TASK 44 You are a Registered Nurse preparing Mrs. Jasmine Thompson’s discharge. Mrs. Thompson has had a right total shoulder replacement. She is to be discharged home today with assistance from ‘In home Nursing Service’.

Patient            : Mrs. Jasmine Thompson                  

Address          : 73 White Road, Bayview

DOB    : 01.07.1942                                                   

Age      75

Social Family background:  Lives in single-storey house with large garden Utilises cleaning services once a month. Widow. 1 daughter- lives in Bayview, 1 son -married with 2 children, lives in Stillwater.

Daughter will stay with mother for 1 month post-surgery

Medical history                     R humerus fracture- 1997

Osteoarthritis-R shoulder which has not responded to conservative treatment Chronic R shoulder pain-↓ movement and ability to carry out activities of daily living (ADL)

Current medications             Voltaren 50mg daily (ceased 14 days pre-operatively)

Panadeine Forte (codeine/paracetamol) 30/500 mg x 2, 6hrly p.r.n.

Admission diagnosis:              R shoulder osteoarthritis

Medical treatment record:

11.07.17          R Total Shoulder replacement (TSR)

Medical progress: Post-op R shoulder X-rays confirm position of TSR Post-op exercise regime – compliant with physiotherapy Post-op bloods – within normal limits  Post-op pain management-analgesia, cold compress R shoulder R shoulder wound-clean & dry, drain site-clean & dry

15.07.17 Plan for discharge home with daughter today -home nurse to assist at home

Nursing management           Observations – T, P, R, BP (all within normal range)

Neurovascular observations – colour, warmth, movement, sensation Oral analgesia    Wound care and observations

Cold compress/shoulder-brace 4 hours per day ADL assistance as required

Physiotherapy management

Exercises as per TSR protocol- Neck range of movement exercises Elbow and hand ROM exercises.

Pendular shoulder exercises               

Cryo cuff (cold compress) 4 hours per day Discharge education

Follow-up physiotherapy outpatients appointments Referral to community hydrotherapy

Discharge plan                                  

Patient discharge education – Post TSR:                    

R arm sling for 4 weeks

Strictly no lifting for 4 weeks            

Physiotherapy outpatients x 2 per week, plus hydrotherapy x 1 per week

10 days post-op-staples removal, follow-up appointment in Orthopaedic Joint Replacement Outpatient Department

Orthopaedic Joint Replacement Nurse Specialist contactable by calling hospital, Mon-Fri for any concerns

Referral to ‘In- Home Nursing Service’- assist with showering, administration of LMWH (Clexane) subcutaneous for 4 days as DVT (deep vein thrombosis) prophylaxis

Writing Task: Using the information given in the case notes write a letter of referral to Ms. Roberts, a home nurse, Informing her of the patient’s situation and requesting appropriate care. Address the letter to Ms. Nita Roberts, In-Home Nursing Service, 79 Beachside Street, Bayview.

Submit your OET letters for correction: (for a minimal fee)
https://goltc.in/oet-writing-correction/