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Case Notes 2.3 – Fiona Carwell

Occupational English Test

Writing: Nursing

Reading Time: 5 Minutes. Should not write during this time.
Writing Time: 40 Minutes

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


Assume that today’s date is 20 September, 2023. You are Miss Fiona Carwell’s School Health Nurse and the patient is attending 6th grade at your school.

Patient Details:

  • Name: Fiona Carwell
  • DOB: 06 Dec 2011 (12 y.o.)
  • Address: 32 Station Road, Oakville

Social background:

  • She’s from a migrant family from Spain relocated to Oakville since 1998
  • Father died recently (June 2023) due to MVA
  • Family reports grief. Pt reports extreme stress re. worries about the future in the absence of Father who was really close with her.
  • BMI 29 (overweight) – recently gained due to poor diet control
  • Older brother-mental health problems (2 suicide attempts in last 12 months)

Medical history

08 July, 2021, 0915 hrs

  • feeling very thirsty
  • passing urine more often than usual, particularly at night
  • feeling very tired all the time
  • weight loss of 6 kg in 2 months
  • Frequent oral thrush
  • Blurred vision
  • Emergency hospital admission (Oakville General Hospital) following an episode of LOC

Lab investigations:

  • Random Blood Sugar of 11.9 mmol/L
  • HbA1C indicates high
  • Diagnosis: type 1 DM
  • Treatment: Novolin N 4 Unit at tarde
  • Solostar 8 unit at nocte
  • Discharge Date: 15 July, 2021

Discharge recommendations:

  • Dietician referral
  • Lifestyle management
  • Diabetes Nurse Specialist referral at Oakville General Hospital for follow up care (diet, insulin)
  • Review at DNS:

11 March, 2023

  • Well maintained Blood Sugar.
  • Following healthy lifestyle along with proper nutrition (well balanced calorie diet).
  • RBS 4.6
  • Reduced Solostar to 6 unit due to several hypo attacks at night.

18 July, 2023

  • Blurred vision
  • Increased power
  • s/b ophthalmologist
  • started to wear spectacles.
  • Reduced symptoms
  • No headache or Blurred vision thereafter.

Present complaint:

20 September, 2023

  • dizziness and light-headedness, sleepy during class
  • Pt reports stress due to grief
  • Pt reports stress induced overeating


  • RBS 16.8, urine ketones high
  • Blood ketones 0.9


  • Referral to Diabetes Nurse Specialist.
  • Review of meds.
  • Discus ways to encourage lifestyle changes.
  • Plan further management.

Writing Task

Using the information given in the case notes, write a letter of referral to Ms Catherine Flanagan, Diabetes Nurse Specialist, Oakville General Hospital.

In your letter, briefly outline Ms Carwell’s recent history requesting advice and a review of her medication.

In your answer:

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

Your letter should have a word count of 180 – 200 hundred words. However, the numbers can go up or down depending on the relevance of information.

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

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