All posts by Jomon P John

Monica Osburn OET letter

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TASK – 68 Ms Osburn is an elderly patient at the Newport Community Health Centre

You are the attending nurse.

Patient details                       

Name: Monica Osburn                      

Age:    69 years

Marital status:           Divorced        

Family:           One daughter (married)

First attended centre:  September 2003                     

Last attended centre: January 2010

Diagnosis:      Hypertension, depression

Social background:   Present: lives alone, rented house in Newport

Moving to rented one-bedroom unit in Woodville close to daughter (daughter’s request)

Income: aged pension. Long history excessive alcohol intake, ↑ when anxious

Medical history: Hypertension (10 years).             

Depression (2 years)

Periodic problems with self-administration of medication

Medications:  Anti-hypertensives and anti-depressants

Nursing management and progress: Regular monitoring by community nurse in Woodville to ascertain medication compliance and alcohol intake

Discharge plan:         Establish contact with medical practitioner after move Monitor medication compliance, alcohol intake and diet Encourage expansion of family social activities – elderly citizens clubs, voluntary groups, etc.

Writing task: Using the information in the case notes write a referral letter to the Community Nurse, Community Health Centre, Woodville, outlining relevant information and requesting continued care

OET WRITING TASKS

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Mrs Margaret OET letter

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TASK – 67: Maggie Goldstein is a 60-year-old female Alzheimer’s disease sufferer currently admitted to North Caulfield Private Hospital for a dislocated elbow after a fall at her aged care home.

Patient details           

Name: (Mrs) Margaret (Maggie) Goldstein              

Age:    61 years

Marital status:           Married          

Family:           Husband, Solomon (Sol) Goldstein aged 65, no children

Admission date:         8 November 2016                   

Discharge date:          12 November 2016

Admission diagnosis: Dislocated R elbow                 Early dementia; progressing rapidly

Social background:   Full-time care at Eventide Residential Aged Care, 333

Glen Eira Road, Ripponlea, Vic. 3185. Husband lives nearby in Elwood;

Business Owner/Manager “Computers’R’Us”

Previous career and Hobbies: Computer programmer, championship golf

Medical history:        Obesity – Height 157cm/ Weight 90kg, HTN, Alzheimer’s onset detected (11/2014)

– no known Alzheimer’s sufferers in close family

Current condition:    Ready for discharge back into full-time care

R elbow in cuff w sling; healing slowly Skin intact

Uses wheelchair, transfers with some assist Continent of bowel/incontinent of bladder (10/11/2016) Reluctant to wear disposable briefs Requires assist with showers and incontinent care

Medications:  Oxycodone 5 mg 3/day to be continued as needed

Atacand Plus 32/12.5 25mg/day Remeron 15mg/day

Management and progress: Medically stable

Discharge plan:         Spouse will      collect patient when    discharged       to transport back to Eventide. Monitor healing of elbow Monitor incontinence care.

Follow-up w physiotherapist, appt 28/11/2016, 2pm, at Eventide

WRITING TASK: You are Charge Nurse at the hospital where Mrs Goldstein was admitted 3 days ago for treatment of a dislocated elbow. Using the information in the case notes, write a discharge letter to the Supervisor at Eventide Residential Aged Care, 333 Glen Eira Road, Ripponlea, Vic. 3185, for discharge back into permanent full- time care.

OET WRITING TASKS

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Aisha Amari OET letter

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TASK – 66 Mrs Aisha Amari is a 75-year-old woman presenting in the clinic in which you work.

Clinic: Westborough Medical Clinic, Westborough 2065

Patient details           

Name: Aisha Amari   

Age:    75       

Residence:      Braybrook

Admission date:         16th of July, 2017                               

Discharge date:          16th of July, 2017

Presenting complaint:Left foot turns out on ambulation. Weak ankle  Ankle pain: chronic – burning sensation

Past medical history:             Mild memory loss       Vision blurry – retinal damage Hypertension – 3 years

Type 2 diabetes – 18 months

Past surgical history:            Cataract surgery (1992)          Appendectomy (circa 1986)

Family history:          Unknown

Diet:                Diabetic                      Low cholesterol          Family brings some meals

Medications:  Self-administered (son calls to remind):         Paracetamol as required Deep heat cream Diabex

Beta blockers                          Calcium channel blockers

Physical review:        5’8″ 63kgs                    Alert and oriented

Hearing and speech are within normal limits Skin intact                   Continent of bowel and bladder

Assessment:   Ambulates / transfers independently No assistive devices in house               No recent falls

Mobile phone with her at all times Pull-cord in bedroom and bathroom

Notes: Speaks only Arabic.

Son (Ahmed) interpreter and information source He is very involved – shopping, errands, finance

Management plan:    Check foot / ankle.

Personal assistance required shower 2d/4h/wk Needs help with dressing

Some household chores and laundry Needs installation of assistive devices

WRITING TASK: Using the information given in the case notes, write a referral letter to home care nurse, Sharon Wilkins, at “Prestige Care”, 393 Victoria Road, Newtown, Braybrook, who will be attending to Mrs Amari at home.

OET WRITING TASKS

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Mr Walter Pitman OET Letter     

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TASK – 65

You are a nurse in Nurselead Outpatient clinic in Newtown hospital. You taking care of Mr. Pitman

Name of the patient: Mr Walter Pitman          

Age: 69 years          

Family:           Married, has 2 children

Job:     Retired accountant                 

Habits:           No smoking or alcoholism Sedentary lifestyle, no exercise

Past history:  Hypertension since 2008 Overweight

Admission date:         01.07.2018                  

Discharge date:          03.07.2018

PATIENT HISTORY

Present history: Accidental cut injury when using hand saw for cutting wood, referred by family physician for further care. Brought to Newtown hospital with deep lacerations on lower left arm. On admission wound cleaned, sutured and dressed well Prophylactic IV antibiotics starts and course completed

02.07.18          Stopped IV antibiotics. Oral antibiotics started, regular dressings Blood Pressure:  140/90 mmHg (sitting). 180/90 mmHg (supine)

03.07.18   Discharged, advised visits to Nurselead Outpatient clinic

04.07.18  Visited Nurselead Outpatient clinic of same hospital

He had severe pain with mild hematoma: recorded 8/10 on pain scale

Blood Pressure:           186/89 mmHg (sitting)           190/86 mmHg (supine)

06.07.2018 : Wound condition is better, healing, dressing done Blood Pressure:     190/86 mmHg (sitting)196/88 mmHg (supine)

08.07.2018      Wound is healing       

Blood Pressure:           182/80 mmHg (sitting). 194/86 mmHg (supine)

11.07.2018      Wound dressing done, healing well without infection Blood pressure still elevated

14.07.2018: Wound healed well        

Blood Pressure:   190/84 mmHg (sitting)       196/86 mmHg (supine)

Assessment:   BP elevated?? Orthostatic hypertension Plan: Cardiac assessment for hypertension

Family physician referral

Writing Task: Write a referral letter to the family GP Dr Lacricell, Newtown 2137, asking him to do a full cardiac assessment and management of Mr Pitman’s hypertension.

OET WRITING TASKS

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Mrs. Rose Debham OET letter

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TASK – 64    

Patient’s name:         Mrs. Rose Debham

Date of Birth: 4th July, 1989  

Social History:         

recently married, no smoking or alcohol drinking

Past Medical History:          

previously fit, Migraine diag 5 months ago – another GP

Medication History:  Aspirin & Codeine & Metoclopramide to control migraine

Family history:          mother- hypothyroidism

2/12/2009 Subjective: feeling unwell for 3 months, intermittent fevers and sweats, anorexia Joints & muscles- ache, hands- painful & clumsy with stiffness in mornings for about 1 hour

Objective: looks flushed, Temperature 38.6 degree C, Facial oedema – present, pulse rate- 95/ min, BP- 110/65, Multiple aphthous-like ulcers on buccal mucosa, heart & lungs – normal, spleen – enlarged, hand joints swollen and tender.

Assessment: possibility of autoimmune disease or infections

Plan: Explain the possibilities, confirmatory tests such as urinalysis, blood tests, ESR, C reactive protein, blood culture, antibodies screening, Ibuprofen 400 mg 3 times daily for symptomatic control, review in a week’s time

10/12/2009. Subjective: noticed slight improvement but still has pain in hand joints, no fever, concerned about serious complications of autoimmune diseases

Objective: swelling in hand joints -reduced, temp- normal, urinalysis-trace of protein (0.3g/L), complete blood examination – haemolysis & pancytopenia, ESR- 55mm/hour, C reactive protein – 5 mg/L, Blood Culture – Negative, X ray (hand joints ) – soft tissue swelling & no erosion, CXR- normal, Antinuclear & double stranded DNA antibodies- positive.

Assessment: Systemic lupus erythematosus

Plan: general measures (exercise, avoidance off UV light, screen), continue NSAID (Non-Steroidal Anti-Inflammatory Drug), hydroxycloroquine 200 mg 2 times daily, refer to specialist to assess systemic involvements, regular reviews every month

20/1/2010. Subjective: regular check-up, all symptoms under control, able to cope normal daily activities, arthritis, fever & lethargy -well managed with current medication expressed a strong desire to conceive in near future, use condoms & spermicide for contraception

Objective: all examinations – unremarkable            

Assessment: well-controlled SLE

Plan: Continue current medication to prevent recurrence, Explain the risks to mother & fetus, refer to consultant obstetrician for advice prior to conception

Writing Task: Using the information in the case notes, write a letter of referral to Dr. Stephanie Coleman, Consultant Obstetrician at the Royal Adelaide Hospital, North Terrace, Adelaide SA 5000.

OET WRITING TASKS

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Kenneth Mason OET letter

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TASK – 63:   You are the charge nurse in the Emergency Department at Newtown Hospital. Read the case notes below and complete the writing tasks which follows.

Patient’s Details:      

Name: Kenneth Mason          

Address:         8 Stuart Street, Perth, WA 6000

DOB:  February 27, 2000

Social Background:  A secondary student studying in Perth University, a varsity football player.

Medical History:  January 2018- Had right femur fracture sustained during one practice.

March 2015- Suffered Concussion after being hit accidentally with a ball

Allergies to Food: nil Previous medications: nil

Date of Admission: 16 June 2018 Presenting Situation:

Chest pain is increasing especially when coughing

Suffered Chest contusion 20 minutes earlier after playing football. Difficulty of breathing

Diagnosis is chest pneumothorax as confirmed by Chest X-ray. Shortness of breath.   

Assessment:   92% Oxygen Saturation

Has nasal Flaring upon inspection (has difficulty in breathing) Restless

Cannot complete sentences when speaking Oriented, knows his name, age and present location

Has peripheral bluish cast/discoloration in the skin and mucous membrane

Chest Palpation: No mass heaving upon palpation

Chest Auscultation: Normal but still has pain Lung Inspection:        Left lung: Normal

Right lung: present air upon entry

Treatment:    Immediate insertion of ICC and connected to water sealed drainage

IV Fluid of 2li/24 hours Morphine 10 mg given IV stat

Monitoring of any bleeding in the ICC May have free fluids and light meals

Care Plan:     Monitor Blood present in the ICC                   Monitor Vital signs until stable

The nurse will accompany patient in ward to report medical history, current situation, treatment plan, etc.

Writing Task:: Using the information in the case notes write a letter to Ms. Angela Coyne the charge nurse in Surgical Ward A, Newtown Public Hospital, 900 Carrington Street to report medical history, current situation, treatment plan, etc.

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Anna Paro OET letter

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TASK 62        MARCH-2018            You are a district nurse (nurse caring patient at homes) taking care of Mrs. Anna Paro, who needs daily dressing for the leg ulcer.

Patient Details:         

Name  : Anna Paro                

Age      : 75 years

Medical History : COPD, Osteoarthritis, Appendoctomy-2009, Suffering with leg ulcer, Taking salbutamol pm, ipratropium 25/250 2 puffs daily

Social History            Lives alone, Husband died      Two children-one native, other overseas

10/03/2018.   Subjective        : SOB increase (especially day activities, not at night), Salbutamol ineffective, Need rest or sit down to hold breath back

Objective        : Comfortable at rest, no sob RR: 18/Mt, BP: 130/80.    Auscultation. Good air entry both sides, little wheeze on left Observed patient’s inhaler use inappropriate

Diagnosis        : SOB worse due to? COPD, inhaler use

Treatment, Ventolin 2 puffs under supervision

Educated about inhaler use with spacer – patient claims “this is not the way my pharmacist told”. Plan. Refer/advise pharmacist re inhaler.

WRITING TASK: Write a referral to Paro’s pharmacist to teach her about inhale

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Steve Gladson OET letter

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TASK 61      You are a registered Nurse in the pediatric isolation ward of Calvary Hospital, Bruce Canberra

Patient Details:         

Name   : Steve Gladson (7 years)      

Mother : Susan Gladson         

DOA   : 9/3/14

Reason for Admission : Complaints of high fever, body pain & headache

Rashes, (water-filled blisters) red colour over face, hands and back

Diagnosis                    Chickenpox (1stattack)          

Physical Examination

Height 47.8”               

Weight 50 pounds                  

V/s Temp 39°C, P/r 90/min Resp 18/min

Family background

Lives with mother, grandma and 2 siblings, Mark (10 years), Julian Good family bonding

Father, Glandson Clark worksabroad

Social Background: School going, very active.

Many friends, best friend – Cathy (she had chicken pox – possible cause of disease transmission)

Psycho-sexual developmental Stage:Latency

Medical History        Frequent fever, cold   

Fever last month – taken treatment Allergic to eggs and tomato

Immunization schedule incomplete (same for all 3 children)

Treatment Plan         Adequate rest and good food              Tab Ibuprufen. 250 mg TID (↓ fever)

Tab Piritone 5mg BID. Increase fluid intake (fresh juice & water) Emollient calamine lotion for rashes and itching

Precautions (family)

Chicken pox highly contagious

Causative organism Varicella Zoster virus Mode of transmission droplets Incubation period – 11 to14 days

Chances of spreading exist till blisters got healed and dried up. Avoid travelling and close contact with neighbours, friends and relatives Vaccinate siblings (if not vaccinated) within 5 days. Parents -take booster vaccination dose

Writing Task: Using the information in the case notes, write an advice letter to the mother of Steve, informing her about the chances of disease transmission and necessary precautions to be taken.

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Alison Cooper OET letter

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TASK 60        You are the school nurse at Toohey Point Primary State School Today’s Date

07/03/2010     

Patient Details: Alison Cooper Year 5 student DOB: 14/6/2000. 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 lives near school – provides after school and holiday care looks after children if unwell

School Medical Record: Regular absences from school dating back to time of father’s death Year 2: 3 days

Year 3: 4 days                        

Year 4: 10 days                      

Year 5: 8 days in first term

School Health Centre Records

2010 February 8: Complained of headache. Have paracetamol, rested and returned to class. eczema on hands red and weepy has ointment at home.February 16: Complained of stomach ache. Called grandmother for pick up. February 22: Complained of aching legs. Called grandmother for pick up. March 4: Complained of headache. Have paracetamol, rested 1 hour, still had headache. Called grandmother for pickup

March 6: Feeling nauseous eczema on hands red and weepy. Called grandmother for pick up.

2009 February 15: Complained of toothache. Called grandmother for pick up April 4: Complained of headache. Have paracetamol-rested 1 hour. May 14: Headache, eczema on hands red and weepy, rested 1 hour not better called grandmother for pick up. July 25: Feeling nauseous. Called grandmother for pick up. August 16: Slight fever. Called grandmother for pick-up. September 22: Feeling unwell. Eczema irritation. Called grandmother for pick up. October 23: Complained of stomach ache. Rested 1 hour, returned to class November 27: Complained of headache. Have paracetamol, rested 30 minutes.

Social History: Alison started school well but since Grade 3 has had trouble concentrating rarely participates in class activities unless encouraged. Avoids sporting activities – standard of her school work is declining. Has few friends and is often teased by her classmates. Embarrassed about hands which don’t seem to be responding well to ointment suggested by chemist. Mother was contacted by class teacher regarding these issues. Says Alison is also becoming withdrawn at home. Alison was very close to her father – often talks to her about him and cries because she misses him. Seeks comfort in food like chips and cakes after school.

Plan: Refer her to the school psychologist to find out whether Alison has underlying grief related or other psychological problems

WRITING TASK: Using the information in the case notes, write a letter to refer this girl to the school psychologist, Barnaby Webster, to assess her. Outline the purpose of the referral. Provide details of significant factors which will assist the psychologist to make this assessment.

View sample answer by Lifestyle Training Centre

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Ms Patricia Styles OET letter

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TASK 59. You are a nurse visiting Ms Styles at her home who is taking self care at home

PATIENT HISTORY. Name: Ms Patricia Styles

Age:04/08/1955 (63 years)

MEDICAL BACKGROUND: Hypertension diagnosed in 2012, on Carpinol medicine, blood pressure 2014 (190/100) Now BP under control (140/90)

Diabetes Mellitus diagnosed in 2009 (Type II), taking oral hypoglycemic (Metformin+Glipizide)

Depression diagnosed first in 2015, depressed after her husbands

death, attends medical counseling for mood swings and diabetes mellitus management

SOCIAL BACKGROUND: Hobbies walking, reading

Lives alone, no close relatives, her cousin helps her sometimes Medications

Carpino! 6.25 x 2 times daily Metformin- 500mg x 2 times daily Glipizide 10mh x I daily

MEDICAL HISTORY: On 07/04/2018 she admitted in Green Valley Hospital with chest pain (pleuritic),shortness of breath(SOB), tiredness.

Management: Glucose monitored regularly, sugar and BP (well controlled)

Blood test: ESR (24). Creat (2.0). Platelets (Stress/inflammation)

Oral throat swab Type B influenza Chest X-ray Normal Echocardiogram Pericarditis

Diagnoşis: Type B influenza plus pericarditis          

Treatment:  IV saline, Antibiotics

Discharged on 09/04/2018 advising further follow up home visits

She was on self home care after discharge. She was keeping well and the home nurse left her 2 days ago.

14/04/2018 Home visit: Subjective:Ms Styles feels tired and has chest pain Examination Unwell, Chest pain (when sitting), SOB, fatigue Vital signs Mild temperature (38), HR-122, RR-28. BP-180/90 Assessment ?? Relapse/Complication pericarditis

Plan: Refer patient to Newtown Hospital Emergency Department (nearest hospital) Inform emergency doctor about patients: Medical history Medications Past history

WRITING TASK: Write a referral letter for MS Styles to the Emergency Doctor on Duty requesting urgent assessment and management of her pericarditis. Address the letter to: Emergency Doctor on Duty. Newtown Hospital, Comer Street, Newtown 1104.

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