TASK 30 Read the case notes below and complete the writing task which follows.

Today’s Date: 22/03/2014

Hospital:  Spirit Hospital Medical Assessment Unit (MAU) Admission Date          : 20/03/2014-

Discharge Date            : 22/03/2014

Patient Details                                   Name  : Sandra Peterson Date of birth: 01/01/1923

Address           : 258 Addison St. Applethorpe Marital Status: Widowed 25 Years

Next of kin : Daughter- Ann Macarthur, Ph: 0438856277

Diagnosis: URTI (Upper Respiratory Tract Infection) – dehydration, bi-basal crackles heard on chest, SOB

Polypharmacy– on 24 medication encouraged by her daughter.

History of Presenting Illness

13/03/2014 : Coughing (yellow sputum)

18/03/2014 : led mobility, found in a sitting position on the floor in her room, no injuries.

19/03/2014 : led confusion had another fall in the toilet, no injuries. 20/03/2014 : BP 190/90, SOB, dizziness, the 3^rd fall, an ambulance was called

Past Medical History

Moderate dementia, HTN, Incontinent of urine- Occasionally

Social History: Lives in 2 bed room flat with her daughter and son-in-law

Daughter is overly supportive, overreacting and anxiety 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.

Homecare worker visit 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 mmg x BD. per os.

Now intermittent dry cough; IV normal Saline for 24 hrs

Medications rationalized by doctor as detailed in discharge plan.

BP 150/70 – after adjustment of anti- hypertensive.

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 referral; Continue 500 mg tablet of Augmentin BD 5/7, should be taken at the start of a meal.

Metoprolol 25 mg BD.; Candesartan 16 mg mane

Medications- monitoring and assistance.; Daughter requires education/monitoring due to Hx of polypharmacy.

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.

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TASK 28: Shannon Warne, 23, is a university student who involved in a car accident three months previously. He has been in the Royal Adelaide Hospital for three months and is ready to be transferred to the Hampstead Rehabilitation Centre.

Name: Shannon Warne

Age: 23 years     Admitted: April 6, 2007.                 Discharged: June 14, 2007

Diagnosis:    Broken neck and fractured pelvis.

Probable permanent neurological damage affecting mobility, speech and memory areas

Social background:  Single. 3^rd year architectural studies student at Adelaide University

Was living in flat but now needs long term rehabilitation

Parents living and willing to care for him; may eventually return home. Currently eligible for disability pension

Nursing management and progress:

Has made good progress but will need high level care for some time. Recently started using a wheelchair

Needs daily physiotherapy, hydrotherapy 2x a week and speech therapy 3x a week. Was suffering bed sores but improving with increased mobility. Frequent headaches Nurofen 200g max 4x a day

Discharge plan:

Depression needs to be treated with activities and interests; likes reading & writing

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 Do not use note form in the letter; expand the relevant case notes into full sentences.

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TASK 27 Read the case notes and complete the writing task which follows.

Hospital          :North West Hospital Roehampton Unit

Patient Details        :Name: Ted Watson,Age 12 yo

Marital status :widowed 10 yrs

Next of kin     : daughter-Margaret Alwood ph. 98253899 Admission Dates           : 10 May 2007

Discharge Date          :12 August 2007

Diagnosis        :↓ed mobility-surgical repair (dynamic hip screw) of # R Neck of Femur (1 May 2007 at Newtown Hospital)

Past Medical History: NB: Medical Alert + +

Anaphylactic reaction to amoxicillin/penicillin (antibiotics) 1997

Social History/Supports: Retired store man Ramsay’s Ltd; Lives alone: ground floor flat in public housing

Hobbies: quiet reading/listening to ‘big band’ music/TV sports All home aids installed by O.T.

Vary supportive daughter, visits frequently – ? anxious how father will manage when returns home

Local day centre 2 x wkly. Local council home support visits

Medical Progress: Slow due to:

Febrile episode→ periods of contusion. Caused by urinary tract infection.

Treated w. trimethoprim (antibiotic), Ural urinary alkalizer) and paracetamol (analgesic). Now fully resolved.

Onset of large arterial leg ulcer R ankle. Regular dressings, now ling in size.

Nursing Management: Vital observations: stable, afebrile. Mobility: v. slow – independent ambulation with pick up frame. Hygiene: max assistance with showering/dressing.

Continence: self-care with permanent indwelling catheter.

Skin integrity: DuoDerm (occlusive) dressing wkly to ulcer.Psycho/social: alert, reserved.

Discharge Plan: Continue with all home supports Community nurse referral

-for hygiene: assistance with showering/dressing -wound management -urinary catheter change 6-wkly

-ongoing monitoring and care

WRITING TASK: You are the charge nurse on the hospital ward where Mr Ted Watson has resided during his hospital stay. Using the information given in the case notes, write a letter referral to the Community Nurse Supervisor at the Community Nursing Centre, Newtown, who will be attending to Mr Watson following his discharge.

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TASK 26 Rend the case notes and complete the writing task which follows

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 years) 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)

Management and Progress during Hospitalisation:

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 decrease 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

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TASK 25

Read the case notes and complete writing task which follows                       Name: Mrs Jane Lapaglia Age: 71

Culture & religion data: Italian & Catholic, speaks functional English Admission Date  :4^th March 2011- Prince Albert Hospital Discharge Date          : 28^th April 2011

Diagnosis        :Renal failure 2˚ 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)

Management and Progress during Hospitalisation: 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 02 therapy as per 02 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.

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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.

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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

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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

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