Case Notes 39.1

Occupational English Test – Writing (Nursing)


  • You have 45 minutes to write this letter.
  • During the first 5 minutes, you should not pick the pencil.
  • Start writing only when you are told.
  • During the Reading Time, try to understand the case notes.

Melons Steps

  • Eliminate (E) irrelevant information.
  • Launch (L) the letter with DADR.
  • Open (O) the letter with PRPDD or PRPTT.
  • Narrate (N) the remaining paragraphs using V or W.
  • Sign (S) the letter with S/F.

Melons Errors

  • Punctuation “Marks”.
  • Follow “Expansion” Rules.
  • Obey “Language” Rules.
  • Have an “Order” (DADR, PRPDD, V/W, S/F)
  • Do not change “Names”.
  • Sex (Mr, Ms, Mrs, His, Her).

Details to Fill In:


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


Today’s Date: 11/07/2024. This patient, who has been under your care since admission, wishes to get a discharge soon as she wishes to live with her eldest daughter in Canberra and get treated by a Respiratory specialist she knows.

  • Patient Name: Emma Watson.
  • DOB: 15/04/1962
  • Address: 45 Green Street, Brisbane.
  • Marital Status: Married

Medical History:

  • Hypertension (diagnosed 2010)
  • Type 2 Diabetes (diagnosed 2015)
  • Asthma (diagnosed 2000)
  • Appendectomy (2018)
  • Allergies: Penicillin

Social History:

  • Occupation: School Teacher
  • Smoker: No
  • Alcohol: Occasional (1-2 drinks per week)
  • Exercise: Regular (3 times a week)
  • Support System: Husband and two daughters (the eldest, Mona Freeman lives in Canberra but visits her parents every week).

Current Medications:

  • Metformin 500mg BD
  • Ramipril 5mg OD
  • Salbutamol Inhaler PRN


  • Acute exacerbation of asthma.
  • Shortness of breath (onset 3 days ago).
  • Wheezing; Tightness in the chest.
  • Persistent cough.
  • Expresses her wish to be taken care of by her son (respiratory specialist in another hospital).

Examination Findings:

  • BP: 150/95 mmHg; HR: 98 bpm
  • RR: 24 breaths/min; SpO2: 92% on room air
  • Peak Flow: 250 L/min.

Treatment Provided:

  • Oxygen therapy (4 L/min via nasal cannula)
  • Nebulized Salbutamol (2.5 mg) and Ipratropium Bromide (0.5 mg)
  • Prednisolone 40 mg PO
  • IV Fluids (Normal Saline).

Nursing Management:

  • Oxygen therapy initiated (4 L/min via nasal cannula)
  • Administered nebulized Salbutamol (2.5 mg) and Ipratropium Bromide (0.5 mg)
  • Administered Prednisolone 40 mg PO
  • Provided IV Fluids (Normal Saline)
  • Monitored vital signs (every 2 hours).
  • Conducted peak flow measurements every 4 hours
  • Maintained oxygen therapy as prescribed
  • Encouraged fluid intake
  • Educated patient on asthma management and medication use.
  • Arranged transfer to another hospital where her son works.

Discharge Plan:

  • Allow the patient to be seen and treated by her son.
  • Prescribe a short course of oral corticosteroids (Prednisolone 40 mg for 5 days).
  • Ensure patient has an asthma action plan.
  • Refer to asthma educator for further education.
  • Special request: Arrange a new GP at Doctor Hospital (current GP is retiring soon).
  • Transfer all medical records to Doctor Hospital within 2 working days.

Writing Task

Ms Watson’s GP has decided that she be transferred to Doctor Hospital, Silent Valley, Canberra where her son, a respiratory specialist, works. Using the case notes, write a letter to Dr Arthur Freeman Watson, for further management. Address the letter to Doctor Hospital, Kent St, Canberra 2600, Australia.

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. Do not pick your pencil during the 5 minutes of reading time.

  • Question of

    Who is the recipient?

    • A new GP
    • A respiratory specialist in the same hospital.
    • A respiratory specialist in another hospital.
  • Question of

    Is this a known case?

    • Yes
    • No
  • Question of

    Is the patient’s condition diagnosed?

    • Yes
    • No
    • Partially.
  • Question of

    Is the patient on medication for the current condition?

    • Yes
    • No
  • Question of

    What is the patient’s current medical condition (P3)?

    • Diagnosed.
    • Treatment provided.
    • Recuperating.
    • No notable progress.
  • Question of

    What is the purpose of this letter?

    • Further care and management.
    • Diagnose the patient.
    • Advice.

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Listening Part A 38.1

Role Play 39