Still a little unbalanced. Rests most of the day. Does not remember being showered yesterday. House still disorganised, washing piled up in bathroom. Dorothy says she would be lost without help from neighbours who also appear to be cooking meals for the couple.

Concerns: Provided there are not complications with the wound healing, your role in providing nursing care ends when sutures are removed on 24 March. You consider that Jim and Dorothy need to be assessed for further on-going assistance in managing the house and garden and with shopping and the preparation of cooking.

Plan: Request a home visit by the Aged Care Assessment Team as soon as possible to fully assess their needs and to arrange for appropriate further assistance to be provided.

WRITING TASK Using the information in the case notes, write a letter to The Director, Aged Care Assessment Team, Brisbane South Region, 78 Masterson St. Acacia Ridge, Brisbane 4110. Explain why you are writing and what types of assistance may be required.

Nurses Writing Task 4

Read the case notes below and complete the writing task which follows


Today's Date

25/07/12

Notes

Vamuya Obeki was admitted through the Children's Emergency Department for acute meningoencephalitis as a result of a complication following mumps.

Patient History

Address: 32 Sexton St, Ekibin Phone: (07) 38485555 Date of Birth: 23 May 2008 Admitted: 15th July 2012 Gender: Male

Discharged: 25th July 2012 Country of birth: Sudan Diagnosis: acute meningoencephalitis

Social History

Parents: Miri & Abdullah Obeki, refugees, arrived in Australia in 2012. Employment: Abdullah: Golden Circle pineapple factory, shift worker Miri: housewife Accommodation: Recently moved to rental accommodation GP: No family doctor Sibling: 2 year old brother, Saeed Language: Dinka, Arabic Interpreter needs: Abdullah understands spoken English but has limited written skills. Miri has limited understanding of English. Abdullah attends English classes.

Medical History

Parents state that both children had some kind of vaccination at birth but the vaccination record has been lost. Parents unaware of vaccine for Mumps.

Discharge Plan

Appears to have fully recovered from mumps and acute meningoencephalitis. Will need advice on recommended vaccines for both children. Will need neurological check-up.

Writing Task

Using the information in the case notes, write a letter to The Director, Community Child Health Service, 41 Jones Street, Ekibin, requesting follow-up of this family.

Task 5 Case Notes: Jim Middleton

Time allowed: 40 minutes Read the case notes below and complete the writing task which follows: Today’s date: 9/7/12

Patient Details

Jim Middleton aged 84 was admitted to your ward following surgery for a left inguinal hernia. His doctor has advised he can be discharged within 48hrs if there are no complications following the surgery. Jim reports some pain on movement but has recovered well from the surgery and is keen to return home.

Name: Jim Middleton Date of Birth: 3 July 1928 Admitted: 7 July 2012 Planned Discharge Date: 9 July 2012 Diagnosis: Left inguinal hernia

Medical History

Hypertension diagnosed 2002 Medication Atacand 4mg daily

Family History

Married 50 years to wife Olga DOB 8/2/36 – one son living in USA Jim is Second World War veteran – served two years in Borneo –Prison of War 16 months. Own their own home with large garden which they maintain without assistance. Very independent and proud that they have never applied for a pension or home assistance. Have always managed quite well on their income from a number of investments. Olga told you she is worried as income from these investments has recently been

significantly reduced due to severe stock market falls. She is concerned Jim will not be able to continue to maintain their garden and they will not be able to afford a gardener or any other help at this time. Transport is also a problem as Olga does not drive. Not close to any reliable public transport so will have to rely on taxis. Olga thinks they may now be eligible to receive a pension and other assistance from the Department of Veteran Affairs but doesn’t know how to find out - doesn’t want to worry Jim. Olga is in good general health but becoming increasingly deaf - finds phone conversations difficult. She would appreciate a home visit. You agree to enquire on her behalf. Their address is 22 Alexander Street, Belmont, Brisbane 4153 Phone (O7) 6946 5173

Discharge Plan • Must avoid any heavy lifting• Should not drive for at least six weeks• Light exercise only• May take 2 Panadol six hourly for pain• Appointment made to see surgeon for post operation check at 10am on 11 August• Contact Department of Veterans Affairs re eligibility for pension and home help

WRITING TASK Using the information in the case notes, write a letter to The Director, Department of Veterans Affairs, GPO Box 777 Brisbane 4001. In your letter, explain why you are writing and the assistance they are seeking.

Task 1 Case Notes: Nicole Smith



Today's Date

13/09/12

Notes

Ms. Nicole Smith is an 18 year old woman who has just given birth to her first child at the Spirit Mothers’ Hospital in Brisbane. You are the nurse looking after her.

Patient Details

Address: Flat 4, Matthews Street, West End 4101

Phone: (07) 3441 3257

Date of Birth: 4 September 1994

Admitted: 9th September 2012

Discharged: 13th September 2012

Marital Status: Single

Country of birth: Australia

Social Background

Nicole is single and has had no contact with father of child for six months. She does not know his current address. No family members in Brisbane. Parents and sister live in Rockhampton. Does not currently have contact with them. Lives in a rental share flat with one other woman. Currently receives sole parent benefits. Feels very isolated and insecure. Doubts her ability to be a good mother and has talked about offering the baby for adoption.

Medical History

General health good Had appendicectomy at 15 years Non-smoker No alcohol or illicit drug use. No drug or other allergies

Obstetric History

First pregnancy Attended for first antenatal visit at 16 weeks gestation. 8 antenatal visits in total. No antenatal complications.

Birth Details

Presented to hospital at 1900hrs on 9th September Contracting 1:10mins 1st stage of labour: 16 hrs Mode of delivery: emergency caesarean section Reason: fetal distress and failure to progress.

Baby Details

DOB: 10th September 2012 Time: 1120hrs Sex: Male Weight: 4.4 kg Apgar Score: 6 at 1 min, 9 at 5 mins Resusitation: O2 only for few minutes

Postnatal Progress

Maternal post partum haemorrhage of 800mls Blood loss now minimal Wound: Clean and dry Haemoglobin on 12/09/12: 90 g/L Started on Fefol (Iron supplement) and Vitamin C Started breast feeding but not confident. Prefers to change to bottle feeding. Not confident in bathing and caring for baby

Baby weight at discharge: 4.1 kg Feeding well No jaundice

Writing Task

Using the information in the case notes, write a letter to The Director, Community Child Health Service, 41 Vulture Street, West End, Brisbane, 4101 requesting a home visit to provide advice and assistance for Nicole and her baby.

Task 2 Case Notes: Betty Olsen



Today's date

10/07/12

Notes

Betty Olsen is a resident at the Golden Pond Retirement Village. She needs urgent admission to hospital. You are the night nurse looking after her.

Patient Details

Address: Golden Pond Retirement Village 83 Waterford Rd, Annerley, 4101

Phone: (07) 3441 3257

Date of Birth: 29/01/1929

Marital Status: Widowed

Country of birth: Australia

Social History

Moved to a retirement village following the death of husband in December 2010.

Next of kin: Son, Nicholas Olsen, 53 Palmer Street, Warwick 4370 Ph (07) 4693 6552.

Retired triple certificate nurse - was the matron of a small country hospital for 15 years. Very aware of and interest in health issues. Likes to discuss and be kept fully informed of any changes to her medication or treatment.

Normally alert and orientated. Enjoys bridge, bingo and reading.

Medical History

Hypothyroidism since 2000 Hypertension since 2007 Glaucoma since 2007 Allergic to penicillin

Prescription Medications

Karvea 150mg 1 daily Oroxine 0.1mg 1 daily am Timoptol Eye Drops 0.5% 1drop each eye am & pm Normison 10 mg as required

Non prescription Medication

Golden Glow Glucosamine Tablet - 1 with breakfast for arthritis Vitamin C Complex Sustained Release – 1 with breakfast

Mobility / Aids

Independent with walking stick. Arthritis in hands. Wears glasses

Continence: Requires continence pad

Recent Nursing Notes

16/05/12 Flu vaccination

29/06/12 Complaining of indigestion following evening meal. Settled with Mylanta

07/07/12 Unable to sleep – aches in shoulder. Settled following 2 Panadol and 1 Normison

09/07/12 Requested Mylanta for indigestion,Panadol for shoulder pain – slept poorly

10/07/12 am Tired and feeling generally weak. BP 180/95. Confined to bed. GP called and will visit 11/7/12 after surgery.

10/07/12 pm Didn’t eat evening meal. Says felt slightly nauseous. Trouble sleeping, complaining of shoulder and neck pain. BP 175/95 Given 1 Normison 2 Panadol at 10pm Rechecked 10.45pm – Distressed, pale and sweaty, complaining of persistent chest pain, BP 190/100. Ambulance called and patient transferred

Writing Task

Write a letter for the admitting doctor of the Spirit Hospital Emergency Department. Give the recent history of events and also the patient’s past medical history and condition.

Task 3 Case Notes: Nina Sharman



Today’s Date: 21/03/12

Patient Details

• Name: Ms. Nina Sharman• DOB: 09/02/1951• New resident of Dementia Specific Unit, Westside Aged Care Facility• Single• Under the Australian Guardianship and Administration Council protection

Medical History

• Ischemic heart disease (IHD) since 2005, takes Nitroglycerine patch, daily• Stroke May 2011, after stroke - unsteady gait• In 2011 - diagnosed with severe dementia - able to understand simple

instructions only, confused and disorientated• Diabetes mellitus (type 2) since 2000 – on a diabetic diet• Osteoarthritis of both knees 20 yrs. Voltaren Gel to both knees BD• Weight gain 10 kg over the last 5 months, current weight 106kg (BMI of 30)• Chronic constipation, takes Laxatives PRN• No allergies to medication or food• No teeth – has entire upper or lower dentures, sometimes refuses to wear

dentures due to confusion and disorientation• Increased appetite– usually eats full portion of offered meals x 3 times daily and,

also, goes into other residents’ rooms and eats their food as bananas, biscuits orlollies

Social History

• No friends• Lack of interests, but likes colouring and watching TV• ↑emotional dependence on nursing staff• Non-smoker, no use of alcohol or illegal drugs

Recent Nursing Notes 15/02/12

• Chest infection. Keflex 500mg QID x 7 days

26/02/12

• Occasional cough & episodes of SOB with ↑RR

27/02/12

• Sporadic throat clearing after eating yoghurt

20/03/12 1700 hrs

• Episode of choking on a piece of food (? food not chewed properly). Shesuddenly turned blue, grabbed the throat with both hands and coughed. Thepiece of solid food was removed.

1710 hrs

• Nursing assessment after treatmento Pulse 110 BPMo BP 120/70 mmHgo RR – 22/mino T– 37.1° Co BSL – 6.0 mmol/L

1800 hrs

• No complaintso Pulse – 88 BPMo BP – 115/70 mmHgo RR – 16/mino T- 37.0 °Co Skin: normal colour.o Hospital visit not required

WRITING TASK

You are a Registered Nurse at the Dementia Specific Unit. Using the information in the case notes, write a letter to Dietician, at Department of Nutrition and Dietetics, Spirit Hospital, Prayertown, NSW 2175. In your letter explain relevant social and medical histories and request the dietician to visit and assess Ms. Sharman’s swallowing function and nutritional status urgently due to a high risk of aspiration.

Task 4 Case Notes: Sandra Peterson



Today’s Date: 22/03/12

Hospital Spirit Hospital - Medical Assessment Unit (MAU) Admission Date: 20/03/2012 Discharge Date: 22/03/2012

Patient Details

• Name: Sandra Peterson• DOB: 01/01/1921• Address: 258 Addison St, Applethorpe• Marital status: widowed – 25 yrs• Next of kin: daughter – Ann Macarthur ph 0438856277

Diagnosis

• URTI (Upper Respiratory Tract Infection) – dehydration, bi- basal cracklesheard on chest, SOB

• Polypharmacy - on 24 medications at admission including a variety of OTCmedication encouraged by her daughter

History of Presenting Illness

• 13/03/2012 –coughing (yellow sputum)• 18/03/2012 - ↓ed mobility, found in a sitting position on the floor in her room,

no injuries• 19/03/2012 - ↑ed confusion had another fall in the toilet, no injuries• 20/03/2012 - BP 190/90, SOB, dizziness, the 3rd fall, an ambulance was called

Past Medical History

• Moderate dementia• HTN• Incontinent of urine – occasionally

Social History

• Lives in 2-bedroom flat with her daughter and son-in-law• Daughter is overly supportive, overreacting and anxious about her mother’s

health• Religion: Orthodox Christianity, attends church weekly with daughter• Hobbies: listening to classical music, watching movies• Requires some assistance with bathing, dressing and toileting

• Home Care worker visits 2 x wkly (bathing)

Medical Progress

• X- Ray – normal• FBC – WCC 9.0, Hb 115g/L• CT-brain – no acute changes• Commenced on Augmentin 500 mg x BD, per os• Now intermittent dry cough• IV normal saline for 24 hrs• Medications rationalised by doctor as detailed in discharge plan• BP 150/70 - after adjustment of anti-hypertensives

Nursing management

• Vital signs: afebrile, haemodynamically stable, saturating 96% room air• Mobility: short distance – independently ambulant with a seat walker, long

distance – wheelchair x 1 assistant• Hygiene: full assistance require with bathing, some assistance with dressing and

grooming• Psycho/Social: Mild confusion, but co-operative

Discharge Plan

• Community nurse referralo Continue 500-mg tablet of Augmentin BD x 5 days, should be taken at

the start of a mealo Metoprolol 25 mg BDo Candesartan 16 mg maneo Medications – monitoring and assistanceo Daughter requires education/monitoring due to Hx of polypharmacyo Ongoing care with personal hygiene required

Writing Task You are the charge nurse on the MAU where Mrs Sandra Peterson has resided during her hospital stay. Using the information in the case notes, write a letter to the Community Nurse at Spirit Community Health Centre, Cnr Bell & Burn Streets Applethorpe, NSW, 2171. In your letter explain relevant background and medical history and provide information about discharge requirements.

Task 5 Case Notes: Alison Cooper

Read the case notes below and complete the writing task which follows. Time allowed: 40 minutes You are the school nurse at a Toohey Point Primary State School Today’s Date 07/03/2012 Patient Details Alison Cooper Year 5 student DOB: 14/6/2002 Height:138cm Weight:40 kg Overweight for her age Eczema outbreaks on hands and mild asthma – has ventolin inhaler No other significant illnesses Youngest in her class Social History Father died in motor accident 18 months ago. Lives with mother, a bank manager, working full time Middle child- brother, Simon, aged 7 and sister, Lisa, aged 12 Paternal grandmother liv

writing test...mansoura, public health nurse, 125 canterbury road, ringwood, victoria 3134...

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