WRITING SUB-TEST: NURSING

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Notes:
Assume today is 17th February 2022. You are a community health nurse at
Suncoast Hospice Care Center, North Pinellas, Florida, USA.

PATIENT DETAILS

Name: Mr. Michael Minneses

Age: 78 years
Marital status: Married
DOA: 10th February 2022

Diagnosis: Chronic renal failure, Acute lung failure, DKA

Social History:
• Origin: Philippines
• Retired English teacher (at a community college)
• Volunteer at church
• Highly involved with religious activities
• Lives with wife
• One son, Japhet, lives in another town-occasionally visits
• Sister: Nun at a church (Philippines)

Family History:
• Father: CKD, T2DM, HTN (died)
• Mother: COPD (died)

Past Medical History:

• H/O fall from stairs-fracture-cast applied-15 years back
• T2DM: 15 years
• HTN: 5 years
• Angina: 1 year, mild, occasional episodes
Medications:
• Insulin glargine 16 units BD
• Glucophage 500 mg OD
• Osnate D daily
• Ascard 150 mg OD
• Metoprolol 25 mg BD

Recent Nursing Notes

8th February 2022
• Sudden chest heaviness, SOB, anuria, and unconsciousness
• Admitted to nearby emergency care (needed advanced breathing support)
• Family refused intubation-BIPAP attached
• Code: DNR comfort care
• Kept in SCU
• Plan: Transfer to a hospice care facility

10th February 2022

• Pt. shifted to Suncoast Hospice Care Center
• GCS 7/15, BP 110/65 mm Hg, HR 76 b/min, RR 28 breaths/min
• Breathing via BIPAP
• First degree bedsore-heal area, mineral oil applied
• Air mattress in place, continuous skincare
• ROM and positioning
• NG feed q6h
• Wife requested to stay with pt.

17th February 2022

• Family requested to take pt. home
• Need pt. Under spiritual care and support
• Requested for home care aid
• Family intends to remain involved in pt. care

Discharge Plan:
• Shift pt. back to home (as per family’s request)
• Involve spiritual workers to support the family
• Involve home care aid-24/7 support-provided by Suncoast Hospice Care Center
• Pressure sore care and dressing q4h
• ROM and positioning q4h
• NG feed q6h
• Positioning q2h
• Medications
○Tramadol 100 mg PO
○Ventolin Nebs q6h
○ Ipratropium bromide Nebs q6h

Writing Task

Using the information given in the case notes, write a discharge letter to
Mr. Michael Minneses’ family physician, informing about the patient’s condition
and the continuous home care support required. Address this letter to Dr. Shelly
Thomson,North Pinellas Medical Center, Florida, USA.

• DO NOT use note form in the letter.

• Expand the case notes where relevant into full sentences.
• Use formal letter format.

The main part of the letter should be approximately 180-200 words long.