Case Notes 47.1

Occupational English Test (Nursing)

Notes

This patient has been visiting his GP at City Hospital where you are his charge Nurse.

Patient Details:

• Name: William Carter
• Age: 59
• Occupation: Former Tennis Player

Medical History:

• Diagnosis: Age-related Macular Degeneration (AMD)
  • Onset: Diagnosed 2 years ago
  • Progression: Worsening over the past 6 months
  • Symptoms: Blurred vision, difficulty recognizing faces, central vision loss
• Mental Health: Recent episodes of hearing voices
  • Onset: Last 2 months
  • Frequency: 3-4 times per week
  • Duration: Lasts for a few minutes to an hour
  • Description: Voices are usually indistinct, causing anxiety and confusion

Medications:

• Aflibercept (Eylea)
  • Dosage: 2 mg intravitreal injection every 8 weeks
  • Indication: AMD
• Olanzapine
  • Dosage: 5 mg daily
  • Indication: Hearing voices, potential psychotic episodes

23/07/2024 (Today)

• Vision: Further deterioration noted (by GP), with increased difficulty in daily activities
• Hearing: Continues to experience auditory hallucinations
• Mental State: Reports anxiety and distress due to the hallucinations

Family History:

• Father: Diagnosed with AMD at age 65
• Mother: History of depression

Social History:

• Lives alone
• Visits from a close friend twice a week
• Smoking: None
• Alcohol: Occasional (1-2 drinks per week)

Examination Findings:

• Vision: Visual acuity test shows significant central vision loss
• Mental Status: Appears anxious, no overt psychotic symptoms during the visit
• Physical Exam: Normal, no other abnormalities noted

Investigations:

• OCT (Optical Coherence Tomography): Shows progression of AMD
• Psychiatric Assessment: Recommended due to ongoing auditory hallucinations

Plan:

• Referral: To Ophthalmologist for further AMD management
• Referral: To Psychiatrist for assessment and management of auditory hallucinations
• Medication: Continue current medications, monitor for side effects
• Support: Referral to support services for daily living assistance and mental health support

Next Appointment:

• Follow-up: In 4 weeks for review of symptoms and treatment efficacy.

Writing Task

Using the patient’s history, write a letter of referral to Dr Risha Patel, Ophthalmologist, Central Eye Hospital, Sydney.