All posts by Jomon P John

Phillip Satchell  OET letter

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TASK 80: 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.

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Mrs Beryl Casey OET letter

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TASK 79:

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 1200hrs

Fainted getting out of bed & fell to the loor. Found by son 2 hours later.

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

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

Post operation: Intravenous (IV) therapy: 3 units packed cells – with IV Lasix (furosemide) 40mg therapy after each unit (intraoperative & post op)

Maintained IV therapy for 36hrs, then ceased and oral luids encouraged

Intravenous antibiotics (IVABs) – Cephazolin 1g t.d.s. for 3/7 – course completed

Vital signs: BP hypotensive – 95/60, other obs. within normal limits

Anti-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: Dressing V

Total of 600ml haemoserous luid discharge from Exudrains over 24hrs

Drain 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 assistance

Day 3 Mobilising with pick-up frame (PUF) & 2-person assist

Day 4 Uneventful

Day 5 Mobilising short distances with PUF & 1-person assist Abduction pillow when resting in bed (RIB)

Anti-embolic stockings in situ for 14 days ADLs – full assistance

Day 6 Uneventful day Preparing for discharge

Discharge plan:

Day 7 (1100hrs) Discharge to the Rehabilitation Centre

Discharge medications – Ramipril 5mg daily, paracetamol 1g qid prn

Family to be notified of transfer. Hospital 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 meds Assess 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.

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Mr Robert OET letter

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TASK 78: 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.

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Mr Ming Zhang OET letter

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TASK 77: 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 mentalhealth 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.

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Mr Dallas Walters OET letter

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TASK 76: 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.

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Mr Benjamin OET letter

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TASK –75: 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 and Progress: Dressing Daily 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.

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Martin Wilson OET letter

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TASK –74: 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

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.

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Maria Joseph OET letter

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TASK –73: 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.

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

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We hope this information has been valuable to you. If so, please consider a monetary donation to Lifestyle Training Centre via UPI. Your support is greatly appreciated.

Would you like to undergo training for OET, PTE, IELTS, Duolingo, Phonetics, or Spoken English with us? Kindly contact us now!

📱 Call/WhatsApp/Text: +91 9886926773

📧 Email: [email protected]

🗺️ Find Us on Google Map

Visit us in person by following the directions on Google Maps. We look forward to welcoming you to the Lifestyle Training Centre.

Follow Lifestyle Training Centre on social media:

Thank you very much!

Mr Lionel Ramamurthy OET letter

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TASK –72: 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 <10)

Sean, teacher (30, married, working overseas, 1 infant)

Admission date: 04 February 2014              

Discharge date: 11 February 2014

Diagnosis: Pneumonia                                  

Past medical history: Osteoarthritis (mainly fingers) – Voltaren

Eyesight ↓ due to cataracts removed 16 mths ago – needs check-up

Social background: Retired school teacher (history, maths). Financially independent. Lonely since wife died. Weight loss – associated with poor diet.

Medical background: Admitted with pneumonia – acute shortness of breath (SOB), inspiratory and expiratory wheezing, persistent cough →chest & abdominal pain), fever, rigors, sleeplessness, generalised ache.

On admission – mobilising with pick-up frame, assist with ADLs

(e.g., showering, dressing, etc.), very weak, ambulating only short distances with increasing shortness of breath on exertion (SOBOE).

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.

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Harry Kovacs OET letter

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TASK –71: . 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.

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