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.

Notes:

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

Management:

• RBS 16.8, urine ketones high
• Blood ketones 0.9

Plan:

• 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.