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Case Notes & Analysis 2

This case notes will be used for writing today’s letters for correction. Before you proceed to writing this letter on the writing page, please read this case notes and answer the questions that below:

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: Nursing
TIME ALLOWED: READING TIME: 5 MINUTES | WRITING TIME: 40 MINUTES

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

NOTES

Today’s Date 12/05/2020

You are Avinash / Agni, a registered nurse at the Fiona Stanley Hospice, 11 Robin Warren Dr, Murdoch WA 6150, Australia. Anousheh Ashraf is a patient in your care.

Patient Details

Name: Anousheh Ashraf
Address: Unit 6, 45 Walter St, Holland Park 4121, Perth
Phone: +61 1800 672 555
Date of Birth: 9 October 1951
Country of birth: Iran

Social History:

  • Widowed, no children.
  • Next of kin: Brian Hewson (brother), 67 Bridge Street, Toowoomba; Ph +61 1800 326 675.
  • Family and patient have requested no further treatments be used, other than those necessary to maintain comfort and dignity and to relieve pain.

Medical History:

March 2020:

  • Laparotomy.
  • Found to have cancer of the lower intestine with wide spread metastases.
  • Partial bowel resection and colostomy performed.

April 2020:

  • 6 weeks radiation therapy for relief of symptoms.
  • Prognosis: Not expected to survive more than 3 – 4 months.

05/05/2020

  • Admitted to FSH following collapse at home.
  • No breakage but extreme pain in the lower limbs.
  • Dehydration, nausea, severe pain.
  • IV fluids commenced – trans-dermal patches for pain, light low fiber foods only.

06/05/2020

  • Nausea less severe – tolerating jelly, low fat yogurt
  • Occasional break through pain – pain medication increased
  • Severe edema of ankles and lower legs, bladder incontinence.
  • Does not feel she will recover sufficiently to leave hospital.
  • Requests visit from social worker.

09/05/2020

  • Generally pain free, very weak and disorientated at times.
  • Rejecting solids – able to tolerate fluids – requests apple juice and lemonade.
  • Requests a list of books she would like to read. Likes to watch television programs of the 80’s.
  • Social Worker contacted brother.
  • Advises limited place (shared room) available at Fiona Stanley Hospice from 15 May, 2020. (The hospice will transfer her to a single room on 23rd May, if requested)

12/05/2020

  • Transferred via ambulance to Fiona Stanley Hospice.

WRITING TASK

Using the information in the case notes, write a letter to the Director of Nursing, Fiona Stanley Palliative Care Hospice, introducing this patient. Using the relevant case notes, give her background, medical history and treatment required.

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.

Now, proceed to the questions below and see your score:

  • Question of

    Who is the patient?

    • Anousheh Ashraf, a woman
    • Anousheh Ashraf, a man
    • Anousheh Ashraf, a child
  • Question of

    What is the present condition of the patient?

    • Recovering
    • Recovered
    • Critical
  • Question of

    What is the purpose?

    • Physiotherapy
    • Occupational therapy
    • Palliative care
  • Question of

    Who is the recipient?

    • Nurse at an old-age home
    • Nurse at a palliative care hospice
    • Nurse at a cancer hospital
  • Question of

    Is the patient known to the recipient?

    • No
    • Yes
    • Can’t say
  • Question of

    What is the admission / discharge status?

    • Admitted
    • Discharged
    • Transferred
  • Question of

    What is the least relevant information?

    • Social
    • Detailed medical history
    • Plan
    • Social worker’s role
  • Question of

    What is the tricky element?

    • Too much irrelevant information.
    • Confusing dates
    • Gender of the patient
    • Known / Not known

Written by Biju John

Love for English begins with understanding its unknown rules. Biju John lives on the internet, teaching OET, IELTS and PTE. More than a million students have thanked him from their heart.

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25 Comments

  1. 12May,2020

    The Director of Nursing
    Fiona Stanley Palliative Care Hospice

    Dear Sir/Madam,

    Re : Mrs Anousheh Ashraf,DOB: 09October,1951

    I am writing to introduce Mrs Ashraf who requires palliative care services,as she has been diagnosed with end stage intestinal cancer.She has been transferred today.

    In March,Mrs Ashraf underwent partial bowel resection and colostomy due to wide spread metastasis of the above mentioned condition. She had radiation therapy for six weeks following surgery to relieve symptoms.How ever,she has poor prognosis with a survival time of 3 to 4 months.

    Mrs Ashraf is a widow and has no children.Her next of kin is her brother.Mrs Ashraf and her family requested only necessary treatment to maintain comfort and dignity.

    Mrs Ashraf was admitted to our care on 05 th of this month with complains of severe pain in the lower legs, dehydration and nausea following a fall at home.Her treatment commenced on transdermal patches and intravenous fluid.

    On subsequent days,she was found to be tired and disoriented.She also reported bladder incontinence and lower limb edema.Currently,she is able to tolerate oral fluids.Three days ago,she was seen by a social worker and was recommended with limited place accommodation.

    In view of the above information, kindly take over the care of Mrs Ashraf and provide necessary treatment.

    Please contact me for further information.

    Yours faithfully,

    Registered Nurse

    • Hi Jubin, you have made a good attempt but you didn’t notice the following aspects:
      1. The patient is not going to recover, so, no need to mention 60% of the treatment we have provided.
      2. You are expected to give details about her further management, not much about the past medical history.
      3. You have not mentioned about the availability and transferring her into a personal room on request.

      As a nurse, your prime duty in the letter is to make arrangements for her life in the next three – four months.

      Your language is highly satisfactory but you lost in organization, conciseness and content.
      Score: 310.

      • The Director of Nursing
        Fiona Stanley Palliative Care Hospice

        Dear Sir/Madam

        13 May,2020

        Re:Mrs Anoushes Ashraf
        DOB:09 October,1951

        This is regard to Mrs Ashraf who requires Palliative care as she has been diagnosed with terminal stage of intestinal cancer.She has been transferred today.

        Mrs Ashraf was admitted to hospital on 5th of this month due to severe pain ,dehydration along with nausea. She was managed with fluids and transdermal patches for pain.On subsequent days ,she was found with deteriorated symptoms. However,she does not feel to recover sufficiently to leave hospital as well as she has request to a visit by the social worker for transfer her to a single room.

        Currently,Mrs Ashraf is able to tolerate fluids .Apart from this she prefers to read books and to see television programmes of 80 ‘s . Mr Ashraf pain progress well and has shows occasional disorientation.

        Mrs Ashraf a widower who has no children and receives help from her brother. She underwent bowel resection and colostomy recently.

        It would be beneficial if you could provide Palliative care and management as her needs. Please note she refuse for further treatment.

        Kindly do the needful if you have any queries donot hesitate to contact me.

        Your’s faithfully,
        Registered Nurse.

  2. The Director of Nursing
    Fiona Stanley Palliative Care Hospice

    12May ,2020

    Dear sir/ madam,

    Re:Mrs Anousheh Ashraf
    Age :69

    I am writing to refer Mrs Ashraf, who has been under our care for the treatment of cancer. She requires further hospice care from your service.,as she. is being tranferred to your facility today.

    Mrs Ashraf has had lower intestinal the with wide spread metastases since March ,2020 .Recently, she was admitted to hospital with dehydration, nausea and severe pain following a collapse at home. During hospitalization, she was treated with intravenous fluids and transdermal patches for pain. Additionally, she has been commenced on low fiber food, but she tolerates only liquid diet and is visited by a social worker.

    Mrs Ashraf has had radiation therapy and had undergone partial bowel resection. But ,her prognosis is poor and expected life span is only for 3- 4 months. Therefore, she and her family requested to maintain comfort, dignity and to relieve pain.

    Mrs Ashraf is a widow and has no children. Her brother is the only relative for her and based on the advice of a social worker he has requested to transfer her into your center. And also booked for a private room.as she is advised to limit places.

    It would be greately appreciated if you could provide further care and also ensure the availability of special room for her.

    Please do not hesitate to contact me if you have further queries.

    Yours sincerely ,
    Registered Nurse.

    • 1. Purpose is wrong. No treatment required (Error number 1).
      2. Too much unnecessary medical details for palliative care is totally unacceptable.
      3. Not aware of the date (Error number 9).
      4. Unnecessary importance to the recent fall.
      5.Again, “she has been commenced.” (Error number 5)

      Please refer to the “20 Errors in OET Letters”

      Score 300.
      Please work harder.

  3. 12th May 2030

    The Director of Nursing
    Fiona Stanley Palliative care Hospice

    Dear Sir/Madam,

    Re:Anoushen Astraf,Age 69.

    I write to transfer to your palliative care,Ms Anoushen who was admitted on the 5th following collapse at home. She was dehydrated, nauseous and complained of severe pain at the lower limb.

    She had intravenous fluids, transdermal patches and subsequent occasional breakthrough medications for pain. Low fibre food regimen was recommended.

    Presently she has no complain of pain, able to tolerate oral fluids but mostly very weak and disoriented.

    Ms Anoushen had laparatomy done in March and was diagnosed of metastasized cancer of the intestine. Partial bowel resection and colostomy were carried out with poor prognosis of 3-4month left to live. She went through radiotherapy for six weeks to alleviate pain and had requested with her family that no further treatment be used other than palliative.

    She requested through the social worker for a private room in your facility. I hereby implore you to monitor and assess her diet, fluid and pain continually.

    I will be glad to attend to your queries regarding her care so far.

    Yours Faithfully
    Registered Nurse.

    • Purpose C
      Language C+ (13 errors)
      Content C (You have focused more on her fall, not her critical (terminal condition)
      Conciseness C+
      Organization – C
      Score 290

      This letter is all about making arrangements for a cancer patient who is going to die in 3 – 4 months. The prime purpose is her stay in the palliative care till her death.

  4. 12 May,2020

    The Director of Nursing
    Fiona Stanley Palliative Care Hospice

    Dear Sir/Madam

    Re:Ms Anoushe Ashraf
    DOB: 09 October,1952

    Iam writing to refer Ms Ashraf, who has been treated with end stage of lower. Intestinal cancer. She requires further care and assistance from your facility. She is being transferred today.

    On March,2020 She was diagnosed with lower intestinal cancer with wide spread of metastasis ,for which she underwent laparotomy with partial bowel resection and colostomy. She was commensed on radiation therapy for relief of her symptoms.

    On 05 May, 2020 she was admitted to hospital followed by collapse at home. On examination she had no fracture and has dehydration , nausea and pain.She was commensed on intravenous fluids and trans dermal patch for pain.

    Following days she is responding with treatment.She has developed sever edema on lower legs and also bladder incontinence.She is responding to solid diet.She requested to visit social worker because she is feeling that she could not recovery in hospital.

    Social worker was contacted her brother and she was recommended that single space room and it is necessity. For further care she advised Fiona Stanley Palliative Care center.

    It would be greatly appreciated if you could provide necessary care and support to Ms Ashraf.

    Yours Faithfully,
    Register Nurse

    • Score 310
      Serious issue found
      Incorrect purpose
      Lack of clarity of purpose
      Language C+
      You are writing to a palliative hospice about information about a terminal stage patient. All you have to discus is information that will help make arrangements for her stay. Medical history too irrelevant.

  5. 12th, May 2020
    The Director Of Nursing
    Fiona Stanley Palliative Care Hospice
    Dear Sir/Madam,

    Re:Ms Anousheh Ashraf, 69 years

    I am writing to request palliative care service for Ms Ashraf who has been diagnosed with carcinoma of the lower intestine. She is being transferred into your facility today.
    Ms Ashraf was presented on5th of this month following a fall at home. On assessment, she was dehydrated and complained of severe pain and nausea. Her treatments commenced on intravenous fluid and trans-dermal patch for pain relief.

    On the subsequent days, Ms Ashraf ‘s condition has worsened. She seemed to be weak and disoriented. Also, she developed Nee lower limb oedema and bladder incontinence. Her prognosis with survival time is expecting for 3_4 months due to the wise spread metastasis. Therefore, she and her family members requested for hospice care. The hospital social worker has arranged a shared room at your centre. Please note, currently, she tolerates oral fluids only.

    A widow, Ms Ashraf has no children. Her next of kin is her brother. She has undergone partial bowel resection and colostomy two months ago and, had 6 weeks radiation therapy. She prefers to read books and watch television programmes of 80’s.

    It would be greatly appreciated if you could provide further care and support to Ms Ashraf.

    Please contact me for further queries regarding Ms Ashraf.

    Yours faithfully,
    AGNI
    Registered Nurse

  6. The Director of nursing
    Flonase Stanley Palliative care Hospice

    12 may,2020

    Dear sir/madam

    Re:Mrs Anoushes Ashraf
    DOB:09 October,1951

    This is regard to Mrs Ashraf who requires palliative care as she has been diagnosed with terminal stage of intestinal cancer.

    Mrs Ashraf was admitted to hospital on 05th of this month due to severe pain dehydration along with nausea. She was managed with intravenous fluids and transdermal patches for pain.On subsequent days, she was found with deteriorated symptoms. However, she does not to feel recover sufficiently to leave hospital as well as she was request to visit by a social worker for transfer her to single in your facility.

    At presently Mrs Ashraf can able to tolerate fluids. In addition,she prefers to read books and to see television programmes of 80’s. Her pain well controlled and has shows occasional disorientation.

    Mrs Ashraf a widower who has no children and receives help from brother.she underwent bowel resection and colostomy recently.

    It would be greatly beneficial if you could provide necessary arrangements for her.please note she refuse further treatment

    Kindly do the needful if you have any queries donot hesitate to contact me.

    Your’s Faithfully,
    Registered nurse.

  7. 12 May,2020
    The Director of Nursing
    Fiona Stanley Palliative Care Hospice

    Dear Sir/Madam,
    Re:Mrs Anousheh Ashraf,70 years

    I am writing to introduce Mrs Ashraf who requires palliative care services,as she has been diagnosed with end stage intestinal cancer.She has been transferred today.

    Mrs Ashraf has been underwent partial bowel resection and colostomy in March,2020.She had radiation therapy for six weeks but she has poor prognosis with a survival time of 3 to4 months.

    Mrs.Ashraf was admitted to our Care on 5th of this month followed by a collapse at home associated with dehydration,nausea and severe pain.She was commenced on IV fluids and transdermal patches for pain relief.
    Mrs Ashraf is a widow and has no children. Her next of kin is her brother.Mrs Ashraf and her family have been requested for the treatment which necessary to maintain her comfort and dignity and to relieve pain.

    Mrs Ashraf is able to tolerate to fluid diet which is to be continued.She has been requested a list of which she would like to read and please note,she prefers television programmes of the 80’s.It would greatly appreciated if you could transfer her to a single room According to availability.

    In view of the above information kindly take care of Mrs Ashraf and provide necessary treatment.
    Please contact me for further queries.
    Yours sincerely,
    Charge Nurse

  8. Director of Nursing
    Fiona Stanley Palliative Care Hospice

    12 May,2020

    Dear Sir/Madam,

    Re:Ms Anousheh Ashraf,69 years

    Ms Anousheh Ashraf requires palliative care services from your facility following her transfer today.She has been diagnosed with last stage cancer of the lower intestine.

    Ms Ashraf was diagnosed with cancer two months ago.She underwent partial bowel resection and colostomy followed by six weeks radiation therapy.Her life expectancy is about three to four months.

    Ms Ashraf was admitted a week ago following a collapse at home.She was treated symptamatically.She requested the visit of a social worker as she feels she doesn’t recover.She and her family also requested for only palliative care and denies further treatments.Social worker has been contacted her brother and advised the availability of shared room facility from 15th of this month and will transfer her to a single room from 23rd of this month if needed.

    Ms Ashraf is a widow and has no children.Her closest family member is her brother.

    Generally,Ms Ashraf is free from pain,very weak and sometimes disoriented.She tolerates fluids and rejects solid food.She has requested a list of books to read and also likes to watch television programs of 80’s.

    Kindly arrange necessary facilities to maintain her dignity and comfort and manage her pain accordingly.

    If you need further details ,please do not hesitate to contact me.

    Yours faithfully,

    Avinash
    Registered Nurse.

  9. The Director of Nursing
    Fiona Stanley Palliative Care Hospice

    12 May 2020

    Dear Sir/ Madam,

    Ref : Ms. Anousheh Ashraf,
    DOB: 9 October 1951

    This is to introduce Ms Ashraf who requires palliative care as she is in terminal stage metastasis intestinal cancer. She is being transferred today via ambulance.

    Ms Ashraf has undergone various treatment methods such as colostomy and radiation therapy for the lower instestinal cancer since March. However, no improvement was noted and her life expectancy is about four months. On 5 th of this month,she was admitted following a collapse at home which was treated conservatively.

    Ms Ashraf’s next of kin is her brother, Brian Hewson, who suggested comfort and pain management for her. Please note, she likes 80’s television programs and interested in reading books.

    Currently, Ms Ashraf is feeble, tolerates only liquids mainly juices and disoriented at times but she is free from pain. A social worker’s visits have been initiated. She has explained a shared room will be available from 15 th due to the limited place in the hospice care unit which may transfer to a separate room on 23 rd if she needed it.

    Based on the above, it would be greatly appreciated for Ms Ashraf and her family if you could arrange comfort care for her into your services.

    Please do not hesitate to contact me if you have any further queries.

    Yours faithfully,

    Registered Nurse.

  10. 12/05/2020

    Nursing Director
    Fiona Stanley Palliative Care Hospice
    11 Robin Warren Dr, Murdoch
    WA 6150
    Australia

    Dear Sir/Madam,
    Re: Ms Anousheh Ashraf, 69 years

    I am writing to request further management and palliative car for Ms Ashraf who suffers from advanced lower intestinal cancer for which she underwent partial bowel resection, colostomy 2 months ago and followed by a 6-weeks of radiation therapy with poor prognosis.
    10 days ago, she was admitted to FSH due to severe lower limbs pain, dehydration and nausea. However all necessary treatments were started, on next day, her condition deteriorated and she became edematous. Also, bladder incontinency was reported.
    3 days later, she experienced severe weakness and lost time orientation. She was able to tolerate fluids other than solid foods. Today, she was moved to FSH. On 23rd, the hospice will transfer her to a single room after resting in a shared room for some days.
    Ms Ashraf is widowed and has no child. Her next of kin is Mr Hewson. They have requested pain relief management and providing comfort to her. No further treatment is requested. She requested some books and TV programms of 80s. A social worker will assist her.
    In view of the above, it would be highly appreciated if you could continue her further assistance and management at your care.

    If you need any further queries please contact me.

    Yours faithfully,
    Registered Nurse
    Avinash/ Agni

  11. 12/05/2020

    The director of nursing
    Fiona Stanley Palliative Care HopsicE

    Dear sir/madam,

    Re:Mrs Anousheh Aaharf
    DOB:9 October 1951

    Mrs Anousheh Asharf has terminal lower intestine cancer with poor prognosis so, survival chance less than 4 months .She requires palliative care and support.Today transferred to your facility.

    Mrs Asharf was admitted to Fiona Stanley Hospice after a collapse at home.On examination,she had no fractures complained of sever pain in the lower limbs,dehydration and nausea which was managed conservatively.
    On the subsequent days,her condition has been worsening.she is very weak,disoriented occasionally,bladder incontinence and tolerating only fluids. Social worker was contacted the next to kin Mr brain Hewson as she wont able be to leave hospital due her deteriorating condition.

    March 2020,she under went laparotomy which revealed wide spread metastases carcinoma. So,partial bowel resection and colostomy was performed followed by 6 weeks radiation.she is a widow with no children.she likes watching television programs of 80’s.

    Mrs Asharf is a widow with no children.Family and patient has requested no further medical management. Eventhough,she has to be given pain relieves and provide her with necessary comfort and dignity.

    Please do not hesitate to contact for any further queries.

    Yours sincerely,

    Registered nurse
    Agni

  12. Director of nursing
    Fiona Stanley Palliative Care Hospice

    12 May 2020

    Dear Sir/Madam,
    Re: Anousheh Ashraf,69 years

    Mrs Ashraf is diagnosed with end stage cancer of lower intestine with metastasis.She has requested transfer to Palliative care for further management and support.

    Mrs Ashraf was admitted to the hospice on 5th of this month with an episode of syncope at home. She was managed with IV fluids for dehydration and trans dermal patches were used for pain relief. Presently she complains of frequent episodes of pain which is controlled with analgesia suiting her comfort. Mrs Ashraf requires assistance of incontinent pads for her elimination needs and has edema of lower extremities.

    Mrs Ashraf has laparotomy which revealed metastatic cancer and subsequently colostomy was performed. A month later radiation therapy for 6 weeks was commenced to give relief from pain.
    Considering the above, it would be highly grateful if you could accept Mrs Ashraf into your Palliative care and management as the patient and family is aware of the poor prognosis and does not want to continue any medical treatment except for those pertaining to her comfort and dignity for the rest of her life.

    Please contact me for any queries.

    Yours faithfully,
    Agni,
    Registered nurse.

  13. The Director Of Nursing
    Fiona Stanley Palliative Care Hospice

    12 May ,2020

    Dear Sir/Madam,

    Re: Mrs Anousheh Ashraf, DOB: 9 October,1951

    Mrs Ashraf is being transferred today into your facility for palliative care. She has been diagnosed with cancer of the lower intestine with wide spread metastasis.

    Mrs Ashraf presented to us on 5th of the month with severe pain on the left leg, nausea and dehydration. Her condition was treated with interavenous fluids and trans-dermal patches;however, during hospitalization, she developed bladder incontinence,severe edema on her lower legs and ankles , disorientation and weakness.
    Mrs Ashraf has only three to four months of life expectancy because of which she and her family does not want further treatment expect to reduce pain and to maintain her comfort and dignity. Additionally, she loves to read books and watch 80’s television programs.

    A social worker advised to keep Mrs Ashraf in shared room after three days at Fiona Stanley Hospice and she will be transferred to a single room on 23rd of this month, if she requests.

    In light of the above,I believe that Mrs Ashraf requires further end-life-care from your care. Please note that she is only able to ingest liquid diet such as: apple juice and lemonade.

    Should you have further queries, please do not hesitate to contact me.

    Yours sincerely,

    Registered Nurse
    Agni

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