WRITING MODULE QUESTION NO: 1

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

NOTES:
Hospital : Royal Perth Hospital

Patient Details: Alfred Billy

Admission Date: 21/03/2010

Discharge Date: 5/05/2010

Diagnosis: v Skin cancer-BCC(Basal Cell Carcinoma) (neck)Nodular basal -cell carcinoma

Past Medical History: No prior hospitalisation, no history medications

Social History/Supports: Truck Driver

Lives with his wife
Habit of consuming liquor for the past
30years
Cigarette Smoker
Skin dark
Religion : Protestant

Medical Progress: Skin biopsy is taken for pathological study.

Nursing Management : Pain reliever panadein forte500 mg

No complications noted
Perfectly well at the time of discharge
No complain of any pain

Discharge plan : Daily observation

Medicines to be taken for one more week

WRITING TASK:

You are the charge of this hospital ward. Mr Alfred Billy has recently had his operation. Using the information provided in
the case notes. Write a referral letter to the Community Nurse Head at Care Well Hospital, Birmingham who will be
attending Mr Alfred Billy following his discharge.
WRITING MODULE QUESTION NO: 2

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

NOTES:
Hospital : Mount Lawley Private Hospital

Patient Details: Name : Charles Gardiner

Age: 63
Height: 5'8"
Weight: 177 lbs
Telephone number: +61 8 9240 1108

Social History: Lives with his son

Son provides 24-hour supervision an is the primary care-giver.
Smokes
Doesn't drink
Address for correspondence: 7Cressall Road, Balcatta WA, Australia.

General Condition: Sensory vision WNL with glasses,

Somewhat hard of hearing,
Speech is clear with mild dysphasia,
Ambulates with a cane or rolling walker independently,
Sometimes needs supervision or contact guard on the stairs,
Transfers independently,
Continent of bowel, incontinent of bladder,
Wears disposable undergarments

Medical History: 12th November, 2010:

Diagnosed to have high BP

Presenting symptoms: 17thOctober,2011

Pain, ache, discomfort and tightness across the front of the chest
BP noted as 170/110 mm Hg

Myocardial perfusion scintigraphy confirmed the diagnosis of angina

Operation performed on 25 thof October 2011.

WRITING TASK:

Using the information in the case notes, write a letter to Dr Kelly Fernandez, 148 Douglas Ave, South Perth WA,
Australia, who wanted you to provide all the details about the patient's medical history before taking the patient into
his care.
In your answer:
 Expand the relevant notes into complete sentences

 Do not use note form

 Use letter format

WRITING MODULE QUESTION NO: 3

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
Today's Date:09/09/12

NOTES:

You are Lee Wong a registered nurse in the Coronary Care unit, St Ardrews Hospital ,Brisbane. Bill O Riley is a patient
in your care.

Patient Details: Name: Bill O' Riley

Address :9476 Old Dam Road, Goondiwindi ,QLD 4390
Next of Kin Brother,EmileO'Riley72 Burke StCunnamulla QLD, 4490
Admitted: 2 September 2012
Diagnosis: Obstructive coronary artery disease
Operation: Coronary artery bipass grafts (x 4) on 4th September 2012

Social History: Never married

Lives alone In own home just outside Goondiwindi
Fencing contractor.

Medical History: Smokes 20 cigarettes/day

Alcohol 2×300ml bottles beer/ day
Ht 170cm Wt 99kg
Usual diet sausages, deep fried chips, eggs, McDonalds
Allergic reaction to nuts

Nursing Management and Progress:

Routine post operative recovery
Advised to cease smoking, reduce alcohol
Low fat diet
Walking well
Wounds healing well
Routine visit from Social Worker

Discharge Plan: Returning Home to Goondiwindi

Appointment made for follow up visit to local GP Dr Avril Jensen 2pm 15/9/12
Local physiotherapist t to continue rehabilitation exercise program
WRITING TASK:

Mr O' Riley has requested advice on low fat dietary guidelines and healthy simple recipes. Write a letter to Community
Information Section of the Heart Foundation, Gregory Terrace, Brisbane on patient's behalf. Use the relevant case notes
to explain Mr. O' Riley' s situation and the information he needs. Include Medical History, Body Mass Index and
lifestyle. Information should be sent to his home address.
In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 4

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Miss Cassandra Kinser,a 32-yearold, is a patient in the medical wardin which you work.

Hospital: StVincent’s Hospital, 390 Victoria Street, Darlinghurst

Patient details:
Name: Cassandra Kinser (Miss)
Marital status: Single
Residence: Cabramatta
Next of kin: unknown
Admission date: 17 January. 2016
Discharge date:17 January, 2016
Admissiondiagnosis: Lip laceration
(alleged assault by boyfriend/did not seek medical care)
Abdominal pain
Burning with urination last several days
May have STD
Denies vomiting / diarrhoea
Sexually active. does not use protection

Social background: Smoker (chain)

Alcoholism
Denies illicitdrugs

Past medical history: History of schizophrenia

Diagnosis: 1.Lip laceration

2.Urinary tract infection (UTI)

Medical progress: Constitutional: Denies fever, chills, dizziness, weakness.

Cardiovascular: Denies chest pain / palpitations
Respiratory: Denies shortness of breath / cough All Other review or systems
negative

Nursing management:
For lip: Cipro 500 mg orally twice daily x 6 days Clindamycin 300 mg orally 4 x
daily x 10 days peridex mouthwash 10ml swish and spit after meals and before bed
Oxycodone one orally every 4 hours.
UTI:follow up with GP

Assessment: Discharged home good condition

Discharge plan: Appointment made at sexual health clinic

Follow upWithGP.Monitor antibiotics. urine appears infected. Treat for UTI

WRITING TASK:

Using the information given in the case notes, write areferral letter to Miss Kinser’s General Practitioner ,Travis Wrenn
at punt Road Medical Clinic, 172 punt Road, Mosman, 2088 for further medical evaluation.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 5

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Today's Date 16.02.13

Patient History:
Miss Cathy Jones - 25 year old single woman
Occupation - receptionist
Family history of deep vein thrombosis
On progesterone-only pill (POP) for contraception
No previous pregnancies

15.02.13

Subjective
Presents to GP surgery at 7 pm, after work
Complains of lower abdominal pain since the evening before, worse in right iliac fossa
Unsure of last menstrual period, has had irregular bleeding since starting
POP 2 months ago, New partner for past 2 months
No bladder or bowel symptoms

Objective
Mild right iliac fossa tenderness, no rebound/guarding
Apyrexial, pulse 88, BP 110/70
Vaginal examination - quite tender in right fornix. No masses
Assessment
Non-specific abdo pain
Plan: Asks her to return in morning for blood test and reassessment

16.02.13

Subjective
Pain has worsened overnight. Now severe constant pain.
Some slight vaginal bleeding overnight also.
Felt faint while waiting in reception.
On questioning, has left shoulder-tip pain also

Objective:
Very tender in the right iliac fossa, with guarding and rebound tenderness
Apyrexial, Pulse 96, BP 110/70
On vaginal examination, has cervical excitation and markedly tender in the right fornix,Pregnancy
test result positive.
Urine dipstick clear
Assessment:
Suspected ectopic pregnancy
Plan: You ring the on duty Gynaecology Registrar and ask for urgent assessment, and are
instructed to send her to the A&E Department with a referral letter.

WRITING TASK:

Write Referral letter to the Gynaecology Registrar at the Spirit Hospital, South Brisbane. Ask to be kept informed of the
outcome.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 6

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Patient: Mia Black (MS

DOB: 19.9.1965
Height 163cm, Weight 75kg, BMI: 28.2(18/6/10)

Social History: Teacher (Secondary - History, English)

Divorced, 2 children at home (born 1994, 1996)
Non-smoker (since children born)
Social drinker - mainly spirits

Substance Intake: Nil

Allergies: Codeine: dust mites: sulphur dioxide

PHx: Mother - hypertension; asthmatic; Father - peptic ulcer

Maternal grandmother - died heart attack, aged 80
Maternal grandfather - died asthma attack
Paternal grandmother – unknown
Paternal grandfather - died 'old age 94

PMHx: Childhood asthma, chickenpox, measles

1975 tonsillectomy
1982 hepatitis A (whole family infected)
1984 sebaceous cyst removed
1987 whiplash injury
1998 depression (separation from husband); SSRI – fluoxetine 11/12
2000 overweight - sought weight reduction
2000 URTI
2004 dyspepsia
2006 dermatitis, Rx oral & topical corticosteroids

18/6/10 PC: dysphagia (solids) onset 2/52 ago post viral (2) URTI
URTI self-medicated wita OTC Chinese herbal product - contents unknown
No relapse/remittent course
No sensation of lump
No obvious anxiety
Concomitant gastric pain radiating to back, level T12
Weight loss: 1-2kg
Recent increase in coffee consumption
Takes aspirin occasionally (2-3 times/month); no other NSAIDs
Provisional diagnosis: gastro-oesophageal reflux +/- stricture

Plan: Refer gastroenterologist for opinion and endoscopy if required

WRITING TASK:

Using the information in the case notes, write a letter of referral, for further investigation and definitive diagnosis to
the gastroenterologist, Dr Jasmine Roberts, at Newtown Hospital, 111 High Street,Newtown.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 7

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Today's date: 9/7/08

Patient Details:
Jim Middleton aged 84 was admitted to your ward following surgery for a left inguinal
hernia. His doctor has advised he can be discharged within 48hrs if there are no
complications following the surgery. Jim reports some pain on movement but has
recovered well from the surgery and is keen to return home.
Name: Jim Middleton
Date of Birth: 3 July 1924
Admitted: 7 July 2008
Planned Discharge Date: 9 July 2008
Diagnosis: Left inguinal hernia

Medical History:
Hypertension diagnosed 1998
Medication Atacand 4 mg daily

Family History:
Married 50 years to wife Olga DOB 8.2.32 - one son living in USA
Jim is Second World War veteran - served two years in Borneo - Prison of War 16 months.
Own their home with large garden which they maintain without assistance.
Very independent and proud that they have never applied for a pension or home
assistance.
Have always managed quite well on their income from a number of investments.
Olga told you she is worried as income from these investments has recently been
significantly reduced due to severe stock market falls.
She is concerned Jim will not be able to continue to maintain their garden and they will not
be able to afford a gardener or any other help at this time.
Transport is also a problem as Olga does not drive. Not close to any public transport so will
have to rely on taxis.
Olga thinks they may now be eligible to receive a pension and other assistance from the
Department of Veteran Affairs but doesn't know how to find out - doesn't want to worry
Jim.
Olga is in good general health but becoming increasingly deaf- finds phone conversations
difficult. She would appreciate a home visit.
You agree to enquire on her behalf. Their address is 22 Alexander Street, Belmont,
Brisbane 4153 Phone (07) 6946 5173
Discharge Plan:
• Must avoid any heavy lifting
• Should not drive for at least six weeks
• Light exercise only
• May take 2 Panadol six hourly for pain
• Appointment made to see surgeon for post operation check at 10am on 11 August
Contact Department of Veterans Affairs re eligibility for pension and home help

WRITING TASK:

Using the information in the case notes, write a letter to The Director, Department of Veterans Affairs, GPO Box 777
Brisbane 4001. In your letter, explain why you are writing and the assistance they are seeking.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 8

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Mr. Gerald Baker is a 79-year-old patient on the ward of a hospital in which you are Charge Nurse.
Patient Details:
Marital Status: Widower (8 years)
Admission Date: 3 September 2010 (City Hospital)
Discharge Date: 7 September 2010
Diagnosis: Left Total Hip Replacement (THR)
Ongoing high blood pressure

Social Background: Lives at Greywalls Nursing Home (GHN) (4 years)

No children
Employed as a radio engineer until retirement aged 65
Now aged-pensioner
Hobbies: chess, ham radio operator
Sister, Dawn Mason (66), visits regularly; v supportive
plays chess with Mr. Baker on her visits
No signs of dementia observed

Medical Background:
2008 - Osteoarthritis requiring total hip replacement surgery
1989 - Hypertension (ongoing management)
1985 -Colles fracture, ORIF
Medications:
Aspirin 100mg mane (recommenced post-operatively)
Ramipril 5mg mane
Panadeine Forte (co-codamol) 2 qid prn

Nursing Management and Progress:

Daily dressing’s surgery incision site
Range of motion, stretching and strengthening exercises
Occupational therapy
Staples to be removed in two wks (21/9)
Also, follow-up FBE and UEC tests at City Hospital Clinic

Assessment:
Good mobility post-operation
Weight-bearing with use of wheelie-walker; walks length of ward
Without difficulty
Post-operative disorientation re time and place during recovery,
Possible relating to anaesthetic - continued observation
Recommended
Dropped Hb post-operatively (to 72) requiring transfusion of 3 units
Packed red blood cells; Hb stable (112) on discharge - ongoing
Monitoring required for anaemia

Discharge Plan:
Monitor medications (Panadeine Forte)
Preserve skin integrity
Continue exercise program
Equipment required: wheelie-walker, wedge pillow, toilet raiser.
Hospital to provide walker and pillow. Hospital social worker
organised 2-wk hire of raiser from local medical supplier.

WRITING TASK:

Using the information given in the case notes, write a letter to Ms. Samantha Bruin, Senior Nurse at Greywalls Nursing
Home, 27 Station Road, Greywalls, who will be responsible for Mr Baker's continued care at the Nursing Home.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 9

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

You are a Nurse at Newtown Medical Clinic. Mr Barry Jones is a regular patient of yours.

Patient: Mr Barry Jones

54 Woods Street
Newtown

D.O.B: 01.04.1972 (age 44)

Reason for presenting: Wants to return to work after back injury-employer supportive.

Medical history: 1984-Appendix removed.

Family and social history: Married-Susan Jones, 3 children.

Work- drives forklift in a large warehouse (requires prolonged sitting / occasional
heavy lifting).

Current medications: Naproxen (non-steroidalant-intlammatory drug)

Carisoprodol (muscle relaxant,blocks pain)

Condition history:

21/03/18

● Presentation: Hurt back liftng heavy box of floor at work.

● 4 days since initial strain.

● No rest, pain worsening

● X-ray: No disc problems.

Diagnosis: Lower back strain- severe.

Treatment: Exercise: walking daily -gradual increase time and distance.

● Referral to physio.

● Prescription- naproxen and carisoprodol.

● 30 days off work and certificate to give to employer.

● To review In 30 days.

18/04/15

Progress:

● Back: Still sore.

● Moving very stiffly.

● Physio: Exercises "very painful" but Pt is compliant.

● Exercise: Walking up to 10 min per day.

● Treatment: Extended time off work - 30 days. To review in 30 days.

19/05/15

● Progress:

● Back: recovering well-still in pain.

● Still moving very stiffly.

● Physio: Attending regular appointments.

● Exercise: Walking 15-20 mins per day - 'very tiring.'

● Treatment

● Increase Naproxen dose.

● Extended time off work - 30 days. To review in 30 days.

20/06/15

● Progress:

● Back: Recovering well - still in pain.

● Moving stiffly but increase ROM.

● Pain increase after 20-30 mins of sitting or lying down.

● Physio: Still attending appointments.

● Exercise: Walking 30 mins per day-’tiring’.

● Discussions:

● Pt bored, discouraged, wants to return to work. Restless.

TREATMENT

● Return to work if no lifting & with regular breaks.

● Letter to OT requesting assessment of workplace (advise on duties Pt can

porform, etc.).

WRITING TASK:

Using the information in the case notes, write a letter to Ms Jane Graham, an Ocupational Therapist,detaling Mr Jones'
situation and requesting an assessment of his workplace. Address the letter to Mr Jane Graham, Newtown Occupational
Therapy, 10 Johnston St, Newtown.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 10

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Ms. Bethany Tailor is a 35-year-old patient in the psychiatric ward where you are working as a doctor or nurse.

Patient Details:
Ms Bethany Tailor

Next of Kin: Henry Tailor (father, 65) and Barbara Tailor (mother, 58)

Admission date:01 March 2018

Discharge date:18 March 2018

Diagnosis:Schizophrenia

Past medical history:

Hypertension secondary to fibromuscular dysplasia

Primary hypothyroidism -Levothyroxine 88 mcg daily

Social background:

Unemployed, on disability allowance for schizophrenia.

History of polysubstance abuse, mainly cocaine and alcohol.
Last used cocaine : 28/02/18

Admission 01/03/2018:
Patient self-admitted : decompensated schizophrenia

Medical background:

● Not compliant with medications.

● Admitted for auditory command hallucinations telling patient to harm self.

● Visual hallucinations - shadow figures with grinning faces.
● Delusion - personal connections to various political leaders.
● 01/03/2018-agitated and aggressive, responding to internal stimuli with thought
blocking and latency.
● Commenced antipsychotic meds (Rispoderone).
● 10/03/2018: Patient ceased reporting auditory or visual - hallucinations.
● Less disorganised thinking. No signs of thought blocking or latency.
● Able to minimise delusions and focus on activities of daily living.

Nursing management:

● Assess for objective signs of psychosis.

● Redirect patient from delusions.

● Ensure medical compliance.

● Help maintain behavioural control, provide therapy if possible.

Assessment:

Good progress, chronic mental illness, can decompensate if not on medications or abusing
substances. Insight good, judgment fair.

Discharge plan:

 Discharge on Risperidone 4g nightly by mouth.

 Risperidone 1 milligram available twice daily prn for agitation or psychosis.

 Discharge back to apartment with follow-up at Proudhurst Mental health clinic.

WRITING TASK:

Using the information given in the case notes, write a letter to the receiving nurse at the long-term care home where
the patient will go following discharge, Mari DiCoccio,Proudhurst Mental Health Home, 231 Brightfield
Avenue,Proudhurst

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 11

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

You are a Nurse where Toby and his mother came for treatment.

Patient name: Toby Philip (10days)

DOB: 30/10/2019

Mother: Mrs Maria Philip, 28years, G1 P1

Father: Mr Philip Georse, Business man

History:

● Born on 30/10/2019 via an emergency LSCS.

● Birth weight- 3.8kg, APGAR-4
● Gastric reflux increase

01.11.2019

● Weight 3.5kg. APGAR-4

● Difficulty in breast feeding
● Educated to mother regarding feeding techniques

02.11.2019

● Mother is depressed due to feeding ditficulty

● Advice given regarding supplementary bottle feed

03.11.2019

● Both discharged
● Medications: Amoxicillyn,50Omg for 7days
● Phototherapy for 3days
● No heavy lifting and vigorous exercises for 6 weeks.
09/11/2019

● Toby brought to ED by mother complaining of increased gastric reflux , vomitting.

● Subjective: Increased gastric reflux, vomiting pain while feeding and wound site pain
while baby latch on.
● Objective: Baby has no active problem
● Mother wound healing well, but nipples found lacerated and painful

Diagnosis:

● Mother-Breast nipple infection

● Baby- No issues

Medications: Flucanazole cream, Tab: Naproxin and Tab: Panadol.

Discharge plan: Community Nurse to monitor Baby's development and weekly Mother's health and post -
operative activities with breast feeding techniques.

WRITING TASK:

Write a letter to the Community health Nurse explaining the care required for Toby and Mrs Philip. Address the letter
to Ms Margaret Sol, Community Health Nurse.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 12

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Mr Lionel Ramamurthy is a 63-year-old, is a patient in the medical ward of which you are Charge Nurse.

Hospital: Newtown Public Hospital, 41 Main Street, Newtown

Patient details:

Name: Lionel Ramamurthy (Mr)

Marital status: Widowed-spouce dec. 6 months.

Residence: Community Retirement Home, Newtown.

Next of kin:
Jake, engineer (37, married, 3 children <10)
Sean, teacher (30, married, working overseas, 1 infant

Admission date: 04 february 2014

Discharge date: 11 February 2014

Diagnosis: Pneumonia

Past medical history:

 Osteoarthritis (mainly fingers) - Voltaren

 Eyesight decreased due to cataracts removed 16 mths ago - needs check-up.

Social background:

Retired school teacher (history, maths).

Financially independent. Lonely since wife died.
Weight loss - associated with poor diet.
Medical background:

 Admitted with pneumonia - acute shortness of breath (SOB), inspiratory and expiratory
wheezing, persistent cough (-chest & abdominal pain), fever, rigors,sleeplessness,
generalised ache.
 On admission - mobilising with pick-up frame, assist with ADLS
(e.g., showering, dressing, etc.), very weak, ambulating only short distances with
increasing shortness of breath on exertion (SOBOE).

Medical progress:

Afebrile.
Inflammatory markers back to normal.
Slow but independent walk & shower/toilet.
Dry cough, some chest & abdom. pain.
Weight gain post r/v by dietitian.

Nursing management:

Encourage oral fluids, proper nutrition.

Ambulant as per physio r/w
Encourage chest physio (deep breathing & coughing exercises).
Sitting preferred to lying down to ensure postural drainage.

Assessment: Good progress overall.

Discharge plan: Paracetamol if necessary for chest/abdom. pain.

Keep warm.
Good nutrition -increase fluids, eggs, fruit, veg (needs help monitoring diet).

WRITING TASK:

Using the information given in the case notes, write a discharge letter to Ms Georgine Ponsford, Resident
Community Nurse at the Community Retirement Home, 103 Light Street, Newtown. This letter will accompany
Mr Ramamurthy back to the retirement home upon his discharge tomorrow.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 13

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Evony Bellard is a 5years old boy who is the son of one of your newly referred patient in the community mental
health centre where you are a mental health case manager.

Date of birth: 15 April 2006

Place of birth: Sydney Children's Hospital, Sydney

School year: Kindergarten

Religion &ethnicity : Catholic & both parents Australian born Hungarian

Mother's name: Elizabeth Bellard

Mother's community admission date: 16 May 2011

Diagnosis: Mother v- Major depression with psychotic features

Son -? Early onset separation anxiety disorder

Family/psychosocial:  Elizabeth suffered PND — depressed since

 She sometimes hears voices calling her and sees 'men' running
around her house — nil serious psychosis in functional terms.

 Recently 1 st psych admission for 6/52 after high lethality DSH

attempt.

 Evonypsychological status ok until DSH and hospitalisation;

after this +++ signs of separation anxiety

 Father is self employed and works long hours 7/7. Rarely sees
Evony& dismissive of Evony's emotional states, 'He's like a bloody girl now!' he told us.

 Evony loves soccer and playing with his dog, 'Rusty'.EczemaSerous

otitis medla — required grommets at 18 months.Hearing NAD now.

Medication : Nil meds

Case management care and progress:

 Elizabeth new to our area (from Parramatta) & referred to us post D/C from
Bankstown MH inpatient unit 2/52 ago
 We will provide her with long term MH case management.
 Evony now I) cries and panics whenever Mum leaves his sight 2) Socially
withdrawn & refusing to attend kindergarten 3) insomnia & nightmares 4)
preoccupied with Mum's daily activities &that she might leave him again.
 This ↑ greatly pressure on Elizabeth when her MH is already fragile.
 Father, John, uninterested in meeting in person or discussing problems in detail.
 Evony attended initial assessment with Elizabeth and separation anxiety behaviour
very obvious

Referral plan: Referral to early childhood mental health team for assessment and management of
Evony's early onset separation anxiety disorder.

WRITING TASK:

You are the Case Manager caring for Evony bellard's depressed mother but due to his psychological issues
need to write a referral for him to John Dyer, Clinical Psychologist on the Bankstown early childhood
mental health team at Bankstown Hospital.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 14

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

You are the school nurse at a Toohey Point Primary State School

Today’s Date: 07/03/2012

Patient Details: Alison Cooper

Year, 5 student
DOB: 14/6/2002
Height: .138cm
Weight: 40 kg Overweight for her age
Eczema outbreaks on hands and mild asthma — has ventolin inhaler
No other significant illnesses
Youngest in her class

Social History:
Father died in motor accident 1 8 months ago.
Lives with mother, a bank manager, working full time
Middle child-brother, Simon, aged 7 and sister, Lisa, aged 12
Paternal grandmother lives near school - provides after school and holiday care -
looks after children if unwell

School Medical Record :

Regular absences from school dating back to time of father ’s death
Year 2: 3 days
Year 3: 4 days
Year 4: 10 days
Year 5: 8 days in first term

School Health Centre Records:

2012
February 8: Complained of headache. Gave paracetemol, rested and returned to
class.
Noted eczema on hands red and weepy - has ointment at home.
February 16: Complained of stomach ache. Called grandmother for pick up.
February 22: Complained of aching legs. Called grandmother for pick up.

March 4: Complained of headache. Gave parcetemol, rested I hour, still had

headache.Called grandmother for pickup.
March 6: Feeling nauseous. - eczema on hands red and weepy.
Called grandmother for pick up.

2011

February 15: Complained of toothache. Called grandmother for pick up.

April 4: Complained of headache. Gave paracctcmol - rcstcd I hour.
May 14: Headache, eczema on hands red and weepy, rested I hour not better called
grandmother for pick up.
July 25: Feeling nauseous. Called grandmother for pick up.
August 16: Slight fever. Called grandmother for pick-up.
September 22: Feeling unwell. Eczema irritating. Called grandmother for pick up.
October 23: Complained of stomach ache. Rested I hour, returned to class.
November 27: Complained of headache. Gave paracetemol, rested 30 minutes.

Social History:
Alison started school well but since Grade 3 has had trouble concentrating - rarely
participates in class activities unless encouraged, Avoids sporting activities -
standard of her school work is declining. Has few friends and is often teased by her
classmates about eczema & weight. Embarrassed about hands which don't
seem to be responding well to ointment suggested by chemist.

Mother was contacted by class teacher regarding these issues. Says Alison is also
becoming withdrawn.at home. Alison was very close to her father. — often talks to
her about him and cries because she misses Yim. Seeks comfort in food like chips
and cakes after school.

Plan: Refer her to the school psychologist to find out whether Alison has
underlying grief related or other psychological problems.

WRITING TASK:
Using the information in the case notes, write a letter to refer this girl .to the school psychologist, Barnaby Webster, to
assess her. Outline the purpose of the referral. Provide details of significant factors which will assist the psychologist to
make this assessment.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 15

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Today's date: 10/07/09

Betty Olsen is a resident at the Golden Pond Retirement Village. She needs urgent admission to hospital. You are the
night nurse looking after her.
Patient Details:
 Address: Golden Pond Retirement Village
 83 Waterford Rd, Annerley, 4101
 Phone: (07) 3441 3257
 Date of Birth: 29/01/1926
 Marital Status: Widowed
 Country of birth: Australia

Social History:
 Moved to Retirement Village following the death of husband in December 2007.
 Next of kin: Son, Nicholas Olsen, 53 Palmer Street, Warwick 4370,Ph (07) 4693 6552
 Normally alert and orientated. Enjoys bridge, bingo and reading.
Medical History:
 Hypothyroidism since 1997
 Hypertension since 2003
 Glaucoma since 2004
 Allergic to penicillin
Prescription Medications
 Karvea 150mg 1 daily
 Oroxine 0.1mg 1 daily am
 Timoptol Eye Drops 0.5% 1 drop each eye am and pm
 Normison 10 mg as required
Non prescription Medication
 Golden Glow Glucosamine Tablet- 1 with breakfast for arthritis
 Vitamin C Complex Sustained Release — 1 with breakfast
Mobility / Aids
 Independent with walking stick. Arthritis in hands.
 Wears glasses
 Continence: Requires continence pad

Recent Nursing Notes

16/05/12: Flu Vaccination
29/06/09 : Complaining of indigestion following evening meal.
Settledwith Mylanta
07/07/09: Unable to sleep — aches in shoulder. Settled following 2 Panadol and 1 Normison
09/07/09: Requested Mylanta for indigestion. Panadol for shoulder pain — slept poorly
10/07/09 am: Tired and feeling generally weak. BP 180/95. Confined to bed. GP called and will
visit 11/7/12 after surgery.
10/07/09 pm
 Didn't eat evening meal. says felt slightly nauseous. Trouble sleeping, complaining of
shoulder and neck pain. BP 175/95 Given 1 Normison 2 Panadol at 10pm
 Rechecked 10.45pm — Distressed, pale and sweaty, complaining of persistent chest pain,
 BP 190/100. Ambulance called and patient transferred.

WRITING TASK:
Write a letter for the admitting doctor of the spirit hospital emergency department. Give the recent history of
events and also the patients past medical history and condition

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 16

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

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

Patient:Joshua Vance
Gender:Male
DOB:17/11/13
Normal vaginal delivery at 38 weeks' gestation
No perinatal or neonatal complications
Birth weight 3250g
Parents:Pamela Vance (mother) - first child
Stewart Vance (father)
31/12/13: Routine 6-week baby check

History: Mother concerned regarding bowel actions: only one bowel action every 3 days:
stools a little hard. Is breastfed. Making wet nappies, feeding well, demand
feeding, sleeping through the night.

Examination: 6-week check-good tone, hands & feet normal, hips normal, genitalia male, no
herniae, no evidence of spina bifida occulta, abdominal/chest/heart exam normal,
fontanelles normal,red reflex present, nose & ears normal, palate intact. Perianal
examination normal, no fissures. Weight 3900g

Assessment: Mild constipation in breastfed baby, otherwise normal 6-week check.

Plan: Reassurance - bowel habit variable in infants & can often settle. Try expressing milk
from one feed a day & giving it in a bottle with some water (boiled & cooled to body
temp)
Review 2/52

13/01/14
History: Still hard stool every 3 days. Now waking up crying, pulling legs up to chest every half
hour throughout the night. Pulis away from breast halfway through feeds. No vomiting.
No fever. No respiratory symptoms. Making wet nappies.

Examination: Hydration status normal

Abdominal examination: hard faeces.
Periar examination normal, no fissures.
Weight 4200g.

Assessment: Constipation no better. Has put on weight.

Plan: Trial of Coloxyl drops daily. Express milk from two feeds a day & give it in a bottle
with some water (boiled & cooled to body temp).
Review 1/52

18/01/14
History: Has not passed a bowel action for last 5 days. Refusing feeds. No wet nappies today.
Cornit x 1. No fever.

Examination: Irritable 8%-week-old.

Mildly dehydrated dry mucous membranes, tissue turgor & capillary return normal: P 120;
RR 30.
Abdominal examination: mild generalised tenderness, no guarding or rebound
tenderness.
Weight 4100g.
Assessment: Constipation & mild dehydration. Refusing leeds.

Plan: Needs review at Children's Hospital ED for rehydration & further assessment regarding
Constipation.

WRITING TASK:
Using the information given in the case notes, write a letter of referral to the Admitting Officer at the Emergency
Department Children's Hospital, Newtown.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 17

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
You are a doctor at Bayview Medical clinic. You are assessing a 22-year-old man who has worsening asthma.
PATIENT DETAILS:
Name: Mr Zach Foster
DOB: 25/10/91 (Age 22)
Address: 77 Creek Road, Bayview
Medical History: Asthma, since age three – problematic at times, 2
previous hospital admissions (most recent- 3 years ago)
Eczema
Smoker – 4 years, 10-20/day
Allergies: Cats, Hayfever.
Medications: Ventolin prn
Pulmicort 200 mcg one puff bd
Family history: Sister (age 18) – asthma
Social history: Builder, single
Presenting complaints: For last 3/52 (3 weeks):
- SOB – when playing sport.
- Wheeze & cough – waking patient at night.
- Increase use of Ventolin for symptoms.

Treatment Record:
11.10.14
Subjective: Preventative inhaler(Pulmicort): compliance
unclear: claims to use inhaler some of the time.
Burning sensation in lower part of the chest
after meals- consistent with gastro-oesophageal
reflux disease (GORD).
Objective: Chest clear.
Peak flow 500L/min.
Abdomen lax and non-tender.
Tests: CXR, FBE
Diagnosis: Unstable asthma, possible trigger GORD
Treatment: -Ensure compliance with Pulmicort.
-Trial of pantoprazole (PPI) for GORD.
-Discussion about smoking cessation.
-Review 1/52.
18.10.14
Review: Still smoking.
Non-compliant with Pulmicort- forgets to
take it.
PPI – effective, nil side effects.
Test result: CXR- clear
FBE- normal

Treatment: -Use pantoprazole for another 7/52 (7 weeks) then review.

-Discussion about Pulmicort missed dosage-

take as soon as remember, then back to normal, do not double dose.

-Advice on smoking cessation (e.g. nicotine

patch, information brochures, support Groups, etc.)

-Continue current management: refer to

respiratory specialist for lung function

and advice about asthma management

-Review appointment 7/52.

WRITING TASK:

Using the information given in the case notes, write a letter of referral to Dr Willliams , a respiratory specialist, for
further management of Mr Foster’s asthma.Address the letter to Dr Tanya Williams, Respiratory Specialist, Bayview
Private Hospital, 81 Canyon Road, Bayview.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 18

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient: Mrs Maximillan (DOB: 21/11/1941) is a 72-year-old
woman who is being discharged from hospital to a
rehabilitation centre.

Marital status: Widowed (recently)

Family: 2 children- son lives locally and daughter interstate.

Social: Lives alone in 2-bedroom house with stairs to entrance.

Son (married,2 children- 6 & 8) lives 20 minutes away
-visits twice a week.
Enjoys gardening.

Medications: Anti-hypertensive (Ramipril) 10 mg.

Admission date: 04/02/14 at 1200 hours.

Fainted getting out of bed and fell to the floor.
Found by son two hours later.

Diagnosis: X-ray—fractured left neck of femur (#L-NOF) post fall

Treatment: Left hemiarthroplasty (Austin Moore hip replacement);

general anaesthesia, incision closed with staples &
2x Exudrain.

Post operation: Intravenous (IV) therapy: 3 unit packed cells- with IV

Lasix (furosemide) 40 mg therapy after each unit
(intraoperative & post op)
Maintained IV therapy for 36 hours, then ceased and
oral fluids encouraged, intravenous antibiotics (IVABs)
-Cephazolin 1g r.d.s for 3/7 –course completed.
Vital signs: BP hypotensive- 90/60, other obs, WNL.
Anti-hypertensive medication reviewed by Dr- Dose
now Ramipril 5mg daily.

Pain management: Patient-controlled analgesia (PCA) with Fentanyl for

36 hours- pain relief- satisfactory. Commenced oral
analgesia 36 hours post op-Panadeine or Panadol
4/24 prn. Max 4 doses/24 hours.
Wound management: Dressing-
Total of 600 ml haemoserous fluid discharge from
Exudrains over 24 hours. Drain tubes removed 48 hours
post op (Day 2). Alternate staples removed day 5 and
dressing changed.

Mobility and activities of daily living (ADLs):

Day 2 Sitting out of bed (SOOB) short periods, full assistance

Day 3 Mobilising with pick-up frame (PUF) & 2-person assist

Day 4 Uneventful

Day 5 Mobilising short distances with PUF & 1-person assist.

Abduction pillow when resting in bed (RIB)
Anti-embolic stockings in situ for 14 days.
ADLs- full assistance.

Day 6 Uneventful day.

Preparing for discharge.

Discharge Plan:

Day 7(1100 hours) Discharge to the rehabilitation centre.

Discharge medications- Ramipril 5 mg daily,
Paracetamol 1 g qid prn.
Family to be notified of transfer
Hospital transport arranged for 1100 hours.

Day 8 Repeat check of hemoglobin (hb) levels.

Monitor BP b.d., for 3/7, due to adjustment in
anti-hypertensive meds.
Assess for rehab therapy (inpatient).

Day 10 Removal of remaining staples, wound can remain

exposed afterwards.

WRITING TASK:
Using the information given in the case notes, write a discharge letter to the Nursing Unit Manager, the Rehabilitation
Centre, Waterford.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 19

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient: Mr George Poulos is a 45-year-old man who has hurt his
back. He presented at your general practice surgery for
the first time in late june.

21/06/14
Subjective: Severe lower back pain of two days duration:
Two days ago at home lifting logs ( approx weight
20-30 kg) from ground into wheelbarrow.
Action: bending, lifting and rotation.
Sudden severe pain- mid lower back. Thought he felt a
click, was locked in semi-flexed position, almost
impossible to walk. Wife helped him into house & bed.
Took 2x Panadeine Forte, repeated 4 hours later.
Disturbed sleep
Pain only low back, no radiation to thighs.
Yesterday pain less severe,able to ambulate around
house. Today again pain less severe.

Patient History: Stockbroker- 45 y.o.

Married- 3 children secondary school, 1 primary school
App: Good. Diet irregular.
Bowels: Normal. Diarrhoea if stressed.
Mict: Normal
Wt: Varies- BMI 27.
Sex: Often too tired.
Exercise: Nil
Tobacco: 25/day
Alcohol: Frequently 10+ to 15+ std drinks/day.

Allergies: Pethidine, penicillins, radiographic contrast agent

(unspecified)?? Iodine.

Family History: No Ca bowel, no diabetes, no cardiovascular.

HPI: Head injury (football) approx 15 yrs ago.
MRI brain: NAD.
Reacted to contrast medium.

Objective: Full examination:

CVS, RS, RES, CNS: NAD.
P 68bpm reg. BP 135/80.
Musculo-skeletal: stands erect. No scoliosis.
Loss of lumbar lordosis.
Lumbar spine: Flexion fingertips to patella.
Expression of pain. Extension limited by pain.
Lateral flexion: L & R full.
Rotation: L & R full.
No sensory loss.
Reflexes: Patellar and ankle L+ R+
SLR (straight leg raise ):L 90 R 90

Plan: Take time off work. Analgesia: paracetamol

500mg 2x 4 hourly max 8 in 24 hours or
Panadeine Forte , or 1 of each. Warned – risk
of constipation with Codeine. Review 1 week.

26/06/14 Has now developed pain which extends down

back of R thigh, lateral calf & into dorsum of foot.

Objective: Examination: As before except that now lumbar

Flexion limited to fingers to mild thigh and
SLR: L 85 R 60. Review 1 week.

05/07/14 Pain worse.

Almost immobile. Severe pain down R leg.
Tingling in R calf.

Objective: Examination: lumbar flexion almost nil.

Other movts more restricted by pain.
SLR: L 70 R 50.
Loss of light touch sensation lateral distal calf
& plantar aspect of foot.
Loss of R ankle reflex.
Diagnosis: low back pain, probably discogenic,
with radiculopathy.
Refer to neurosurgeon & request that the
neurosurgeon order an MRI and provide advice
regarding the possibility of surgery.

WRITING TASK:
Using the information given in the case notes ,write a letter of referral to Dr B White, Neurosurgeon, City Hospital,
Newtown.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 20

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Your long term patient, Mrs Welshman, has attended your GP surgery with her daughter. Both are concerned about Mrs
Welshman’s memory.

Patient: Mrs Patricia Welshman (DOB: 28/03/1930)

Address: 24 Kenneth St, Newtown

Marital status: Widowed,5 adult children

Next of kin: Christine- daughter

Diagnosis: Osteoporosis. Dementia (? early stage Alzheimer’s)

Social background: Widowed 40 years. Lives alone, children within

10 km radius.

Medication: OsteVit-D 1000IU, atorvaststin (Lipitor) 20 mg

mane, ibuprofen (Brufen) 200 mg prn, metoprolol
(Metrol) 100mg b.d., paracetamol (Panadol)
500mg prn.

Past Medical History:

2007-2013 Regular GP visits to this clinic, Pathology, BP-stable

19 June 2014 Fall- bruised nose only, X-ray—NAD. Will begin to

take it easy, slow down.

27 July 2014 Occupational Therapist (OT) home assessment:

Evaluated shower rails, ramp. Bed ok. Review
4-6 months. Discussed shower with OT. All ok.
Shower every other day to avoid falls.
Community Support: Home care provided by local
Council, 1/fortnight.

14 December 2014 BP 145/85

Pathology: FBE, U&Es, LFTs- all NAD.

Lipids: Total cholesterol 4.8mmol/L (<5.5)
HDL cholesterol 1.4mmol/L (0.9-2.2)
*LDL cholesterol 2.9mmol/L (< 2.0 )
Triglycerides 1.1mmol/L (0.5-2.0)
LDL/HDL 2.1
ChoL/HDL 3.4
*Vitamin D <54 (60-160nmol/L)

Discussions: Spare scripts - ? not filling them or taking

medication regularly.
Assures me she is taking medication regularly.
Suggested Webster pack ( a folder used to store
medication on a weekly basis), reluctant,
promised to adhere to medication regime.
Rev 2 months, post-pathology.

13 February 2015

Pathology: FBE, U&Es, LFTs- all NAD

Lipids: Total cholesterol 5.3 mmol/L (<5.5)

HDL cholesterol 1.3mmol/L (0.9-2.2)
*LDL cholesterol 3.5mmol/L (< 2.0 )
Triglycerides 1.2mmol/L (0.5-2.0)
LDL/HDL 2.7
ChoL/HDL 4.1
*Vitamin D <20 (60-160nmol/L)

Discussions: BP 130/80 √ encouraged.

Vit D ↓, LDL ↑- agreed to use Webster pack.
Rev 2 months, post-pathology.

19 April 2015 BP 130/70, Vit √ & Lipids √

Medication sorted
Daughter with Pt, both want to discuss
memory issues.
Poor memory noted ++, e.g., forgetting hair
dresser, dinner engagements, missing social
events. Behavioural changes, decision-making
Issues. Family concerned.

Mini memory assessment:

Poor short-term memory, day & date-several
attempts, no result. Month- 3 attempts.
Confirmed the year correctly. Quite worried.
Requested further assessment.
Family history of Alzheimer’s.
Asked about dementia-explained difference
b/w Alzheimer’s (disease- ↑amyloids in brain)
and dementia (symptom). Alzheimer’s-
common cause of dementia.
More assessments before diagnosis. Referred
→ Memory Clinic. Rev, post-assessment.
WRITING TASK:
Using the information given in the case notes, write a letter of referral to Dr Jones at the Newton Memory Clinic, 400
Rail Rd, Newtown, to provide him with your brief assessment and request full memory assessment and diagnosis.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 21

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
You are Sarina Chai, a registered nurse at the Royal Brisbane and Women s Hospital (RBWH). Maeve Greerson is a
patient in your care.

Patient Details:
Name: Maeve Greerson
Address: Unit 6. 45 Walter St. Holland Paik 4121
Phone: (07) 3942 1658
Date of Birth: 9 October 1951
Country of birth: Australia

Social History- Widowed, no children.

Next of kin: Brian Hewson (brother) 67 Bridge Street. Toowoomba Ph (07) 4693 6558.
Family and patient have requested no further treatments be used, other than those necessary
to maintain comfort and dignity and to relieve pain.

Medical History
March 2009: Laparotomy. Found to have cancer of the lower intestine with wide spread
metastases.
Partial bowel resection and colostomy performed.
April 2009: 6 weeks radiation therapy for relief of symptoms.
Prognosis: Not expected to survive more than 3-4 months.

24/07/09
Admitted to RBWH following collapse at home. Dehydration, nausea, severe pain IV
fluids commenced - transdermal patch for pain, light low fibre foods only.

25/07/09.
Nausea less severe- tolerating jelly, low fat yoghurt
Occasional break through pain - pain medication increased Severe oedema of ankles and
lower legs, bladder incontinence.
Does not feel she will recover sufficiently to leave hospital. Requests visit from Social
Worker

28/07/09
Generally pain free, very weak and disorientated at times. Rejecting solids but able to
tolerate fluids.- requests apple juice and lemonade.
Social Worker contacted brother. Advises place available at Glen Haven Hospice in
Toowoomba from 1 August 2008.

01/08/09
Transferred via ambulance to Glen Haven Hospice

WRITING TASK:
Using the information in the case notes, write a letter to the Director of Nursing, Glen Haven Palliative Care Hospice,

971 Arthur Street, Twowoomba, introducing this patient.

Using the relevant case notes, give her background, medical history and treatment required.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 22

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
You are the nurse in a Community Health Centre. A patient you have been monitoring is moving to another city to live
with his daughter

PATIENT DETAILS:
Name: Mr Peter Dunbar
DOB: 18.03.1932

Current medication:
Metformin 500mg t.d.s (oral hypoglycemic)
Ramipril 5mg daily (anti-hypertensive, ACE inhibitor) — for hypertension
Warfarin variable 3-5mg (anti-coagulant)
Sotalol 40mg daily( beta blocker)

Treatment record:

September 2017: Diagnosed with type 2 diabetes August 2016. Fasting (BSL) = 9
GP recommended dietary management: low-fat, low-sugar, calorie restrictions;
Limit alcohol . Increase Exercises
Pt. lives at home with wife. Wife cooks. Wife managing dietary requirements, but
pt. likes 2-3 glasses wine with meals

December 2017: Wife deceased. Pt depressed/grieving. Referred back to GP for

monitoring/medicating
Fasting BSL= 9. Pt. non-compliant with diet. Excessive fat, salt, sugar, alcohol
(wine/beer)

March 2018: GP prescribed metformin (oral hypoglycemic agent). Now Pt. cooking for self
non-compliant with diet. Non-compliant with medications. Blames poor memory.
Pt appears unmotivated. Resents having to take medications,‘ always been healthy'
Takes medication intermittently; encouraged to take regularly
Educated regarding need for regular medications and potential adverse effects of
intermittent dosing.
Discussed strategies of memory aids

June 2018: Pt. hospitalized (City Hospital, Newtown) with myocardial infarction (MI)
following
retrosternal pain, nausea/vomiting, dizziness, sweating. Confirmed by ECG.
Treatment: Aspirin, streptokinase infusion. Prescribed ramipril 5mg daily.
Diagnosed with Atrial fibrillation post MI — commenced sotalol and warfarin.
June-Aug 2018: Pt. attended twice weekly

October 2018: Pt now with a stick. Signs of diabetic neuropathy. Poor exercise tolerance.
Restricted mobility
Non-compliance with diet continues. Still self-catering. Discussed alternatives.
e.g., community based meal delivery service; moving in with adult children
(son/daughter); retirement village.
Had respiratory infection 2 wks ago. Amoxicillin prescribed. Pt. discontinued all
other medications as felt unwell. Resumed medications but still only taking
intermittently
Again provided education re. importance of adherence to drug regimen.

22 January 2019: Pt attended with daughter. Pt. moving to Centreville to live with daughter & her
husband.
Daughter will cook — requires education re. Pt. needs & monitoring.
Daughter advices that pt. resistant to dietary alterations and medication regimen.
Still misses or doubles dose- all medication. Refuses to reduce salt, sugar, alcohol,
fatty food
Patient continues to require monitoring and encouragement.
Letter to transfer the patient to the care of the community health nurse in
Centreville, where the pt. is moving to live with his daughter.

WRITING TASK:
Using this information given in the case note, write a letter to the Community Health Nurse in Centreville, outlining
the patient’s history and requesting ongoing monitoring. Address the letter to the Community Health Nurse, Eastern
Community Health Centre, 456 East Street, Centreville.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 23

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Andy Williams is a 65-year-old man who presented on 15/06/2018 at the clinic in which you work

Clinic: Eastern Medical Centre, Melbourne 3002

Patient: Andy Willians

Age: 65

Height: 183cm

BMI: 46.6Kg/m2

Social History:
Radiologist
Recently divorced
Depressed about financial problems/ stressful changes at work.
Partner does all cooking and shopping

Family history:
Family history positive for obesity ( father and older sister obese )
Mother healthy; normal weight
Grandfather – gout

Medical history:
Type 2 diabetes
Hypertension
Gout
Sleep apnea
BG levels (morning): 100 -130 mg/dl
Hemoglobin A1c (AIC) level: 6.1%, ( WNL)
Triglyceride: 201 mg/dl
Serum insulin: 19 ulU/ml

Medications:
30 and 70 units NPH insulin before breakfast/before or after dinner
850 mg metformin twice daily
Atorvastatin 10mg
Lisinopril, nifedipine
Allopurginol
Weight history:
Childhood obesity
Reports gaining weight every decade
At highest adult weight
Participated in commercial and medical weight-loss programs
Regained weight within months of discontinuing programs.
Consulted registered dietician
Reluctant to consider weight-loss surgery in past, concerned
about complications from bariatric surgery

Diet/Food intake:
3 meals/day
Dinner, his largest meal of the day, 7:30 p.m.
Reports binge eating triggered by stress – ‘maybe once a month’

Plan:
Pt concerned about health/wants to get life under control
Wants to learn about surgical options.
Partner encouraging
Referral to The Weight Centre for evaluation of obesity,
Recommendations for treatment
Will consider surgery if The Weight Centre recommends

WRITING TASK:
Using the information given in the case notes, write a referral letter to sureon, Dr D Kurac, at The Weight
Centre, 393 Victorian Road, Richmond, Melbourne.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 24

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient details
• Name: Mrs Maria .James
• Age:56
• Address : 956 Addison St, perth
• Admission Date: 15/04/2014
• Discharged Date: 18/04/2014
• Diagnosis: chronic kidney disease and bronchial asthma
Medical History
Reason for admission:
• Fever, breathing difficulty’ for 2 days, tiredness for 1 week, vomiting 5 times.
Past Medical History'
• Hypertension -2007 (Lisinopril)
• Diabetes mellitus - 2OOi(Glyciphagesoomg b d)
• ST'EMI - 2005 (underwent PTCA)
• Bronchial asthma - Since 2003
• Osteoarthritis - Since 2007
• Gastritis - Diagnosed in 2008. Notyet controlled.
Social History
• Family - Lives with his husband in a rented house
• Mother-Hypertension
• Husband- diabetes mellitus type 2
• Martha, Her neighbour, is very’ friendly, visits her in hospital daily.
• Habit of consuming Alcohol in excess (for the past 20 years)
• Cigarette smoker
Medical Management
• Lasix 100 mg IV Stat
• BudecortandDuolinNebulization
• Oxygen Administration
• Commenced treatment on Corticosteroids, Immunomodulators and methylxanthines
On admission,
• HB-6g/dL
• RBS-6o5mg/dL
• Urea - 105 mg/dL
• Creatinine - 5.4 mg/dL
• Calcium-6 mg/dL
• Phosphorus- lOmg/dL
• Potassium - 9mEq/L
• Phosphorus- lOmg/dL
• Potassium – gmEq/L
• X Ray - Pulmonary Edema
• Total cholesterol - 225 mg/dL
• CBC:6.5OomL
Nursing management
• Vital signs: BP - 200/100 mm og Hg, pulse 120/ mnt, respiration - 26/ mnt, temp - 100
• 2 unit packed cell transfused
• High Fowler’s Position recommended
• Chest physiotherapy and deep breathing exercises
16/04/ 2014 Assessment
• Bp -180/100 mm of hg, pulse -100, respiration - 24, temp - 99
• Pedal edema 3+
• Weight: 51kg
• Abdomen was protuberant
• Shortness of breath
• Advised chest physiotherapy and deep breathing exercises
17/04/ 2014 Assessment
• Bp -190/100 mm of hg, pulse -105, respiration - 22, temp- 99
• Breathing difficulty’ and advised to provide high fowler's position with oxygen therapy’
• Oliguria
• Efcorlin 100 mg
• Lasix 40 mg
• Gained 2 kg body weight
• Bowel pattern impaired. Now treated with laxatives.
18/04/2014 Assessment
• Bp - 200/100 mm of hg; Pulse - ico; Respiration - 20; Temp - 99
• Weight: 54kg
• Pitting edema 4+ (Pedal Oedema)
• Oliguria
• Melon a
• Need to continue same antihypertensive drugs and hypoglycaemic agents.
• Stool occult blood positive
. HB-7.2g/dL
• RBS-5iomg/dL
• Creatinine-5.2 mg/dL
• Potassium - 8mEq/L
• 1 unit packed cell transfused
• Discharge from the hospital
WRITING TASK:
Using the information given in the case notes, write a referral letter to the nephrologist, Dr Abraham John, Hyde
hospital, Adelaide St. Perth.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 25

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient: Name:Mr Michael Weir (DOB:20 September,1972)
Height:193cm
Background: smoker ,overweight
Married, 3children
Depression (Sertraline Hydrochloride since1992)
Not get time for exercise or relaxation
Active social life

PATIENT HISTORY:

29/06/2014
Subjective Data:Here for general Check up
reports feeling rundown, tiredness
Examination:Bp(110/80mmHg),HR-72b/min
BMI:28.9(wt:93.1kg)
Chest Clear
Skin:no suspicious lesions found
Tests: CBC,Cholesterol, lipids
PLAN- R/V in 1wk(discuss test results)

07/07/2014
Subjective: Here to receive results of blood tests
Still tired, feeling down,often complaints of left leg weakness
Examination: Bp(90/80),HR(79b/min)
Sertraline Hydrochloride- ongoing
BMI: 29.5(95.5kg)
Test Results: Cholesterol-6.37mmol/l
CBC-low;WBC-low,RBC-low,Hb&Hct: other results are in normal range.
Assessment/Plan: Repeat assessment of hypercholesterolaemia in 3months
Monitor general health-tirdness,depressed feelings
Suggested to make lifestyle changes (stop smoking, diet, exercise, recreation)
R/v in approx. 1month to assess general health, feelings of tiredness &feeling down.

09/08/2014
Subjective:complaints of dizziness and reports 2 recent blackouts (lasted for few minutes
each)
Feels stressed-busy at work, Mood up and down since last visit.
Reports tingling in hands, L leg still feels week,Breathless, occasional constipation, short
of energy
Has been trying to eat better and exercise more
Still smoking
Examination: BP(88/70mmhg), HR(76b/min)
BMI:28(93.7kg)
Chest clear
Loss of sensation on L&R hands
Refluxes: Diminished L patellar reflex
Test: Ordered Head and lumbar spinal computed tomography (try
To determine the causes of leg weakness and associated objective hyporefluxia(Central or
spinal)
To check spinal cyst,tumorsetc)
Assessment:? Multiple Sclerosis
Plan: Refer to Neurologist: full neurological assessment; ? Order MRI

WRITING TASK:
Using the information given in the case note ,write a letter to Dr M McLearn,Neurologist, Suit 3,67 The Crescent,
Newton.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 26

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient: Sally Mc Conville(Ms),aged 38

Occupation: Administrator

Marital Status: Single

Patient History: - Past history: asthma, hypertension, cholecystectomy, ankle fracture, depression,
non – smoker.
- Medications: ramipril- 2.5mg daily, paroxetine- 20 mg daily, fluticasone250-
2 puffs daily, Ventolin (salbutamol)- 2 puffs if required
- Allergies: nil

10/9/14
History: 2-day history of runny nose, cough productive of yellow sputum, slight fever,
wheezy, but not short of breath. Asthma usually well-controlled on
preventer (Fluticasone 250- 2 puffs daily)

Examination : Temperature 37.5, pulse 82, BP 120/80,respiratory rate 12, obvious nasal
Congestion, throat red, ears normal, no increased work of breathing, no
accessory muscle use, chest scattered wheeze, no crepitations.

Assessment: 1. Viral upper respiratory tract infection

2. Infective exacerbation of asthma

Treatment : Ventolin 2 puffs 4-hrly, continue preventer

Medical certificate for work
Review as required

12/9/14
History : Increasing shortness of breath & wheeze over last 24hrs, feeling feverish at times,
Minimal yellowy sputum, short of breath on minimal exertion

Examination: Temperature 38, pulse 95, BP 120/80, respiratory rate 16, throat red, ears normal,
Mildly increased work of breathing, chest-widespread wheeze, no crepitations.

Assessment: Infective exacerbation of asthma – symptoms worse.

Treatment: Amoxicillin 500mg 3 x daily, prednisolone 25mg daily x 3days

Continue 4- hrly Ventolin & preventer.
13/9/14
10:30am
History: More short of breath today despite prednisolone & antibiotics. Feeling feverish &
unwell .

Examinations: Short of breath at rest, respiratory rate 25, obvious accessory muscle use & increased
work of breathing, pulse 112, BP 100/65, temp 37.7,chest exam- widespread
wheeze, bibasal crepitations
Assessment: Acute asthma, ? pneumonia.

Treatment: Ventolin Nebules ( salbutamol) 5mg, review.

10:45am No improvement. Still obvious respiratory distress

Refer to Emergency Department for acute management and investigation
? pneumonia

WRITING TASK:
Using the information given in the case notes, write a letter of referral to the Admitting Officer at the Emergency
Department, Newtown Hospital.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 27

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
You are a registered Nurse at Royal Brisbane Hospital were Anthony Nutt is a patient in your care.
Today’s Date: 29|05|2017
Patient Name: Anthony Nutt
Age : 86 years
Next of kin: Son, Joseph Nutt

MEDICAL HISTORY:
 Breast cancer 20 years ago- right total mastectomy- didn’t receive adjuvant radiation,
chemotherapy,hormone therapy or medical follow up postoperatively
 Dementia
 Non smoker
 No known allergies
 Non drinker
Family History: ● Mother died of colon cancer

Social History:
 Retired 20 years ago
 Married- wife suffering from newly onset dementia
 One son- unmarried-lives 30 minutes away
Diagnosis: Recurrent Infiltrating ductal carcinoma of breast

23/05/2017
 Presented to ER with ulcerated hemorrhagingright anterior chest mass
 As per the patient developed a mass on his anterior chest wall -2 years ago
 Mass Increases in size began to ulcerate -bled in this morning- didn’t seek medical attention
until this morning
Objective:
 Temperature-97.4
 Pulse-80
 Saturation 100%
 BP- 162/88
 Right sided pedunculated 8cm×7cm mass with a cauliflower like appearance on chest
ulcerated, erythematosus, malodorous, with scant bleeding
 CBC – Normal
 HCT- 36.2
 Glucose 106
 Creatinine 1.72
 CT chest- a soft tissue mass in right chest wall measuring 5.2×2.75×5cm with posy- operative
changes of the axillary
 Incisional biopsy of right breast mass performed.

28//05/2017

 Pathology returned consistent with recurrent moderately differentiated duct carcinoma of the
breast with ulcerative of overlying epithelium-stage 3
 Pt. Not found to be suitable for chemotherapy or curative tr- oncology and geriatric evaluation
by doctors
 Pt.commencedin hormone therapy with tamoxifen 20 mg daily with one course of palliative
radiation.
 Family Meeting called- son verbalised concerns over mother’s state of health; son unable to
take care of father due to time off work- hospice care recommended for pt- - consensus
decision
 Pt.to be transferred to Queensland Aged care centre for hospice care- Bed available from
29/05/2017 for patient.
 It’s wife to be admitted to the same facility due to general dconditioningWhen bed is available;
Mother to live with son interim
Discharge Plan:
 Transfer to Aged care home
 Son will visit weekly
 Contact community social worker to notify son when bed available for Antony’s wife at
Queensland Aged Care home.

WRITING TASK:
Using information given in the case note, write a letter to Ms Carrie Andrews, Director of Nursing, Queensland Aged
care home, 52 Albert street, Brisbane 4101,introducing the patient.
In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 28

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Patient: Rosalind Hinds

Age: 6 days

Next of Kin: GenetteKeating(Mother)

Date of birth: 22 April 2011

Discharge Date: 28 April 2011

Diagnosis: Lowbirth weight & opioid dependence

Family: Will live with mother at maternal grandmother's house

Background: Mother {22 yrs) heroin dependent 2 yrs.

` Mother, son& and recently worked as a sex worker_

*Estranged from father of Rosalind as alleged domestic

violence towards her during pregnancy.

*Genette's mother supportive, first child

*Department of Community Services involved but approve

discharge living situation as long as with grandmother

Medical History and Medications:

See Dr's notes (to be forwarded)
Management and Progress during Hospitalisation:

Both mother and baby completed heroin withdrawal without complications

*Baby 2.0kg at birth; 2.3kg 28/4/11,Bottle feeding erratically ? ,.appetite
*Poor bonding between mother and baby.
*Genette often needs prompting to care for baby.
'Drug and alcohol team involved in managing Genetteongoing addiction issue.

Discharge Plan:

*Daily visits until pt stable weight and feeding stable

*Ensure safe environment for baby and update
Department of Community Services if risks present
*Monitor mother's coping and psychosocial state
*Educate mother and grandmother on infant care
*Liaise with drug and alcohol team to provide integrate support for mother to
risk of heroin use.

WRITING TASK:
You are the Charge Nurse on the maternity ward where Rosalind Hinds was born and need to letter to the local
community midwifery team outlining relevant Information and requesting discharge follow -up. Address the
letter to Maitland maternal and child health centre, Maitland.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 29

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
You are a nurse working in Stillwater Hospital Emergency Department. Today you had a patient called Ms Garcia, who
was referred by her General Practitioner (GP), Dr Bradbury.
Patient Details
Name: Ms Isabel Garcia
DOB: 01.01.1995
Address: 29 Greenfield Road, Stillwater
Medical history: 2007 Fracture R arm
2009 Unexplained weight gain, ?stress
2014 Difficulty sleeping
Allergies: Certain washing detergents cause skin irritation.
Medications: Doxylamine prn (encouraged not to use).
Family history: Mother – breast cancer, age 38.
Social history: University student (2nd year).
Reasons for referral: Suspected meningitis.
Treatment Record
23 May 2015:
Subjective: Painful, stiff joints for 1 wk.
Sensitivity to light.
Bruising.
Headache, neck stiffness, photophobia, rash
On examination: Afebrile
Bruising L arm.
Petechial rash abdomen and legs.
Unable to touch chin to chest when lying supine.
Tests ordered: Full blood count(FBC), renal function, liver function test(LFT), C-reactive
Protein (CRP), lumbar puncture, blood cultures.
Results: WBC: 14.0X104/L
C- reactive protein: 150
Lumbar Puncture: WBC 1000 (elevated)
Polymorphonuclear (PMN) predominance
Glucose: 10mg/dl (reduced)
Protein: 70mg/dl (elevated)
Subsequent microscopy and culture: Neisseria meningititis
Diagnosis: Bacterial Meningitis
Treatment: Ceftriasone 2g IV bd while awaiting lumbar puncture culture results.
Dexamethasone 10mg IV before first dose of antibiotics, then 10mg IV every 6hrs
for 4 days.
Following lumbar puncture results: benzylpenicillin 1.8g IV every 4hrs for 5 days.
Pt. responding well to treatment.
Department of Human Services notified
Discussed with family re: ensure family immunized.
Letter to GP recommend:
Contact close family & friends of pt.
- Seek medical attention ASAP : observation for any signs of unexplained illness
required
- ? Chemoprophylaxis for people in recent close contact with pt.

WRITING TASK:
Using the information given in the case notes, write a letter to Dr Bradbury, the doctor who referred Ms Garcia, to
update her on the patient’s status and follow- up treatment that may be required in the future. Address the letter to Dr
Lorna Bradbury, Stillwater Medical Clinic, 12 Main Street, Stillwater.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form
WRITING MODULE QUESTION NO: 30

TIME ALLOWED: READING TIME: 5 MINUTES

WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
NOTES:
Ms Olivia Hawthorne is a patient at your practice where you are a nurse. She has come to have her intrauterine device
(IUD) removed

PATIENT DETAILS:

Name: Olivia Hawthome

DOB: 01.04.79 (40 years old)

Address: 31 Rawley Crescent, Lowtown

Social background:
Married, 2 sons (7 and 5 y.o.)
Active lifestyle: yoga teacher (9 years); swims 3x/week
Non-smoker, social drinker, vegan diet

Family history: Father —Parkinson's disease

Medical history: G3P2 (3 pregnancies, 2 live children)

2007: Proximal DVT —R leg (28 y.o.) while long hours in stressful office job (lots of air
travel)
2008: Iron deficiency anemia
2009: Menorrhagia & dysmenorrhea diagnosed
2012 Third degree perineal tear
2014: Elective C-section

Medications: Warfarin (ceased 2008)

Ferrous sulphate 200 mg/day mane

Reason for presenting:

Removal of IUD as currently ineffective for menorrhagia & dysmenorrhea

Treatment Record
16.04.07
Proximal DVT in R leg diagnosed; warfarin prescribed: treated Successfully, no. further
issues

21.04. 09
Menorrhagia and dysmenorrhea diagnosed – Cerazette(desogestrel) prescribed
22.04.14 Ceased Cerazette to conceive child 1

26.09.12
Menorrhagia and dysmenorrhea worse than pre-pregnancy
Combined pill Cilest prescribed
02.06.13 Ceased Cilest to conceive child 2

10.04.15
Menorrhagia returns with menstrual cycle IUD Mirena coil inserted

21.04.18
Menorrhagia improved; no more dysmenorrhea —no menstrual bleeding since fitting
Vaginal thrush: Pt treated with Canestan x5 since last appt

02.04.19
Menstrual spotting = 3 months; experiencing menorrhagia and dysmenorrhea; hairiness;
increased greasiness of skin
Canestan x5 in last year
Removal of |UD with nurse prescribed

06.04.19
Removal of |UD unsuccessful attempted for 15 mins; unable to locate strings - Pt can't
recall last time strings located

Pregnancy test administered —negative

? IUD shifted/fallen out
Refer to OB/GYN for further investigation + ultrasound

WRITING TASK:
Using the information given in the case notes, write a letter of referral to Dr Shah, Consultant Obstetrician, for
further investigation. Address the letter to Dr Miriam Shah, Consultant Obstetrician. Royal Hospital, Lowtown.

In your answer:
Expand the relevant case notes into complete sentences
Do not use note form