in ,

Case Notes 20.3 Derek Shepherd


Writing Sub-Test – Nursing
Reading time – 5 minutes
Writing time – 40 minutes

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


Today’s Date: 03.09.2023

You are a registered nurse in the Coronary Care Unit in charge of the patient;

  • Patient Name: Derek Shepherd (Mr) (Patient)
  • DOB: 13 September 1976
  • Address: 108 Queen Street Melbourne
  • Admitted: 26.08.2023
  • Date of discharge: 02.09.2023
  • Diagnosis: Obstructive coronary artery disease
  • Operation: Coronary artery bypass grafts

Social, Occupational, Lifestyle

  • Lives alone in own home
  • Works as a Business Development Manager at a bank
  • Constipation (occasionally) isabgol for relief
  • Smokes 5-6 cigarettes/day
  • Alcohol: 2 x 300 ml bottles beer/day
  • BMI- 29
  • Dietary habits: Sausages, deep fried chips, pizzas, pastas,
  • Allergic reaction to nuts


  • Severe chest pain, extreme tightness in chest
  • Diagnosed with Obstructive Coronary artery disease
  • Operation coronary artery bypass grafts (27.08.2023)
  • Routine postoperative recovery
  • Constipation related to decrease response to urge to defecate secondary to surgical procedure


  • No stool for 2 days
  • Given isabgol for constipation
  • Low fat diet commenced
  • No complaints of constipation


  • Explained post discharge instructions (resume work after 4 wks., avoid travelling/strenuous exercises till 6 wk., follow-up after 6 wks., medications)
  • Counselled on changes to lifestyle (cease smoking- referred to Quit line, decrease alcohol, reduce weight, low-fat diet, exercise regime)
  • Worried about future
    “I don’t know how I will cope with my job and finances, I might be fired if I don’t go to work for a month” – refer to Cardiac Rehab. S/W for support.”
  • Wound healing well – daily dressing change.
  • Educated re smoking cessation – referred to Quitline
  • Educated re decreasing alcohol
  • Low fat diet (continued)
  • Medications: Aspirin ½ daily, Vicodin q4

Discharge Plan

  • Ready to Return Home.
  • Avoid strenuous activities, travelling till 6 wks., resume work after 4 wks.
  • Follow-up visit after 6 weeks.
  • Refer to District Nurse (wound management, monitor medications, diet, temp.)
  • Low-fat diet after discharge
  • Requested more information on simple low-fat recipes that can be prepared at home.
  • Refer to local Social Worker at Cardiac Rehab. for support to pt. for applying leave from work, financial assistance.

Writing Task

Write a letter to Addison Burke, Dietician, Suite 1, 348, 5th floor, Church Street, Melbourne.

In your answer:

  • Expand the relevant notes into complete sentences
  • Do not use note form
  • Use letter format

The body of the letter should be APPROXIMATELY 180-200 words.

What do you think?

Written by English Melon

Biju John, author of ByeBle and Maclins, is an English Language Trainer. He has also authored his educational Fiction. All these titles are available on Amazon and Google. You can contact his office on WhatsApp / Telegram number +917510923061

Leave a Reply

Your email address will not be published. Required fields are marked *

GIPHY App Key not set. Please check settings

Gaps 20 Series – Questions