Case Notes 42

Occupational English test

Instructions:

• You have 45 minutes to write this letter.
• During the first 5 minutes, you should not pick the pencil.
• Start writing only when you are told.
• During the Reading Time, try to understand the case notes.

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

Notes:

You are the nurse in a Community Health Centre. A patient you have been monitoring is moving to another city to live with his daughter.

Patient Details

• Name: Mr Peter Dunbar.
• DOB: 18 Mar 1940.

Current medication:

• Metformin 500 mg TDS (oral hypoglycaemic).
• Ramipril 5 mg daily (anti-hypertensive, ACE inhibitor) – for hypertension.
• Warfarin variable 3-5 mg (anti-coagulant).
• Sotalol 40 mg daily (beta blocker).

Treatment record:

• Diagnosed with type 2 diabetes (August 2017).
• Fasting blood sugar levels (BSL) = 9
• Doctor recommended dietary management: low-fat, low-sugar, calorie.
• Restriction; limit alcohol. ↑Exercise.

March – July 2023

• Pt lives at home with wife. Wife cooks.
• Wife managing dietary requirements, but Pt likes 2-3 glasses wine with meals.
• Wife deceased.
• Pt depressed/grieving.

August, 2023

• Referred back to doctor for monitoring / medication.
• Fasting BSL = 9.
• Pt non-compliant with diet.
• Excessive fat, salt, sugar, alcohol (wine/beer).

12 October, 2023

• Doctor prescribed metformin (oral hypoglycaemic agent).
• Now Pt cooking for self.
• Non-compliant with diet, medication. Blames poor memory.
• Pt appears unmotivated. Resents having to take medication.
• Educated need for regular medication and potential adverse effects of intermittent dosing.
• Discussed strategies of memory aids.

02 February, 2024

• Pt hospitalised (City Hospital, Newtown) with myocardial infarction (MI) following retrosternal pain, nausea/vomiting, dizziness, sweating. Confirmed by ECG
• Treatment: aspirin, streptokinase infusion. Prescribed ramipril 5mg daily.
• Diagnosed with atrial fibrillation post MI – commenced sotalol and warfarin

22 March, 2024

• Pt attended twice weekly

21 April, 2024

• Pt now walking with a stick. Signs of diabetic neuropathy.
• Poor exercise tolerance. Restricted mobility
• Non-compliance with diet continues. Still self-catering.

22 April, 2024

• Discussed alternatives e.g., community-based meal delivery service; moving in with adult children (son/daughter); retirement village
• Had respiratory infection 2 wks. ago. Amoxicillin prescribed. Pt discontinued all other medication as felt unwell. Resumed medications but still only taking intermittently

23 April, 2024

• Pt attended with daughter. Pt moving to Centreville to live with daughter & her husband.
• Daughter will cook – requires education re Pt needs & monitoring
• Daughter advised re patient’s resistance to dietary alterations and medication regimen.
• Still misses or doubles dose – all medication. Refuses to reduce salt, sugar, alcohol, fatty food;
• Pt continues to require monitoring & encouragement
• Letter to transfer the Pt to the care of the community health nurse in Centreville.

Writing Task:

Using the information given in the case notes, write a letter to the Community Health Nurse in Centreville, outlining the patient’s history and requesting continuity of monitoring. Address the letter to the Community Health Nurse, Eastern Community Health Centre, 456 East Street, Centreville.

In your answer:

• Expand the relevant notes into complete sentences (Do not use note form).
• Eliminate irrelevant details.
• Follow the MELONS Organization. Follow DADR, PRPDD / TT, V/W and S/F.
• Punctuate appropriately with small and capital letters, full-stops, commas.
• Use correct grammar. Insert “the” before body parts / organs.
• Use letter format.

The body of the letter should be approximately 180–200 words. Do not pick your pencil during the 5 minutes of reading time.