TASK 42 You are a registered nurse working at Newtown Community Hospital. Your patient, Ms. Mary Bell, is being discharged today. Patient: Mary Bell (Ms.) Age : 66 Years
Marital status : Single Family : Nil
First admitted : 24 June 2017, Newtown Community Hospital Discharge : 15 July 2017
Diagnosis : Unstable diabetes mellitus.
Small infected (left) foot ulcer
Medical history : Non-insulin-dependent diabetes mellitus -15 years.
Social/family background: Retired at 65 from managerial position 2016.
Lives alone in own four bedroom home.
Income: small pension – much lower than pre-retirement income.
Reports no relatives or close friends. Reports no outside interests.
Since retirement alcohol intake has increased and dietary quality has decreased.
Periodic problems with self-administration of hypoglycaemic medication.
Nursing management and progress: Medical hypoglycaemic agent (glibenclamide) to continue Antibiotic therapy (Augmentin Duo Forte) for review at completion of current course. Ulcer daily saline dressing, monitor wound margins, observe for signs of complications, review healing progress, etc.
Discharge plan: Monitor medication compliance, blood sugar levels, alcohol intake, diet. Encourage moderate exercise programme.Suggest establishment of income-producing activity Encourage establishment of social activities.Prepare a letter to the community nurse, emphasising the need for an overall life- style plan, and suggesting involvement of community social worker service.
Writing Task:Using the information given in the case notes, write a letter of discharge to Ms. Jane Rudik, the community nurse at Newtown, Community Health Centre, informing her about the patient’s condition and her medical and social needs, Address your letter to Ms. Jane Rudik, Community Nurse, Newtown Community Health Centre, Newtown
This patient has been in your care and is now going home from the Royal Children’s Hospital, Read the case notes below and complete the writing task that follows.
Patient: Brett Davis – 18 months old
Admitted : 10 August 2016
Discharged: 12 August 2016
Brett’s parents instructed to take the child to the Surry Hills
Community Health Clinic – appointment with the Maternal & Childcare Nurse. Diagnosis : Chronic Nasal Congestion / AURTI
SOCIAL BACKGROUND: Brett is the 2nd child in the family- one sister (Emily) aged 5 years
Mother: June Davis – 23 y.o. Working as a waitress; late night shifts
Father: Malcolm Davis – 24 y.o. Construction worker: works during daytime
Lives in rental accommodation, a two-bedroom apartment
NURSING NOTES:
Denver Developmental Screening Test (DDST) administered – normal development
Nasal and ear clearing before feeds and as required
A-febrile after 36 hours
Free fluids given which were well tolerated
Congestion restricted his sucking ability
DISCHARGE PLAN:
Support Mrs. Davis in improving parenting skills
Continue antibiotics (complete 14 day course)
Continue free fluids
Continue ear and nasal clearing as required
Observe for signs of elevated temperature
WRITING TASK: Brett’s parents have been instructed to take Brett to the Surry Hills Community Health Clinic. Write a letter of referral to Sr Mary Bouvier, Maternal & Childcare Nurse, Surry Hills Community Health Clinic, Main Road, Surry Hills, New South Wales 2010 requesting she arrange for Brett to be monitored until antibiotics are completed; Community Nurse to make sure both parents are instructed in proper procedure for ear and nasal clearing. Letter should be 180 to 200 words long / only the first 25 lines will be considered.
TASK 40 Mary White- resident at Kingsville Retirement Village
You are a registered nurse employed by the Kingsville Retirement Village. It is your duty to attend to call outs from the residents in the Independent Living Units as well as assisting the staff in the Low Level Care unit. It is 7 pm (19:00 hours) and you receive a call from the daughter of one of the residents. She has just visited her mother and found that she cannot rouse her. You go to the unit, open the door with your key and find the lady unconscious, face down on the floor. The daughter telephones the Ambulance Service. You examine the lady (Mary White) and find the following:
CNS: rousable only to pain
Respiratory: slow, laboured breathing.
CVS – dusky purple colour to face, good capillary refill to fingers, pulse slow and full.
Urogenital- has been incontinent of urine
Musculoskeletal – flaccid muscles, is able to be moved onto side in the Recovery position to move.
You perform the following measurements:
PR & BP-37 degrees C; 58; 14; 150/90
BSL-6.5mmol/l
Her past history includes:
Pregnancies x4 with live births (30 years ago)
Hypertension
Widowed 6 years ago
Cataracts in both eyes, awaiting surgery
Cardiac arrhythmias for which she takes Digoxin
The ambulance arrives and you verbally hand over the information; they then decide to transport Mary to hospital. Her daughter has packed all her medication with the overnight bag.
Your task: Write an introductory letter for the Admissions Officer (AO) at the Kingsville Hospital, 150 Bridge Road, Richmond, Victoria 3121, they can plan Mary’s care.
This 68-year old 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.
Relationships Has four children – all adults – all married
Gets on well with husband Likes visiting her daughter in the country
Has active social life – visits friends regularly
Medical 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 Plan No special diet Tries not to have sugar Buys diabetic cordial
Taste food while preparing meals in kitchen Eats cream cakes at afternoon tea time Loves fruit
Unaware of consequences of careless diet Had trouble Losing weight
Very little exercise walks around the neighbourhood occasionally Likes a glass of wine with evening meal.
Treatment Plan Monitor urine – Monitor bleed 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 notes 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,
Social History : Ling is a student of the Bachelor of Accounting course in the University of Western Sydney.
She is a cyclist for many years. She lives in a 3-bedroom one-story house with her parents and younger sister.
No tobacco, alcohol or drugs
Past Medical History : None
Allergies: No known allergies.
Date of admission: 26/01/2012 trauma ward at St. Angus public hospital
Date of discharge : 23/02/2012
Diagnosis Left tibial-fibular fracture secondary to cycle accident.
Left above- knee amputation Phantom limb pain.
Description of accident: The patient was parked off the road, when a car skidded across and collide with her cycle.
At Emergency Department
The initial assessment: an open tibial-fibular fracture of the left extremity with near amputation.
Her Glasgow coma scale was 15 and head CT was negative.
Obs: BP 178/90 mmHg. P-110 bpm, RR-22/min, SpO2-90 in room air.
The patient was taken to the operation theatre and above-knee amputation was performed on the same day.
Hospital progression 27/01/2012
Post-operative pain controlled with intravenous opioids (morphine) via PCA infusion pump
The limp has been elevated for one or two hours, two or three times each day to reduce local oedema & pain.
She had been totally assisted with mobility
Bladder care (Indwelling catheter inserted on 26/1/2012 and removed on 28/01/2012)
Deep venous thrombosis (DVT) prophylaxis: The patient had negative Dopplers and prophylaxed with Fragmin 5000 IU once daily, subcutaneously.
Bowel management: The patient was started on Citrucel secondary to her pain being treated with narcotics. On a high fibre diet and fluid intake.
Prevention of Infection: Cephalexin IV tds-5 days, protective dressing and drainage
01/02/2012 She complained of a cramping and twisted posture of the missing limb (phantom limb pain), treated with oploids. (Endone 5mg BD), tricyclic antidepressant (amitriptyline 10 mg tds) and antiepileptic (Neurontin 109 mg tds). Commenced participating in physiotherapy program and involved with pre- prosthetic training.
15/02/2012 Orthopaedics:
Amputation incision remained intact
Stitches out
Wound almost healed
Residual limb wrapped with an ace bandage to swelling and pain and re-applied every 3-4 hours
Mental State: Insomnia, silent rumination, and social withdrawal; She has a fear of being seen in public.
Consulted with social worker.
22/02/2012 Fragmin was discontinued.
No signs of DVT were observed.
Phantom limb pain: she remained stable on Paracetamol- Osteo 665 mg qid and Tramadol prn.
Min oedema of the stump w/peeling skin, no signs of infection.
Bowel management: Citrucel was discontinued. She started Coloxil with Senna one tablet bd and Dulcolax suppository prn.
Fluids, Electrolytes, Nutrition: The patient was on a regular diet.
Able to walk with rolling walker for short distance along the ward and use a wheelchair for long distance, but needs increasing assistance for stairs.
Trained to wrap the stump with ace bandage.
Parents were educated about assistance with ADL’s.
Vital sign with no abnormalities.
Discharge Plan Warm compress, ice packs and massage are recommended for phantom limb pain.
To continue regular exercises as per physio program and dressings with ace bandage to shape the amputated limb for fitting with prosthesis. The patient is at increased risk of developing post-traumatic stress disorder (PTSD) or depression in the late period after the trauma.
Peer counseling or support groups to support her can be helpful.
The patient will be seen at the trauma clinic at 3.30 pm on 13/04/2012.
WRITING TASK: You are a charge nurse at the trauma ward of St. Agnus Hospital, Sydney. Using the information in the case notes, write a letter to a Community Nurse at Spirit Family Medical Practice, 12 Gar Street, Holy Hill, NSW, 2167. In your letter explain relevant social and medical histories and request the Community Nurse to visit Ms. Ling Wu after discharge to provide proper health management and assistance for this patient and her family.
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You are the Nurse Practitioner at a Women’s Health Clinic in Melbourne. As a Women’s Health Nurse Practitioner, you are responsible for the primary service which means you may request appropriate tests and prescribe certain medications, but you are required to refer complex case to Medical Practitioner. You had 2 recent appointments with the patient, Amber Watson, as follows:
Date of Birth: 25/03/1993 Marital Status: Single Next of kin : Janine Watson (Mother)
General Health No known allergiesNo current medications
No significant medical or surgical history Weight: 73 kg; Height 165 cm
BP 125/75; Pulse 76 No reported recreational drug use
Commenced smoking in last 9 months, now smokes 10/day. Alcohol use on weekend only. Drinks -3 ‘Vodka Cruisers'(premix spirit equivalent to 2 standard drinks each) on a night.
Sexual and Reproductive Health On oral contraceptive pill for last 12 months.
Regular menstrual periods each 28 days. LMP 7 days ago. No previous Pap tests.
No history of STI. No pregnancies.
Recently ended monogamous relationship of 10 months and now has a new partner of 2 months- not sure if monogamous. Does not use condoms. Last sexual contact 14 days ago.
Has been immunized for Hepatitis B.
16th May 2012 Amber presented to clinic requesting a Pap test. Pap test suggested by mother. Amber concerned about weight gain of 10 kg over last 12 months and wants to know about other methods of contraception.
Sexual and reproductive health history taken. Partner risk discussed -no IV drug use, no recent overseas travel.
No reports of pain, discharge or irregular bleeding. Urine PCR test for Chlamydia collected.
Pelvic exam. Undertaken- NAD Pap smear taken
Patient to return in 3-4 days for Chlamydia results. Pap test results in 2-4 weeks.
Safer sexual practices discussed, including barrier protection. Cervical screening information sheet provided.
Risks of smoking and benefits of quitting discussed with patient. Referred to Quitline.
Referred to women’s Health nutritionist.
20 May 2012 Returned for results: PCR test positive for Chlamydia trachomatis.
Patient informed of results. Arranged notification of partners
Prescribed azithromycin 1 gram as a single dose. Advised not to have sexual contact for 7 days after treatment.
For referral to GP for further testing and contraceptive advice.
WRITING TASK Write a referral letter to the Dr. Jane Thompson, Medical Practitioner at the North Fitzroy General Practice 12 Raeburn, St North Fitzroy 3124, requesting review of your patient to discuss contraceptive options and further testing for sexually transmitted infections and blood borne viruses.
TASK 36. 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 2695Date 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. X-ray 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
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.
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 2005
Admitted : 15th July 2009
Gender : Male
Discharged : 25th July 2009
Country of birth: Sudan
Diagnosis: acute meningoencephalitis
Social History. Parents: Miri & Abdullah Obeki, refugees, arrived in Australia in 2008 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 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 34Ms. Amy Vineyard is a patient in your care at the St. Kilda women’s Refuge Centre. She is 6 week 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 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.
Started drinking at 16 years old. Lives with a friend, Sophie, on her sofa No contacts 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 Ban, Registered Nurse, Community Health Centre,St Kilda.
Plan: Chloramphenicol 0.5% sterile 1 drop 3 times daily Bion Tears 1 drop each eye 4 hrly. Review 2 weeks
5.6.06 Subjective: Accompanied by husband. Very distressed. Has lost most sight in both eyes can make out light or dark shapes but unable to read or watch TV.
Objective: Marked oedema upper and lower lids. White sticky discharge Unable to read eye chart
Plan: Refer immediately Emergency Dept. Royal Melbourne Eye hospital. Husband will drive to hospital
WRITING TASK Using the information in the case notes, write a letter of referral to the Registrar, Emergency Department, Royal Melbourne Eye Hospital, Alexandra Tce, Fitzroy, Melbourne 3051
