TASK 24        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: Panadeine 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.

Submit your OET letters for correction: (for a minimal fee)
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TASK 23: Miss Alison Watson, a 6 year old, is patient in the medical ward of which you are Charge Nurse. Admitted after near drowning                         Hospital: Westmond Public Hospital 22 High Street, Westmond

Patient details

Name  : Allison Watson         Age      : 6 years                       Next of kin     : Marge Watson (mother)

Admission date          : 21 February 2016                  Discharge date           : 3 March 2016

Diagnosis        : Near drowning, potential hypoxic brain injury

Family            : Lives with mother and father (Tim)

Medical history         Chicken pox (3yo),Fractured collar bone (4yo),Mild asthma

Social background    Primary school student (grade 1) Enjoys sport (soccer, athletics)

BackgroundFell into fresh water lake while on fishing holiday with father Found 15-20 minutes later face down.

Paramedics arrived 10 minutes later, basic life support started. On admission to ED: cyanotic, pulseless, apnoeic, fixed & dilated pupils, tympanic temp 27.7°C

Nursing Management and Progress:           21/2/16            CPR performed

Ventilator & endotracheal tubing inserted;

Heated humidifier, radiant warmer, preheated blankets applied Paediatric ventilator used

Initial ABG (Arterial Blood Gas) =7.04 / 84 / 36 / 19 / 78% Spontaneous circulation achieved

23/2/16            ABG = 7.44 / 34 / 94 / 23 / 97% BP 98/64

Tympanic temp 34.8 ˚C                      Patient stable – transferred from ICU to general ward

25/2/16            Temperature normal Unresponsive to command Moving around the bed

No longer hyperventilated for protection Weaning off mechanical ventilation begun

29/2/16            Responsive to commands

Basic communication possible – slurred speech Speech therapy commenced

Difficulty concentrating Paracetamol 3x daily for headaches Coughing up pink sputum Mechanical ventilation stopped

3/3/16  Communication improving, still some slurring of speech Concentration improving, cognitive function appears ok Neurological exams clear – need more tests to check for delayed problems as precaution.

Parents concerned about permanent speech and cognitive effects. Paracetamol given when needed Occasional cough. Ready for discharge

Discharge plan:           Paracetamol for headaches

Monitor cough, return to hospital ASAP if worsens Speech therapy for speech

Neurologist for tests (neuropsychological, visual-spatial. IQ) in one week

GP to check cough, headaches

Parents to monitor cough, headaches, concentration. Call Dr if Minor issues, bring to ER if severe

Writing Task: Please choose 1 only (as instructed by your teacher)

A: Using the information provided in the case notes, write a referral letter to the GP, Dr Anne Simons, Southern Medical Centre, 15 Eltham Place, Curtain

B: Using the information provided in the case notes, write a letter detailing the post- discharge care required for the patient to the patient’s mother, Mrs Marge Watson, 34 View Rd, Tenningway.

C: Using the information provided in the case notes, write a referral letter to the neurologist, Dr Frank Rivers, Head Neurologist at Western Neurology Group, 95 Fitzroy St. Green Valley.

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

Please note: It’s not common for a nurse to write a letter to a Neurologist in the OET exam. However, adapting your writing to suit the needs of different professions is a useful learning tool

Submit your OET letters for correction: (for a minimal fee)
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TASK 22 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 or lollies

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: 17:00 hrs: Episode of choking on a piece of food (? Food not chewed properly). She suddenly turned blue, grabbed the throat with both hand and coughed. The piece of solid food was removed.

17:10 hrs: Nursing assessment after treatment

Pulse 110 BPM, BP 120/70 mmHg;  RR – 22/min; T – 37.1° C; BSL – 6.0 mmol/L

18:00 hrs: No complaints,  Pulse – 88 BPM, BP – 115/70 mmHg, RR – 16/min, T – 37.0 ° C

Skin: normal colour,  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

View sample answer by Lifestyle Training Centre

Submit your OET letters for correction: (for a minimal fee)
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TASK 21.  Today’s Date 13/09/09

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 1991 Admitted 9th September 2009 Discharged: 13th September 2009 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 goodHad 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 19:00hrs 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 2009 Time: 11:20hrs, Sex: Male Weight: 4.4 kg

Apgar score: 6 at 1 min, 9 at 5 mins Resuscitation: 02 only for few minutes

Postnatal Progress: Maternal post-partum hemorrhage of 800 ml Blood loss now: minimal

Wound: Clean and dry Hemoglobin on 12/09/08: 90g/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.

Submit your OET letters for correction: (for a minimal fee)
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TASK 19 Patient        :           Kylie Swanston, 12 month old girl

Family            :  Moira Swanston (mother)/ Matt Swanston (father)

Family background : Lives at home with mother and 3 y.o. brother, Tom. Mother is experiencing financial difficulties following divorce six months ago. Family lives in a 3 bedroom home in public housing. Moira is receiving the Single Parent’s Pension. She is socially isolated- no car – with little money to spend on public transport. Has no friends. Grandparents lives in Sydney. Tom and his sister, Kylie, usually spend every second weekend with their father, Matt Swanston, who is living with his new partner.

Admitted         : Kylie was admitted six days ago. Is planned for discharge tomorrow. Admitted with 2^nd degree burns to R. trunk and R.arm following accidental scalding with hot water.

Treatment      :  Twice-daily Silvazine dressings to affected area.

IV fluids for 24 hours post-admission, then oral fluids. Medication: Prophylactic antibiotic cover and analgesia. Mother has been recommended to see Hospital’s social worker.

Discharge plan           :           Daily Silvazine dressings. No discharge medications. Monitor mother’s depressed mental state.  Introduce mother to local support groups, agencies, Mother’s Group, local childcare Centre, local financial counsellor and Hospital social worker.

WRITING TASK: Write a letter to the Community Nurse, Rosewall Healthcare Centre, Sharland Road, Corio,Vic 3214. Outline the treatment Kylie has had to date. Request that the Community Nurse: Change the Silvazine dressings daily- until no longer required; Monitor Mrs. Swanston’s mental state;

Make appointments for Mrs. Swanston to go along to the local Mother’s Group for some social activities; Community Nurse to arrange for free childcare one morning a week(for Tom); Community Nurse should also make an appointment with the local Bank for Mrs. Swanston to get some financial management counselling.

Submit your OET letters for correction: (for a minimal fee)
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TASK 18: 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: 08/12/11

Family History

Mother: Aged 24 First Child, Father: Aged 25 Soldier Currently away from home on duty

Birth History: 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 become 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

View sample answer by Lifestyle Training Centre

Submit your OET letters for correction: (for a minimal fee)
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TASK 17

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

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 weeks (21/9). Also, follow-up FBE and UEC tests at City Hospital Clinic

Assessment    :  Good mobility post-operation

Weight-bearing with use of wheelie-walker walks length of ward without difficulty

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 riser, 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.

View sample answer by Lifestyle Training Centre

Submit your OET letters for correction: (for a minimal fee)
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TASK 16: 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.    

DOB:25 September 1924

Social Background: Married wife Elizabeth aged 83. Lives in own home – Both receive age pensions Bob is World War 11 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.

View sample answer by Lifestyle Training Centre

Submit your OET letters for correction: (for a minimal fee)
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TASK 15: 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.

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