Day 23 Case Notes Analysis



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


Arthur Brookes was admitted at Abbey’s Children’s Hospital where you are his in charge. He is getting discharge tomorrow morning.

Patient Details

  • Name: Arthur, 6 years
  • Admission 13/09/2020
  • Discharge 16/09/2020

Recurrent Issues

  • Bedtime refusal and struggles going to bed
  • Frequent “curtain calls” after lights out (such as requests for drinks, hugs or stories)
  • Difficulty falling asleep once in bed
  • Frequent or prolonged night wakings with difficulty returning to sleep independently
  • Waking earlier than desired
  • Resistance to an appropriate sleep schedule
  • Difficulty napping
  • Trouble waking in the morning or getting up for school/classes.

Daytime symptoms include:

  • Fatigue, tiredness, sleepiness
  • Attention, concentration or memory impairments
  • Problems with social, family, occupational or academic performance
  • Mood disturbances or irritability
  • Behavioral problems (hyperactivity, aggression or oppositional behavior)
  • Reduced motivation
  • Poor decision-making and impulse control
  • Low tolerance for frustration

Social History

  • Mother’s death five months ago
  • Anxiety / stress over father being away (father works on a ship, very attached, takes Arthur on board once in two months)

Medical History

  • Restless legs syndrome (Diagnosed, 2018)
  • Obstructive sleep apnea (Suspected since 2019)
  • Mother asthmatic, father depression,
  • Elder brother ADHD, autism in the family
  • Steroids and antidepressants
  • Drinks a lot of Cola and energy drinks

Current Medication:

  • Clonidine, 10 mcg (Doses should be weaned gradually from 15th to the end of of the month)


  • Create comfortable sleep environment
  • Maintain a bedroom that is quiet, calm, comfortable.
  • Keep room dark. Stay with the child at night. Fit a nightlight.
  • Avoid arguments, asking about mother, father
  • Deep breathing in the morning,
  • Encourage watching television but not mobile phones.
  • Remove clocks from the bedroom. Mute all kinds of notification sounds
  • Set bedtime to obtain the usual amount of sleep:
  • Make him get up out of bed instead of tossing and turning.
  • Arrange for behavioral therapist’s visit at 10.30 am, Monday and Friday.

Writing Task:

Using the information in the case notes, write a letter to Mrs Ching, Arthur’s new caretaker who will arrive tomorrow. She works part time at Abbey’s Children’s Hospital, Sydney, 10 minutes drive from home.

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.

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 take this Case Notes Analysis and Proceed to Letter Writing

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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  1. 16 September,2020

    Ms Ching
    Care taker
    Abbey’s Children’s Hospital

    Re: Arthur Brookes,aged 6 years

    Dear Ms Ching,

    I am writing to update regarding Arthur Brookes, who requires your continued care and assistance at home.He is being discharged tomorrow.

    Arthur was admitted three days ago with recurrent sleeping and behavioural issues, fatigue, impairment of memory and attention. His mother died five months ago.He is very much attached to his father,who lives away from home for work. Therefore, he is anxious
    and frustrated.

    Arthur has restless leg distress syndrome and a possible obstructive sleep apnoea,for which he takes steroids and antidepressants.He consumes a lot of cola and energy drinks.

    Kindly ensure, Arthur sleep adequately by providing a comfortable sleeping environment such as calm and dark room, as well as staying with him at night. please note that nothing to be asked about his parents and avoid arguments with him.It is essential to set a time schedule for sleep and encourage him for breathing
    exercises in the morning. it is recommended that a behavioral therapisr visit can be arranged at 10.30 on moday and Friday.

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

    Yours sincerely,
    Charge Nurse

  2. 13th September, 2020

    Mrs Ching
    Abbey’s Children’s Hospital

    Dear Mrs Ching,

    Re: Arthur Brookes, 6 years

    I am writing regarding Arthur Brookes, who requires further continued care and assistance. He is being discharged tomorrow morning.
    On 13th of this month Arthur was admitted to our hospital with chief complaints of fatigue, tiredness and sleepiness. On assessment he attention and memory impairments and behavioral problems. His treatment was commenced on Clonidine 10 mcg.

    Arthur was diagnosed with restless legs syndrome and obstructive sleep apnea in 2018 and 2019 respectively for which he was on steroids and antidepressants and drinks a lot of Cola and energy drinks.

    In view of social history Arthur’s mother was deceased five months ago. Arthur father works in ships. He was quite anxious and stressed over his father being away.

    In view of above it could be greatly beneficial if you could provide continued care and assistance to Arthur’s. Of the note kindly crate comfortable sleep environment and encourage him to watch television and deep breathing exercises in the mornings. Make sure that remove all clocks and mute all kinds of notification sounds. Arrange for behavioral therapists visit at 10:30 am on Monday and Friday.

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

    Yours sincerely,
    In charge Nurse
    Abbey’s Children’s Hospital

  3. 16 September,2020

    Ms Ching
    Care taker
    Abbey’s Children’s Hospital

    Re: Arthur Brookes,aged 6 years

    Dear Ms Ching,

    I am writing to refer Arthur who has behavioural problems requires continued care at his home following discharge tomorrow.

    Two days ago, Arthur was admitted with complaints of fatigue, memory and cognitive imairement along with imapaired sleeping pattern. He was noted for behavioural problems including aggression, hyperactivity and oppositional behaviour. In addition, he has problems with social, family, occupational and academic performance.

    Arthur’s mother died five months ago. He has more attachment with his father who is staying away for work. Consequently, he appears anxious and frustrated.

    Arthur has had resless leg syndrom since 2008 as well as he ia suspected to have obstructive sleep apnea. He is on clonidine 10 mg which has to be weaned gradually from 15th to the end of this month.

    It would be highly appreciated if you could provide a comfortable sleep environment for Arthur by keeping room dark, staying with him at night, in addition to removing all kind of notification sounds. Please make him get out of bed instead of tossing and turning. It is important to avoid argument while he is asking about parents. Kindly encourage him to perform breathing exercise and watching televiaion instead of using phone. Please note, it is beneficial if you could arrange an appointment with behavioural therapist on monday and friday at 10:30 hour.

    Pleass contact me for further information.

    Yours sincerely,
    Registered nurse

OET Grammar Mixed 1

Letter Placing Order