Mr Stapleton Moore is a 63-year-old patient in Care Well Hospital where you are Charge Nurse.
- Marital Status: Widower (8 years)
- Admission Date: 5 September 2021 (Care Well Hospital)
- Discharge Date: 9 September 2021
- THR – Total Hip Replacement
- Higher BP
- Lives in Abrina Nursing Home, 1921 Victoria Street, Ashfield, NSW 2131
- Had been there for 2 years before coming to Care Well
- Has two children, both working overseas
- Worked in a bank as an accountant before quitting at 60.
- No pensioner
- Hobbies: Reading, photography, fishing
- Brother, Peterson, pays visits weekly
- No severe signs of dementia observed yet
- 2017 – Osteoarthritis requiring total hip replacement surgery
- 2015 – Blood Pressure (management ongoing)
- Aspirin (100mg)
- Ramipril 5mg
Nursing Management and Progress
- Dressing Daily
- Recommend stretching exercises
- Follow up FBE and UEC tests
- Good Condition – post operation
- Walks with aid in the beginning
- Now walks perfectly with wheelie-walker
- Appeared disoriented during post operative recovery.
- Possibly anaesthetic Hb dropped (71) post operatively,
- Transfused three units of packed RBCs
- Hb normal on discharge (112)
- Pain reliever given – Panadeine Forte (6 tablets / day)
- Exercise recommended
- Equipment required: Wheelie-walker, wedge pillow, toilet
- Hospital is providing Wheelie-walker and wedge pillow.
- With help from local medical supplier, raiser hired for 2 weeks.
Using the information in the case notes, write a letter to Ms Gladys Makuba. Senior Nurse at Abrina Nursing Home 19-21 Victoria Street Ashfield NSW 2131, who will be responsible for Moore’s continued care at the Nursing Home.
In your answer:
- Expand the relevant notes into complete sentences
- Do not use note form
Use letter format