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

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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.

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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.

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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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TASK 14 Patient       :           Amir Akbari              Age      :           41

Marital status :           Married.                      Religion ethnicity      :           Moslem & Iranian

Admission Date :6^th March 2011, Prince Charles Hospital Randwick       Discharge Date    :22^nd April 2011

Diagnosis        :           Guillain-Barre Syndrome

Family/Psychosocial :           ‘Lives in rented house with Iranian wife & 2 kids (3 & 4) PhD students; pt & wife speak good English support network in Australia.

Children in university childcare 2/7; nil extra days available at center at present

Pt works at service station 3/7. Pt has PTSD issues trauma in mid-80’s – prone to depression and anxiety related to this. Medical History and Medications. Otherwise physically healthy prior to onset of GBS Medication information to be forwarded by doctor

Management and Progress during Hospitalization: *Rapid deterioration and recovery

‘Required ventilation in ICU 3/7 March 20-22’.  At peak of GBS couldn’t move limbs independently

Now muscle tone/strength and needs light assistance with ADLS but can walk slowly with walking frame

Went for regular plasmapharesis and had a total of 5/7worth of IV gamma globulin. Daily physio program including self exercises. Now becoming depressed about his prospects. Wife not coping with financial, study and childcare pressures

Discharge Plan: Continue physio program and encourage pt. to do his, own limb exercises too. Discuss with your team re? Need for psych assessment re? depression. Ensure your s/w is aware of the family and wife’s pressures and provides follow up Halal diet. Pt oxygenation very stable on R/A now but observe for any, in respiratory status or in neurological signs

Writing task: You are the Charge Nurse on the neurological ward where Amir Akbari has stayed for most of his hospital admission. Using information provided in the case notes, write a letter of referral to the Charge

Nurse at Prince Henry Rehabilitation Centre, Malabar Bay where he will be transferred to for rehabilitation after discharge from your ward.

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TASK 13:

Patient      :           Mrs. Joy Rafferty       

Age: 65.

Occupation :           Retired clothing machinist

Patient has attended the Community Health Center since her retirement ten years ago. Recently a new Center has opened much closer to her home.

SOCIAL HISTORY:  Widowed since 1984 and has supported the family since her husband’s death

Lives alone in a Housing Commission flat. Has 6 adult children with 3 living nearby in the same suburb

A close family. Social activities are restricted to family occasions. Outside outings are also restricted (Family does her shopping and collects her for outings, etc.). Previously active with the Church and its social circle however this has stopped because the patient can no longer drive.

MEDICAL HISTORY: Benign hypertension over 10 years, now progressing to essential hypertension 180/100 Coversyl 4 mg daily. Rapid weight gain in past year 75 kg to 90 kg

Undifferentiated osteoarthritis type aches and pains, Analgesics required for pain,  Mild depression

FAMILY INVOLVEMENT:  Several meetings with the family to encourage the patient to make social contacts and therefore become less dependent on the family.

Family concerned and overprotective but in agreement with suggestions

DISCHARGE PLAN: Improve her general health status by Increasing exercise regime and stimulatininer

Continue family meetings. Introduce client to suitable interest and activity groups in the area e.g. Aqua aerobics, local women’s chair, Meals on Wheels, parish visiting groups. Encourage and monitor attendance

WRITING TASK : You are the Community Health Nurse who has been looking after Mrs. Rafferty for the past ten years. You are concerned about her increasing isolation and general health. Write a letter referring her to the new Center. The contact persons is: Ms. Rhonda Johns, RN., Community Health Care, 25 River Street, Clayton, Vic: 31804

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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]

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TASK 11: Name        :           Cheryl Cook                                                  D.O.B  :           2/11/1970

Admitted         :          7th August 2008 Discharged   :          9th August 2008 Diagnosis     :           Laryngities

Patient History: Accompanied by husband to hospital, suffering from hoarseness, sore throat, dry cough, voice loss, lasting 18 days, smoker (0.5 / day), alcohol intake – 30

History of upper-respiratory infections, hypothyroid since 2005-controlled with thyroxin.

No allergies but suffers mild asthma-well controlled, no major attacks for four years

Social History: Married to Christopher, two children aged 5 and 8: works as jazz singer and in loud busy bar, worried about possibility of not being able to keep singing, important concerts next month

Nursing Notes: Laryngoscopy – found vocal cord polyps/nodules; given lozenges (Strepsils-every 4 hours) Corticosteroids (Prednisone inhaler every 6 hours) given water hourly

Discharge Plan: Patient to see ENT specialist re polyps: if any pain or problems in future to see a doctor immediately told to avoid smoking alcohol/caffeine/decongestants until recovered, Continue prednisone for next 7 days strepsils as needed. Rest voice completely, avoid clearing throat, avoid whispering, avoid upper respiratory infections, recommendation to stop bar work-patient reluctant to do this, drink plenty of fluid, gargle salt water, hot steamy shower-install humidifier in home (use bowl of hot water for inhalations 5 mins 2 x daily)

Writing Task: Using the information in the case notes, write a letter of referral to Dr. Tim Richards, 28 Acacia Ave, Box Hill 3128

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TASK 10. Tracy Chapman is a 20 year old single woman with 3 children. She was admitted to an appendicectomy and has recovered, She is ready to be discharge home

Name   :           Tracy Chapman                                  Age      :           20 years

Admitted         :           18 April 1990                          Discharged      :           23 April 1990

Diagnosis        :           Acute Appendicitis                 Operation        :           Appendicectomy 18 April 1990

Social background: Single with 3 children aged 18 months, 3 years and 4 years Lives in a rented flat with her children. The father of the children has no contact Only income is the Single Mother’s Pension Has several friends who all works full time. Tracy’s mother is caring for the children but will be returning to her home in the country when Tracy comes home.

Nursing Management and progress: Routine post-operative recovery Tolerating light diet and fluids Walking normally. Minimal pain relieved with 2 pandol 3 times a day Wound healed sutures removed

Discharge Plan: Rest, Moderate exercise, No heavy lifting or activity for 6 weeks High protein diet

Observe wound for infection Council “home help”

Writing Task: Tracy will require support and assistance to manage her children when she returns home.

Using the information in the discharge summary. Write a letter referral to the community health nurse. Raw Willis, who will assist Tracy at home.

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TASK 9.  Patient History: Victoria Flangan is a patient in your care, who is ready for discharge and will be transferred to a nursing home

Name   :           Mrs. Victoria Flangan            

Age      :           88 Years (D.O.B. 21/10/20)

Admitted         :           16/02/08

Diagnosis        :           dementia and side effects of medication for Parkinson disease (Levodopa with carbidopa 100/25 qid)

Reason for admission  :           confusion, aggression and paranoid behaviour

Treatment: Observed 4 hourly, Medication changed to Bromoryptpine mesylate 1.25 mg nightly for one week, 1 to 2.5 mg nightly 2nd week, Now 1.9 mg.bd.

Assessed for dementia. Assessed for nursing home care

Promotion of physical movement. Exercises to strengthen muscles involved in speaking and swallowing

Nutritional therapy, plenty of roughage.

Social Background

Previously living independently with 89 year old husband (Tom). He is finding it increasingly difficult to cope with aggressive behaviour. Pt. disoriented and waking at night to dress for work or going outside to garden etc. Two children, both living in the UK and visiting once a year.

Nursing Notes:

Confusion, aggression and paranoid behaviour overcome with change of mdx. Dementia symptoms continue memory loss, disorientation etc. Wears glasses Wears hearing aids

Walks with stick/walking frame

Discharge plain         Transfer to nursing home       

Diet: foods that are appetising, easily chewed and swallowed

Physiotherapy, improve muscle tone + Strength of muscles for speaking and swallowing

Elevated toilet seat                 

Upright chair with arms: back elevated Slip-on shoes           

Avoid rugs on floor

Social work visits

Using the information in the case notes, writes a letter of referral to The Admissions Officer, Torquay Nursing Home, 77 Jan Juc. St. Torquary 3763

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TASK 8            TODAY’S DATE   :   21.05.00

You are Grace Jones, a qualified nursing sister working in Ward C26, Princess Alexandra Hospital Contact, Ph: 07 3807 7642, Annette Macnamara is patient in your care, Read the case notes below and complete the writing task which follows

Name   :           Annette Macnamara

Address :          Unit 15, 66 Smart St. West End          Phone  :           (07)33795926

Social Background

Single Age Pensioner – Recently moved to a small flat in new suburb. House she rented for 10 years was sold. Feels increasingly lonely and isolated-rarely sees neighbours-transport problems make it impossible to continue to attend bowls and bridge clubs. Next to kin Niece Stella Attola, Ph 07559847216 lives and works in Southport-generally visits one a fortnight

Medical History

Date of Admission      :           20.05.2000                                          Date of Discharge       :            22.05.2009

Provide no complications and home assistance arranged. Admitted to hospital following fall. Slipped and fell while descending stairs to put out garbage. X-ray revealed fractured right wrist-Laceration to left hand caused by broken glass. Stitches required-Severe bruising of right shoulder and lower back

Medications: Karvea 150 mg daily am – history of high blood pressure now controlled Normison 10 mg-1 nightly for Insomnia when required

Pain relief-2 Panadol 4 hourly while pain persists.

Discharge Plan: Organise daily visits from Blue nursing Service to assist with showering and to dress hand wound. Social Worker to organise meals on Wheels and physiotherapy. (Niece will visit at weekend to help with housework and shopping. Stitches to be removed and situation to be reviewed at Out Patient Department appointment 10.30 am 31.05.09

Writing Task: Using the information in the case notes, write a letter to the Director, Blue Nursing Service, 2 Sydney Street, West End. Do not use note form in the letter. Expand on the relevant case notes explain patients background and medical history and the assistance requested.

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