OET WRITING FOR NURSES

Shamini Mary
 Copyright © 2022 Shamini Mary

All rights reserved

The characters and events portrayed in this book are fictitious. Any similarity to real
persons, living or dead, is coincidental and not intended by the author.

No part of this book may be reproduced, or stored in a retrieval system, or transmitted in

any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
without express written permission of the publisher.
 Contents

Title Page
Copyright
1. BASIC PARAMETERS
2. LETTER TYPES
3. LETTER FORMAT
4. PREPOSITIONS AND ARTICLES
5. SIMPLE AND COMPLEX SENTENCES
6. COMMON STATEMENTS TO USE
7. ORGANIZING CONTENT
8. PRACTICE QUESTIONS
9. SAMPLE LETTERS
10. DO’S AND DON’T’S
11. GLOSSARY & ABBREVIATIONS
Acknowledgement
About The Author
Books By This Author
 1. BASIC PARAMETERS
Time distribution for writing task (45 minutes):

Reading case notes – 5 minutes

Planning content- 10 minutes
Writing the letter- 25 minutes
Checking for errors and final proofread- 5 minutes
Nature of question- Letter writing from the Case studies
given. A case study will be given, you will have to read the
instructions carefully and write a letter based on it.

Parameters of writing evaluation:

Task achievement and relevance

Lexical resource
Topic-related vocabularies
Common and Uncommon- (E.g. Paramount, ubiquitous,
Quintessential)
Comprehension of stimulus
Grammatical range and accuracy
 2. LETTER TYPES
Based on the mode of instruction that is conveyed in each letter,
letters can be categorized into six modes. These are the six
categories of recipients to whom your letter would be addressed
commonly.

To a doctor
To a community nurse
Psychiatric condition or any speciality physician
To a palliative care
To a social person
To the general public

Based on diagnosis letters can be categorized into two types:-

Confirmed diagnosis: - Where a proper diagnosis of the

patient’s condition is made
Unconfirmed diagnosis:-There is no proper diagnosis
made of the patient’s condition. Although, a provisional
diagnosis might or might not be made and expert advice is
needed to provide a proper diagnosis for further evaluation.

Based on the case type:

Old case – A patient who has already come in the past is

there for a follow-up visit
New case – Patient consults for the first time
Unconfirmed – A patient who has consulted but does
not have a confirmed diagnosis, only provisional diagnosis
is made at times and hence, needs to be referred to a
specialist for further assessment and diagnosis
 3. LETTER FORMAT
Every letter word consists of four paragraphs
Paragraph 1-Convey the objective with an introduction
Paragraph 2-Convey the patient’s history and case details as
needed
Paragraph 3-Convey the existing problems and the treatment
needed
Paragraph 4-Convey the instructions and recommendations that are
mentioned in the question
Conclusion-End the letter with one concluding sentence

Letter format elaborated based on case types:

Case-1: A patient who had a problem got treated and now needs
follow-up care and management
A case of confirmed diagnosis:-
Body of the letter:
Paragraph 1-Convey the objective with clarity. Example -I am writing
this letter with regard to refer X who is diagnosed with —- (disease)
and will require (your) follow-up care as well as management (post-
discharge from your centre)
Paragraph 2-Relevant medical and social history and other details
of the patient
Paragraph 3-Treatment provided (problem) (reason for admission)
Paragraph 4- Instructions to the recipient (if any, mentioned in the
question) based on this, it would be greatly appreciated if you could
provide follow-up care (or further care and management for……)
If you require further clarification, please do not hesitate to contact
me.

Case 2- A case of unconfirmed diagnosis:-

A patient showing symptoms of XYZ but not diagnosed yet,
needs expert assessment and management: to a doctor or
Specialist
Paragraph 1-Convey objectivity with clarity.
E.g. I am writing with regard to refer X, who shows possible
symptoms of —, is suspected to have (disease) and requires your
expert (or immediate) assessment and management
Paragraph 2-Relevant medical and social history or details of the
patient as mentioned in the case sheet
Paragraph 3-Reason for admission and main problem (along with
treatment if mentioned)
Paragraph 4-Continuation of problems (if any response to treatment,
recommendations to be added)
Conclusion-Based on this, I would appreciate it if you could provide
your evaluation and management.
If you require further clarification, please do not hesitate to contact
me.

Case 3-old case

Paragraph 1-I am writing with regard to an update on X, who is
recovering from (Disease) and will require your follow-up care and
management post-discharge from your centre
Paragraphs 2 and 3-Reason for admission, treatment, response to
treatment, progress, and improvement
Paragraph 4-Instructions to be communicated based on details
mentioned in the question
Conclusion- Based on this, I would appreciate it if you could provide
your evaluation and management.
If you require further clarification, please do not hesitate to contact
me.
 4. PREPOSITIONS AND ARTICLES
Articles- A, An and The are generally referred to as articles.

Singular – Something that talks about one thing

Plural- Something that is more than one
Countable nouns – nouns that can be counted (Eg. Pen,
book)
Uncountable nouns – nouns that cannot be counted but
measured (Eg. Water, sugar)

A and AN –

A and An can come only in front of singular and countable

nouns
A and AN cannot come in front of plural and uncountable
nouns

The –

Can come in front of any noun, provided the noun is defined

Note: Singular countable nouns and singular uncountable

nouns will always be accompanied by an article or at least a
personal adjective and will never come alone

Eg.

Give me pen (This is grammatically wrong)

It should either be one of these below

Give me a pen (singular noun)

Give me the pen (if you had already spoken about the
pen)
 Give me my pen (my- personal adjective)

The- proper noun, specifically refers to one

An- should be used before a word beginning with a vowel
sound (a,e,i,o,u)

Generally, in front of plural and uncountable nouns, we often

use words like some or many.
Eg:

People(plural noun) are unhappy with the government

Some people are unhappy with the government
Many people are unhappy with the government
Give me some water(uncountable)

Tenses-
is – Generally used for (singular) present (I and you are
exceptions)
Eg:

She is going to the doctor

My pain is reducing
Is the doctor available?

Are – Generally used for (plural) present (I and you are

exceptions)

Where are you going?

The doctors are busy attending an emergency surgery
Are you looking for any additional service from us?

Was – Generally used for past

when was your last check-up?

I was late for my appointment today
Has – Singular, present tense (I and you are exceptions)

The patient has surgery today

The patient has been stabilized and is shifted to the ward
She has her interview today

Have – Plural, present tense (I and you are exceptions)

They have to leave tomorrow

You have to bring your test results tomorrow

Had-Past

I had my doctor consultation yesterday

Hope you had your medicines
The patient hasn’t taken the x-ray yet

List of verbs in different tenses

Take- Took – Takes - Taken – Taking – Will take

Take- Please take your file (present tense)
Took- I took my x-ray during my last review (past tense)
Takes – The patient takes insulin to manage his blood sugar
levels (present tense)
Taken – The tests are already taken (past tense)
Taking – The patient is taking the x-ray (present continuous
tense)
Will take – The patient will take all his blood maca tests before
his next follow-up visit (future tense)

Give- Given –Gave – Giving - Gives – Will give

Give- I will give the reports in half an hour (future tense)
Given – The reports were already given to the doctor (past
tense)
Gave – I gave my blood test yesterday (past tense)
Giving – I will be giving my samples for the test tomorrow
(present continuous tense)
Gives – The patient gives his attender permission to access his
reports (present tense)
Will give – I will give you the reports by tomorrow (future tense)
Prescribe – Prescribed – Prescribes – Prescribing – Will
prescribe
Prescribe – The patient asked the doctor to prescribe him a pain
killer (past)
Prescribed – The doctor prescribed multivitamins to the patient
(past tense)
Prescribes – The doctor prescribes physiotherapy for joint pain
(present tense)
Prescribing – The doctor is prescribing physiotherapy for my
joint pain (present continuous tense)
Will prescribe- The doctor will prescribe the required
medications (future tense)

Suffer – Suffers - Suffered – suffering - will suffer (Ed) (s)

Suffer – The patient had to suffer from the side effects of the
drug (past tense and infinity (to + Verb))
Suffers – The patient suffers from asthma (present tense)
Suffered – The patient suffered from panic attacks last night
(past tense)
Suffering - The patient is suffering from high blood sugar levels
(present continuous tense)
Will suffer – The patient will suffer if the treatment is not
administered on time (future tense)

Live – Lives – lived – living (s) (Ed)

Live – I live in California (simple present tense)
Lives – Mr. Henry lives in California (present tense)
Lived – Mr. Henry lived in California (past tense)
Living – Mr. Henry is living in California (present continuous
tense)
Will live – I will live in California next month (future tense)
 Write down the different tenses of the verbs given below

1. Suggest
2. Practice
3. Advice
4. Argue
5. Complaint
6. Write
7. Continue
8. Require
9. Admit
10. Assess
11. Treat
12. Appreciate
13. Recover
14. Manage
15. Improve

ACTION based sentences

Regular Action: Simple Present tense

He speaks English.
They run in the park.
Ravi runs in the park.

Continuous action:

Ravi is running in the park. (at this moment)

Ravi was running in the park. (at that moment)

Present continuous tense

He is doing it.

Past continuous tense

He was doing it.

 Completed Action
Present perfect tense

She has finished the work. (Recent past)

Simple past tense

She finished the work.

Past perfect tense (Past of a past)

She had finished the work.

When I reached the station, the train had left.

Future action:
Simple future tense

I will do it tomorrow.
I will travel next month.

Future continuous tense

I will be doing it tomorrow.

I will be travelling next month.

Future perfect tense

I would have done it by tomorrow.

Future Active

The Project will be completed in two to three months.

Active Voice
Example: I help patients.
Passive voice
Example: Patients are helped by me.
Using articles
 1. Singular countable nouns will always be accompanied by an
article. (They can never come alone.) or at least a personal
adjective.
Eg, I saw a/the car.
2. The indefinite article (a/an) can come only in front of singular and
countable nouns. They will never come in front of Plural and
uncountable nous.
Examples of places where “a” and “an” are correct to be used:

I saw a car. (Singular countable noun)

I saw a kite. (Singular countable noun)
I saw an owl. (Singular countable noun)

Examples of places where “a” and “an” are wrong to be used:

I saw cars. (Plural countable noun)

I need a sugar. (Uncountable noun)
Give me water. (Uncountable noun)

3. “The” can come in front of any noun provided the noun is

defined.
4. Plural and Uncountable nouns (indefinite) can either come alone
or can be accompanied by words like (some or many).

PREPOSITIONS
1. Of- It answers the questions who or which, association of
who/which
Example:

I am the father of
I am a registered nurse at Wellington healthcare
This is the symptom of

2. In-location-it answers where?

Example:

The pain is in the abdomen

 The cyst is in the uterus

3.On-Used to specify a date or day, it answers the question when

Example:

You are getting discharged on Tuesday

My review is on March
My appointment is on next week

4. For- It conveys a purpose by answering the question why

Example:

chemotherapy is for cancer patients

Blood thinners are for BP patients
Walking is good for diabetes

5. With association with a person or place

Example:

she has a fever with a headache

The patient has diabetes mellitus with blood pressure
The patient is living with his family
She survives with her only child

6. To-it refers to a location or destination, reaching the point. It

answers endpoint.
Example:

I am referring the patient to community welfare

The patient is going to home care
The medicine is going to the body
The patient is going to rehabilitation
The patient is moved to the ward

7. From-refers to the beginning of an activity or action

Example:
 I am working here from 2010
The appointments are available from morning 9 AM to 5 PM

List of conjunctions that can be used between two simple

sentences to join two sentences:

1. And – I will check your vitals and let you know about your
condition.
2. Or – It is imperative for you to follow the prescribed
medication or your health might deteriorate
3. But – You can follow a regular diet but you need to take
fried foods in limits
4. Also – He is a Cardiologist and also an experienced
surgeon
5. Furthermore – You can continue the physiotherapy,
furthermore if you have any doubts, you can reach our
helpline
6. In addition to this – She suffers from hypertension and
anxiety. In addition to this, she also has anemia.
7. However – She has taken the prescribed medications,
however, her sugar levels are still high
8. Firstly- Firstly, let me check your vitals
9. Secondly – Secondly, please recheck your blood reports
before your next visit
10. Though – I will prescribe you a painkiller for an emergency
though you don’t have pain at present
11. Whenever – You can try including walking in your day-to-
day routine whenever possible
12. Prior to – The test should be taken prior to discharge.
13. Post-to – Physiotherapy should be continued post to
discharge.
14. Following – A heat pack can be used following mobilization
to relieve pain.
15. Therefore – Your blood reports are normal. Therefore, you
can continue your regular diet
16. Hence – Obesity can cause further health complications
hence it is important for you to lose weight
17. Although – It is necessary to continue the full course of
medication although you feel better in a day.
18. Even though- The patient has difficulty with ambulation
even though he is using a walker
19. As –As you are still experiencing fatigue you can continue
the supplements for one more month
20. When – You should start doing any physical activity of your
choice on the weekends when you have time
21. Whether- The doctor will check your condition and let you
know whether you should stay or can get discharged
22. Until – It is imperative for you to stay in our care until your
vitals become stable
23. Since- The patient hasn’t taken the prescribed medication
since the last visit
24. When- These tests were taken when the patient was
diagnosed with arthritis
25. Because – The X-ray needs to be taken because only then
we can determine your internal healing
 5. SIMPLE AND COMPLEX SENTENCES
These sentence structures can be practiced and put to use in
your letters. If you get familiar with using them in writing, you will
easily be able to avoid grammatical errors.

SENTENCE STRUCTURE

A Sentence has 2 parts-

1. Subject – What the sentence is speaking about

E.g- Ms.Ann has fractured her leg

The sentence is speaking about Ms. Ann, hence she is the

subject

2. Object- What is told about the subject?

Ms. Ann has fractured her leg. This is the information conveyed
about the subject, hence it is the object.

Noun - Name of person, place, animals, or things/objects.

E.g-Mrs. Patrick, home, wheelchair

Verb - Any action word or a word that involves actions, Eg. Eat,
play, writing, talk, walking Etc.

(is/are, was-were are also categorized as verbs)

Adverbs- day, month, year, time, week, today, tomorrow,

yesterday, etc.

Types of adverbs.

1. Adverb of place - anything which refers to a place.

 2. Adverb of time-anything which refers to a time.
3. Adverb of manner-anything which refers to a manner or
quality. (They usually end with ‘LY’) E.g. Beautifully, quickly,
happily.

Infinity

infinity= to +verb.

E.g., To play, to walk, to eat, Etc.

SIMPLE SENTENCES

1. Simple sentence-format (subject+verb+object)

Eg. Mr. Tony/is walking/comfortably with a walker.

Mr. Tony - subject

is walking - verb
comfortably with a walker - object

2. Subject/verb/adverb

E.g. Mr.Melvin/is on IV**/today.

Mr.Melvin- subject
is on IV *** - verb
today – adverb

3. Subject/verb/infinity

Eg. She /is going/to eat.

She - subject
is going - verb
to eat - infinity
4.Compound Sentence-Combine two simple sentences with a
conjunction (and, or, but) in between.

Simple sentence+ conjunction+simple sentence.

Eg. I ran fast/but/I slipped and fell.

I ran fast - Simple sentence

But - conjunction

I slipped and fell - Simple sentence

COMPLEX SENTENCE

1. Noun clause

Subject/+ verb/+ that/+ simple sentence

(use anyone in the place of a verb- believe, suggest, think,

argue, emphasis, urge)

The format for framing a noun clause sentence is by writing the

subject first, followed by a verb + that and a simple sentence

Example:

1. I /believe/that /you want to make a change in your

lifestyle.

I - Subject
Believe - (Verb) + that

you want to make a change in your lifestyle- Simple sentence

 2. Doctors/suggest/that/walking is good for
health.

Doctors - Subject

Suggest (Verb) + that

Walking is good for health - Simple Sentence

3. Some/think/that/social media is also helpful despite its

drawbacks.

Some – Subject

Think (Verb) + that

Social media is also helpful despite its drawbacks - Simple

Sentence

2. Adverb clause

Use any of the below words between two simple sentences.

Simple sentence + (any word listed below) +simple sentence

(If, because, although, even though, as, when, though,

whenever, whether)

Example:

1. He is able to talk /although/he has breathing difficulty.

He is able to talk -Simple Sentence

Although- Conjunction
 He has breathing difficulty.
- Simple Sentence

2. I will check your vitals/if/ you are comfortable with it.

I will check your vitals - Simple Sentence

If - Conjunction
You are comfortable with it.
- Simple Sentence

3. I couldn’t come for my follow-up yesterday/because/ I had

some personal work.

I couldn’t come for my follow-up yesterday - Simple Sentence

Because - Conjunction

I had some personal work - Simple Sentence

3. Adjective clause

Describes the noun of a sentence using two words

1.Which - Which is used when your noun is not a person.
2.Who - Who is used when your noun is a person

Note: A sentence may have two or more nouns. Always

describe the first noun.

Example:

1.Treatment which is very important/should be given to everyone

who needs it.
Treatment – Subject (not a person -so described using
which)
2. Fruits which are good for health/should be consumed by all.

Fruits - Subject (not a person -so described using which)

3. Children who are unhealthy/ need supplements.

Children – Subject (person -so described using who)

KEY TAKEAWAYS

Simple sentence-format (subject/verb/object)

Eg. Mr.Ann/is walking/with the support of a walker.

Subject/verb/adverb

E.g. Ms.Daisy /is eating a protein-rich diet /today.

Subject/verb/infinity

Eg. She /is going/to play.

Compound Sentence = Combine two simple sentences

with a conjunction (and, or, but) in between.

Simple sentence+ conjunction+ simple sentence.

Example: I ran fast/but/I slipped and fell down.

Noun clause - Subject/+ verb/+ that/+ simple sentence.

Example: I/believe/that /the climate is getting colder.

 Adverb Clause - Simple sentence + Conjunction +simple
sentence.

Example: He cleared the exam/although/the exam was very

tough.

Adjective clause - Describes the noun of a sentence using

two words (which, who).

Eg. Vaccination which is very important/should be given to

all.
 6. COMMON STATEMENTS TO USE

1. Mr/Ms {patient name} was diagnosed with —— (Disease

name)

Mr/Ms {patient name} suffers from —— (disease

name)

1. Pain reliever/medication has been prescribed on SOS

2. (Patient name) has undergone —— (a
surgery/procedure/accident)
3. (Patient name) requires your post-discharge care and
advice
4. (Patient name) has been on insulin to manage his diabetes
mellitus
5. A ——(Procedure/scan/x-ray) revealed —— (condition
name)
6. ——- Procedure was performed for (patient’s name) for
his/her (condition)
7. —- Should continue medication prescribed by —-
(specialist/general physician)
8. —-X will need a —— Opinion for further evaluation
9. Lifestyle/dietary changes has been recommended for X
10. Walker/Willie is recommended for X further support during
ambulation (walking)
11. X has persistent (symptom/problem) which is managed by
(tablet name)
12. X Has previously undergone ——-(procedures if any)
13. X Has previously been on (medications) to treat and
manage (conditions)
14. X reported having (symptoms) Severe pain, headache,
fever, etc
15. X is advised to consume (green leafy vegetables-diet)
16. X has been taking ——(tablet name) to manage ——
(condition name)
17. X is prescribed with—- (100mg tablet name) to be taken
daily
18. X has a family history of —- (condition name)
19. X has difficulty in ——- (Example: walking, upper limb
movements, etc)
20. The symptoms of —————-(pain, swelling) of X was
diagnosed as ——(Rheumatoid Arthritis)
21. Please encourage (ambulation) every few hours with
support.
22. X is advised to be on rest with active mobilization following
physiotherapy post-follow-up.
23. X is compliant with medication
24. Although X has made good progress, he/she has trouble
with ——
25. X has undergone——-(procedure name) following his/her
trouble of —-
26. X ‘s problem is managed by —- (tab name)
27. X has a follow-up in a ——-(week’s) time During which
his/her blood marker tests are to be repeated
28. Encourage X to intake more fluids orally to stay hydrated
29. Since X showed good progress, he/she was discharged on
– – [date]
30. X was admitted after ——(problem)
31. X suffers from——(disease)
32. X was experiencing symptoms of —-
33. X is advised to ———-(lose weight, quit smoking, follow a
healthy lifestyle and diet)
34. X is suspected to have (disease)
35. X is referred to consult a (specialist) for
advice/opinion/diagnosis for further evaluation and
management
36. X should not consume—-
37. X has been on —— (medication) for the past year
38. Please advise and help X to quit alcohol
 7. ORGANIZING CONTENT
Organizing Content to write the letter:-

1. Who are you writing to.?

2. Why are you writing the letter.?
3. What information they should know.?
4. Patient’s brief medical history
5. Medical terms
6. Social history details needed
7. Details of medication
8. Follow-up details
9. Brief summary of the present condition

Format:-
To,
Name XXX
Address
Xxx
Xxx

Date: write the test date if the date is not given the in question

Referral subject
Re: patient name Age/DOB

Paragraph
1- Introduction with purpose and objective
2-relevant medical or social details
3-treatment provided/reason for admission
4-Instructions needed for cure and management

Conclusion
If you require further information do not hesitate to contact me

End with sign

Your name and designation- As mentioned in case notes
(Check for errors and if you have mentioned all the necessary
details)
 8. PRACTICE QUESTIONS
Abbreviations:

C/O – Complaint of/Case of

DM- Diabetes Mellitus

HPN- Hypertension

Question-1 Case study

Hospital: Abbotford regional hospital and cancer centre

Patient details:

Tony Robinson, 65 years old,

Marital status: Married, widowed- lost wife 15 years ago,

daughter to be contacted in any case of emergency,

Christeena Andrew, + 44 65398271

Admission date: 6/2/22

Discharge date: 9/2/22

Diagnosis: Prostate Cancer

Past History: Type-2 Diabetes Mellitus

Medications: Insulin as prescribed, taken regularly.

Social: Retired teacher

Medical Progress: A skin biopsy was taken and sent for

pathological study for further diagnosis, pain reliever was
prescribed.

Management: No complications noted so far.

Discharge plan: Daily obs. (observation). Prescribed oral

medicines to be taken for one more week.

Writing task:1

You are the charge nurse on the hospital ward where Mr. Tony
Robinson has recently had his biopsy. Using the information
provided in the case notes, write a referral letter to the Community
Nurse Head at Pinecrest – community healthcare centre Ottawa, on
who will be attending to him following his discharge.

In your answer:

Expand the relevant case notes into complete sentences.

Do not use note form.
The body of the letter should be approximately 200 words.
Use the correct letter format.

Question-2 Case study

Notes: Ms. Ela Rose is a patient in your care at Royal Jubilee

Hospital. She has a history of Endometriosis and irregular periods
with over bleeding due to endometrial thickening occasionally. She is
on Iron supplements for anemia. She presented a day ago
requesting help for her substance abuse problems. She reports a
desire to reduce or cease her alcohol consumption and drug use. No
desire has been indicated to cease or stop her cigarette smoking
habit. She also claims to have an obsessive eating disorder with
sugar cravings and obsessive eating habits occasionally and wishes
to get into a healthy diet and lifestyle change. She now wishes to be
discharged but will require ongoing support.
Discharge summary:

Name: Ela Rose

Age: 25

Admission: 5/3/22

Diagnosis:

UTS showed thickened endometrium

Substance abuse

Discharge: 7/3/22

Plan:

Community counselling and dietician opinion needed to

understand the cause of obsessive eating habits to
inculcate a healthy eating pattern and lifestyle.
The Salvation Army Alcoholic program to be attended and
followed.
Follow-up appointment in 15 days to evaluate symptoms
Follow-up with gynecologist needed to manage menstrual
irregularities and endometrial thickening.

Reason for admission:

Patient admitted due to concern on substance abuse.

Reported history of irregular periods, anemia, and
endometrial thickening.
Believes to have symptomatic cravings and obsessive
eating patterns.
 Discussed possible rehabilitation for ceasing alcohol
consumption and drug use.
Wants to inculcate a healthy diet and lifestyle.

Treatment:

Patient monitored and blood tests for anemia and other

hormones taken.
Discussed possibilities for rehabilitation and action steps.
Counseled regarding lifestyle and eating patterns
Counselled regarding irregular periods and persisting
symptoms.

Lifestyle:

Nicotine 25-35 cigarettes per day.

Smoker for the past 12 years.
Drugs used cannabis, cocaine, and heroin.
Alcohol 10-15 units per day.
Lives with friend Anne, parents live in CA, and meets
occasionally.

History:

History of suicide attempt once.

Seen a psychologist but never attempted to try the
prescribed advice and follow up.

Writing task:2
 Using the notes, write a letter about Ms. Ela Rose’s situation and
history to the community healthcare dietician at Grandriver
Community Health Centre, Brantford ON. Address your letter to Ms.
Susan, registered dietician, Grandriver community health centre.
Summarize Ms. Ela Rose’s health history and symptoms using
complex sentences. Mention her history of mental health. Do not use
note form.

Writing task:3

Using the notes, write a letter to the gynaecologist at Grandriver

Community Health Centre, Brantford ON to take advice on Ms. Ela
Rose’s menstrual irregularities and persisting symptoms. Address
her symptoms, habits, and concerns in a few sentences without
using note form.

Writing task:4

Write a letter to the South Perth de-addiction Centre for Ms.Ela’s

substance abuse.

Summarize her health history using complex sentences

Mention her habits and substance abuse history

Writing task:5

Write a letter to the psychiatrist at Grandriver Community Health

Centre, Brantford ON to evaluate Ms.Ela Rose’s eating disorder.

Mention her ultrasound scan showing endometrial

thickening
Mention her obsessive eating disorder with sugar cravings
Do not use note form, use complex sentences
 Question-3 Case study

You are a maternal and child health nurse working at South

Riverdale Community Childcare health service

Patient history:

Baby girl: Lara

DOB: 9/4/22
First Born
Address: Queen St, E Toronto, ON M4M
Discharged: 13/4/22

Family History: Mother Beneta aged 26, first child

Father: aged 29, bus driver.

Birth history:

Normal vaginal birth

Birth weight: 3000 gm
No prenatal or postnatal complications
Routine weekly check-ups are done until 2 weeks
Baby was formula fed due to the mother’s lack of milk
supply and inverted nipples
Nipple shield was used to assist the baby in latching
Beneta gives formula feeds when the baby refuses to latch
at times
Beneta complaints that the baby is not latching and feeding
and there is a loss of weight and decreased urination with
constipation that is noted.
 Complaints:

Dehydration
Constipation
Trouble to latch and feed

Plan:

Increase breastfeeds
Refer breastfeeding supporting service
Check if the formula is correctly prepared
Advice on formula preparation to use boiled cooled water
Follow up review in 2 days

Writing task:6

Write a referral letter to the lactation counsellor at the Eastern

Ontario breastfeeding support centre

In your letter, explain the relevant case notes and history in

complete sentences
Do not use note form
The letter should be in 180-200 words approximately

Question-4 Case study

Hospital: Peace Arch Hospital

Patient details: Auther Wilson

Age: 55 years

Admission date: 3/7/21

 Discharge date: 5/7/21

Treatment: Femur- implant removal

Ongoing low blood pressure

Past History: 2012- Underwent a fractured femur- shaft and

implant insertion surgery.

Medications: No complications or history of other ailments

Discharge plan and Management:

Wound dressing needed in one week

Follow up to check wound healing after 10 days
Physiotherapist opinion to take on mobilization post implant
removal

Writing task:7

Using the information provided in the case notes, write a letter to

Ms. Syneta Dein at Hartland place Senior living Nursing home,
Hartland WI who will be responsible for Mr. Auther Wilson’s
continued care at the Nursing home

In your answer:

Expand the relevant notes to complex sentences

Do not use note form
Use appropriate letter format
The body of the letter should be 180-200 words
approximately
 Question-5 Case study

Hospital: Fraser Canyon Hospital

Notes: Joy Mathew 22 year old female was bought to the

emergency room with a history of trauma after a fall, during her
sports activities while rock climbing on her college campus. The
patient was normal 2 days ago until she accidentally fainted and fell
down. After the fall she was taken to the nearest black creek
community healthcare centre, York Gate, ON where first aid
treatment was given. The patient was received at Fraser Canyon
hospital for further treatment and management. No exact history to
be elucidated. First aid treatment was given at black creek
community health centre. Suturing over the forehead and elbow was
done as first aid for injury.

Patient details: Joy Mathew Age:22 years

Admission date: 4/8/22

Discharge date: 14/8/22

Symptoms:

Superficial abrasion over left patella +

Suture wound over the forehead
Left side thigh deformity swelling
Left elbow shows suture wound with POP slab
Right lower limb with the POP slab with heel and ankle
swelling
Distal vascularity

X-ray reports:
 Left elbow showed INTERCONDYLAR COMMINUTED
FRACTURE OF DISTAL HUMERUS
X-ray of the right ankle showed a comminuted fracture of
calcaneum
CT Scan of the cervical spine showed normal study

Past History: Nil

Medications:

Tab. Safefas 1-0-1 for 10 days

Tab. Pantocid 40 mg 1-0-0 for 10 days
Tab. Shelcal 500mg 1-0-1 for 30 days
Tab. Evion 1-0-0 for 14 days
Cap. Tramadol 50mg SOS

Medical Progress: The patient was conscious and making

efforts to improve mobility during discharge

Discharge plan:

Dressing to be changed once in 3 days by homecare

Normal diet
Physiotherapy – full weight bearing walking with walker
support
Bilateral quadriceps and hamstring exercises
Bilateral calf pump exercises

Writing task: 8

Using the information in the case notes write a letter to Ms.

Bethesa Melita, physiotherapist at Regent Park physiotherapy
centre, Toronto, ON on behalf of Joy Mathew requesting a home visit
to provide advice and assistance with improving her mobility post her
cast is removed.

In your answer:

Do not use note form

Expand the relevant case notes to explain her background,
medical history, and assistance required
The letter should be 15-20 lines long. No more than 25 lines
will be assessed

Question-6 Case study

Mr. Bob Haston is a 65 year old patient on the ward of Burnaby

Hospital where you are acting as a charge nurse.

Patient details:

Marital status: Married, wife is out of the country to assist their

daughter with her delivery and postpartum care.

Admission date: 5 January 2022

Discharge date: 8 January 2022

Diagnosis: Total – knee replacement

Past History: History of hypertension for 10 years, has

deficiencies of vitamin-D and B12 and uses patches and oral
medications for the same.

Medications:

Medical Progress and Management:

Post-operative recovery is good
 Walks with aid and tries to walk independently
Vitamin-d and B12 diffused since he was deficient, blood
reports show normal levels on discharge

Discharge plan:

Pain reliever given hyfenac 3 per day

Exercises to be followed – physiotherapist advice to be
taken
Wheelie/walker, raised toilet seat recommended
Dressing to be changed daily
Follow-up required in one week to repeat blood market
tests

Writing task:9

Using information provided in the case notes, write a letter to

Ms.Shelly Alfred, senior Nurse at Elkhart Nursing and Rehab centre
for Senior healthcare who will be responsible for Mr.Bob Haston’s
continued care at the Nursing home. Elaborate on his health history,
management, and post-discharge care.

In your answer:

Expand the relevant notes into complex sentences

Do not use note form.
Use appropriate letter format

Question-7 Case study

Patient – Victor Alice 68 years old Admitted-March 18, 2022

To be discharged – 21 March, 2022
Background
Mr. Victor Alice has retired and lives with his son, daughter-in-law,
and grandchildren. He’s currently in charge of taking care of the
community activities in his locality. He lost his wife 10 years ago. He
attends the local community centre and plays snooker with his
friends. He currently smokes 5 to 10 Cigarettes per day. Does not
have healthy meals, mostly eats high-calorie food at the takeaways
Past history

January 10, 2022, he had an episode of wheezing for which

he was admitted and given nebulization
Was advised to give up smoking
BP: 180/90 Pulse:92 Temperature: Afebrile
Breathless
Was advised on low fat and dairy diet
Nicotine patches were advised

Discharge plan

Support Mr. Victor Alice in monitoring medications

Needs nutritional meals assistance
Monitor his smoking plans and provide assistance to quit
Watch for side effects from the current medications
undertaken

Writing task:10
Write a letter to Mr. Victor Alice’s family stating his health history and
post-discharge care. Summarize care needed using complex
sentences. Mention action plans on following breathing exercise
advice and diet advice along with his BMI and ideal weight. Do not
use a note
Writing task:11
Write a letter to the Physiotherapist of Ridge Meadows Hospital.
Request suggestions on low fat and nutritional diet based on
Mr.Victor Alice’s health history. Mention his BMI and ideal weight,
also state that his family has requested the above details to be
communicated to their address.
Writing task:12
Write a letter to Allendale home care agency, Milton, Ontario, CA to
demonstrate and explain the deep breathing exercises prescribed to
him which are to be followed at home post-discharge. Summarize his
health history using complex sentences. Do not use note form.
Writing task:13
Write a letter to the dietician at Ridge Meadows hospital stating
about Mr.Victor Alice’s health history and post-discharge care.
Summarize his health history using complex sentences. Mention the
diet advice he is suggested and needs along with his BMI and ideal
weight. Do not use a note from.

Question-8 Case study

Read the case notes below and complete the writing task which
follows:
Admission date: 9/6/22
Patient details: Jimmy Bernard aged 72 was admitted to the ward
following surgery for an umbilical hernia. His doctor has advised that
he can be discharged within 48 hours if there are no complications
following the surgery. Jimmy Bernard reports some pain at moment
but has recovered well from the surgery. He has a concern about the
pain if it will persist even post-discharge. He needs advice on oral
medications that can help him cope with the pain.
Planned discharge:12/6/22
Medical history: Type two diabetes mellitus diagnosed in 2002,
takes insulin of 0.5 mg daily. Family history: Jimmy is a retired Navy
professional. He is married for 40 years to his wife Kathy and has
two sons, one son lives in Norway. One son works in the embassy in
Canada. Mr. Jimmy Bernard and his wife
lives in their house, they receive a pension. Kathy is concerned
about the mobility of her husband if he will be able to continue his
day-to-day activities and other works. She’s concerned if Jimmy will
not be able to go to get the essential things needed driving down.
She’s worried as they will not be able to offer a driver who can help
them with the outside work.
Kathy is also concerned if they might not be eligible to receive the
community healthcare fund assistance from the Department of Navy
Veteran affairs but does not know how to find out details about it.
Jimmy is in good health but he has difficulty with his vision he is also
using spectacles. Kathy has requested a home visit and has also
mentioned their address.
Discharge plan:

Must avoid getting heavyweights

Should not drive for at least six weeks
Heavy strenuous activities or exercises not recommended,
light exercises only
Panadol forte is recommended for managing pain on SOS
depending upon the intensity of the pain
Follow-up appointment to be made with the surgeon for
post-operative check in three days
Contact the department of Navy Veteran affairs to check the
eligibility of Jimmy Bernard and his wife regarding pension
and home help

Writing task:14
Using the information provided in the case notes, write a letter to the
director department of Navy Veterans affairs, at the below address
PO Box, 7700 Charlottetown PE C1A 8M9. Explain that you are
writing this letter on behalf of Mr.Jimmy Bernard to receive a pension
for house help and elaborate on what you are seeking assistance.
Do not use note form in the letter. Expand the case notes into full
sentences. The letter should be 15 to 20 lines long. No more than
the first 25 lines.

Question-9 Case study

Mr. Donald Rodriguez, 67 years old is a patient in the medical ward

in which you are the charge nurse.
Hospital: Mission Memorial Hospital
Patient details:
Name: Donald Rodriguez
Marital status: Widowed five years ago
Residence: Glenels community retirement home, Napanee, ON
Social background: Engineer, one daughter lives in the US. He
lives in the retirement home with his friends. Emergency contact
details of his friend and daughter are to be listed below.
Melvin: +44 878788
Andrea: +66 978767
Admission date: 4 February, 2022
Discharge date: 9 February 2022
Diagnosis: Pneumonia
Past medical history: Type two diabetes mellitus, History of
hypertension past 15 years - Needs check-up and management.
Social background: retired cab driver, drives for the airport
authorities. Financially independent, lives alone since his wife died.
Has become weak compromising his diet after his wife’s death by
eating randomly in takeaways.
Medical background: Mr.Donald was admitted with pneumonia.
Had symptoms of breathlessness, asthma, Fever with generalized
tiredness, pain, and sleeplessness.
Medical progress:
Temperature: Afebrile

Blood test reports of markers are normal

Is mobile and independent
Oral medications prescribed for existing symptoms
Nursing management:
Encourage oral fluids and a nutritious diet
Assistance for food supply to registered address is required
Physiotherapy with breathing exercises is recommended to
be followed

Assessment: The patient shows good progress

Discharge plan:
 Paracetamol 1–0 –1 is recommended for the management
of pain on an SOS basis
Good nutrition is recommended – need help with monitoring
diet

Writing task:15
Using the information given in the case notes, write a discharge
letter to miss Regina Chris, the community nurse who will be taking
care of your patient Mr. Donald Rodriguez. Explain the treatment
plan for taking care of the management of your patient. Elaborate on
his health history in sentences by summarizing the details.
In your answer:

Expand the notes into complex sentences

Do not use note form
Use the letter format

Writing task:16
Write a letter to the Physiotherapist of the hospital in which you are
the staff nurse. Elaborate on the details in the case notes. Request
the details of breathing exercises which is recommended for Mr.
Donald Rodriguez to be communicated with him. In your letter
mention his symptoms and health history along with his present
complaints.

Do not use note form

Summarize the case details using complex sentences
The letter should not be in more than 180–200 words

Question-10 Case study

Ms. Alice Benedict is a 66 year old patient in your care at the

hospital where you are acting as the charge nurse.

Patient details:
Marital status: Widower past 11 years
Admission date: May 3, 2022
Discharge date: May 10, 2022
Complaint: Ms. Alice Benedict had an accidental fall without
watching on the wet floor, she was immobile and was bought to the
Emergency
Health history:

Nil complications
Not under any medication

Diagnosis:
X-ray of the pelvis with both hips showed: Right acetabular fracture,
Anterior wall, and, posterior column Left interior pubic rami fracture
Treatment:

Underwent ORIF- open reduction internal fixation: pelvis

Oral medication Tab. movon P 1-0-1 is prescribed for pain
relief and management
Post-discharge care:
Dressing to be changed daily
Stretching exercises recommended to be followed
Advised oral medications to be continued
Wheelchair/Walker and raised toilet seat recommended

Writing task:17
Using the information in the case notes, write a letter to Ms. Sharon
Joey, staff Nurse at Maynard nursing home, Toronto, ON who will be
responsible for Miss Alice Benedict’s continued care.
In your answer:

Expand the relevant notes into complex sentences

Do not use note form
The letter should be in 180-200 words using the letter
format
 Question-11 Case study

Hospital: Westly healthcare

Patient details: Mrs. Rita Joseph 32 years old female with
severe pain in her right foot and ankle. She had a fall and her ankle
got hurt and twisted while she tried to remove the chair which fell on
it, she states. She reports severe pain. She is anxious and
concerned if this will affect her mobility as she has had a history of
fracture in the same ankle. She feels this will affect or have
something to do with her old fracture. She requests advice for her
present pain and history of fractures.
Reports: Radiology- An x-ray was taken. The report reveals that
there is no evidence of fracture or damage.
Admission date: March 25, 2022
Discharge date: March 25, 2022
Provisional Diagnosis: Ligament strain/ligament tear.
Past History: History of calcaneum fracture in the same ankle 10
years ago
Has a flat foot and bone spur as an effect of it
Medications: Inj. Diclofenac
T. Hyfenac 1-0-1 -5 days was given for pain management.
Medical Progress: Feels better with pain relief medication
administered through IV
Discharge plan:

Oral medication as prescribed to be taken for pain relief

Ice pack application to be followed twice a day for swelling
and inflammation relief
To follow-up, if the pain doesn’t subside in two days
No strenuous activities or exercises to be followed for the
next two weeks as it could lead to straining of ligaments.

Writing task:18
Write a letter to the orthopedics in the Carlington Community
healthcare center summarizing Mrs. Rita Joseph’s health history and
current complaints. Also mention her concern regarding her history
of complaints and present pain, to assist her with a diagnosis based
on her symptoms. She also has generalized pain in her legs and
ankle with long walks and needs advice on managing it.
In your answer:

Do not use note form

Use complex sentences to write the letter in the appropriate
format
Your letter should be in 180–200 words

Question-12 Case study

Read the below notes and complete the writing task that is given.
Notes:
Catherine Fernandez a 35-year-old patient in your care who has
delivered a baby through C-section is about to get discharged. She
has a complaint of pelvic pain throughout her pregnancy which
seems to be worsening post-delivery. She complains that it is
affecting her mobility and finds it difficult to move around and take
care of the baby. She’s concerned about pain management and
improving her mobility to recover and get back to her daily activities
and routine.
Social background: Catherine Fernandez is married for five
years. Husband Patrick 40 years works in a bank. Kathrine
Fernandez is an active member of the community social welfare
organization located in Ottawa and organizes several welfare
programs.
Admission: 24 May 2022
Discharge: 27 May 2022
Diagnosis: Pregnancy-related pelvic pain
Medication: T.Lemoncee 1-0-0, shelcal 500mg- 1-0-1,
T.paracetamol on SOS
History: Nil complications
Discharge advice:

Use the hip belt prescribed to aid back support

 Continue oral medications as prescribed
Exercises advised to be followed with physiotherapist
advice

Writing task: 19
Write a letter to the physiotherapy department of Lions gate
Hospital, North Vancouver summarizing Mrs. Cathrine Fernandez’s
health history and present complaints. Do not use note form to frame
the sentences using complex sentences.

Question-13 Case study

Hospital: Modbury Hospital

Social background: Mr. Derik 49 years old works for the Sydney
metro west rail project as a field engineer and technician. He has
been having a lump Resembling swelling in his umbilical region
associated with pain for the past six months. Since his work was
demanding a lot of his time and energy, he couldn’t pay attention to
it. Married to Teresa 39 years old works at the hypermarket. Derik’s
work involves a lot of physical activity and strain. Teresa is worried
as his medical leave will only be up to a week or more. She fears his
work can delay or hinder his healing. Teresa requests a letter to be
addressed to the Sidney Metro West corporation to extend his
medical leave, since he’s not advised to do physical work and strain,
as it could delay his healing progress.

Patient details:
Case of swelling over the umbilical region for the past six months.
Associated with pain, not associated with fever, chills, no complaint
of the bladder, bowel disturbance.
Physical examination: soft, not warm, not tender, a deficit of size 3 to
3.25 cm over the umbilical region.
Temperature-afebrile
PR-80/min
BP-120/86 HS-14.9 TLC-8100 Plt-2.91l PSA-0.61
cough impulse positive, reducible
A defect measuring 18 mm was noted in the anterior abdominal wall
in the umbilical region with fat as its herniating content. Prost
volume – 16 ML
U.bladder- No focal wall thickening, fatty liver.
Admission date: April 9, 2022
Discharge date: April 13, 2022
Diagnosis: Umbilical hernia
Past History: Nil
Medications:
Inj.TT
Inj.xylo T.o
Inj.Taxim 1 gm vial to OT
Medical Progress:

Blood marker reports were taken.

UTS Dash showed fatty liver and umbilical hernia.

Management:
9/4/22- Admission needed for further diagnosis and management
10/4/22- Plan for surgery (provisional)
To see ahed after fitness
11/4/22- A. Fitness done
NPO from 10 pm today
T.Unienzyme 3HS
12/4/22- Lap Umbilical meshplasty
T.raxim200bd
T.pan 40bd
Syp Cremaffin
13/4/22 Discharge suggested
S/p Lap Umbilical meshplasty
Wound healing
No pus
No bleed
Discharge plan:

Report SOS if any complaint of pain

 Continue oral pain medication if needed Syr.Dulcolax - To
be continued if complaint of constipation is noted, to
prevent strain in the abdomen
Follow-up needed in 15 days

Writing task:20
Write a letter to the Sydney metro rail corporation at the below
address:
Address your letter to Mr. Philip, Project manager, Sydney Metro
West Rail
Sydney Metro City & Southwest, PO Box K659, Haymarket, NSW
1240.
Elaborate on the health history of Mr. Derik. Mention his discharge
advice, stating that he is not advised to do any strenuous physical
activity for up to a month, although he can provide remote support if
needed for his comfort. Also mention the procedure that he has
undergone along with the complaint, requesting to prolong his
medical leave.
In your answer:

Use complex sentences

Do not use note form
Your letter should be in 180-200 words

Question-14 Case study

Hospital: Fiona Stanley hospital, Murdoch WA

Patient details: C/O Generalised weakness with Dyspnoea,

giddiness, chest pain, and junctional rhythm. Decreased urine
output. Stabilized and shifted to ward.

Mr. Allen was admitted to the ICU followed by having symptoms

of giddiness and chest pain. Has been feeling symptoms of
palpitation, shortness of breath, chest discomfort, and arm pain.
 Patient lifestyle:

9.30 am- Holter hook up

9.45 am- drive to work

12.00 pm – lunch

1 – takes medication (Nitrostat)

5 – drive home

5.30 – Snacks

7.15 – lifts weights and workout at the gym

Admission date: 4, June 2022

Discharge date: 7, June 2022

Diagnosis: Junctional system DMI HTN

Provisional Diagnosis: Heart block

Past History: KICIO: Hypertension, hyperthyroidism, DM – On

alternative medication, SLE

Current Medications:

HCQ’s-200mg 0-1-0
T. Shelcal – 0-1-0
T.Telmat 1-0-0
T.Thyronorm 12.5 mg

General Physical Examination:

 Edema
Lymphadenopathy
Cyanosis
GCS – 15/15 No FND
Heart S1 S2 +
Chest/lungs-B/E AE C+
Abdomen – soft, tender
Extremities, spine- Nil HR:80Bpm
BP:120/90 mmHg

Medical Progress:

CBC, Creatinine, electrolytes, Trop-T/CPKMB,

Amylase/lipase, Urine-routine and culture, blood and other
viral markers tested. Reports to be followed up.

Primary treatment given, needs further evaluation and

follow-up.

Management:

Dobutamine stress echo to be taken

Keep NPO-Nil per oral on advice as per vitals
Diet and Physiotherapy to be followed up

Discharge plan:

All medications to be rechecked (alternative medications

taken)
Monitor vitals
Follow primary instructions on diet and physiotherapy
Inform SOS
Cardiologist advice to be taken
 Writing task:21

You are the charge nurse in the ward where Mr. Allen is admitted.
Using the information provided in the case notes, write a letter to
Dr.Henry – The cardiologist. Address it to The Royal Melbourne
hospital Parkville, VIC, Aus 1840

In your answer:

Elaborate symptoms and health history of Mr.Allen

Do not use note form
Mention that he is advised to be referred on angiogram
which is to be followed up for further evaluation and
management

Writing task:22

Using the information provided in the case notes, Write a letter to

Mr.Robin Physiotherapist at Paramatta Community Healthcare
Centre, Paramatta, NSW, 2150, Aus who will provide follow-up care
to Mr.Allen.

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.

Question-15 Case study

Hospital: Adelaide hospital, Adelaide SE Aus

 Notes: Ms. Alma 65 years old retired professor (widowed), is
admitted following recurring complications from her previous surgery.
She is having pneumonia. She lives with her friends in St. Basil’s
home for Aged Fawkner VIC 3060, Aus. She has one daughter who
is married and lives in Texas. Receives pension, financially
independent.

Patient details:

KICIO DCLD with portal HTN

Pneumonia atypical
Anemia, AKI
LL Cellulitis, S/P Detridement + fasciotomy
Bronchial asthma C/O on and off wheeze past 1-2 weeks,
increased sleep, abdominal pain, not passed stool since 3
days
Pallor + , edema + , lymphadenopathy + , Heart S1 S2+ ,
chest/lungs :B/L AE +, B2 crepts+, expiratomy wheeze +
Abdomen: Soft, BS Lowered, distended abdomen
R leg cellulitis – Oedema +
BP:107/84
R/R:20
BPM:110
Temp: Afebrile
GCS:15/15

Admission date: 5, April 2022

Discharge date: 9, April 2022

Provisional Diagnosis: Case of DCLD with portal HTN, AK1,

bronchial asthma

Past History:
 HTN
Antibiotics are taken in the past 8 weeks
Family history of ailments - Nil

Medications:

Pan 40 mg
PCT 6mg
Proptaz 4.5 mg
Rifagnt 500mg
H.cort 200mg
Inj. Vit K 10mg IV

Medical Progress:

Investigation was done based on blood marker tests, treated for

existing symptoms (infection control), and stabilized. Tentative
discharge in 2-3 days and to be followed up for vascular surgery

Discharge plan:

Medications to be continued as per advice

Follow up with the vascular surgeon
Spirometry is suggested for increasing lung capacity

Writing task: 23
 Using the information provided in the case notes, write a letter to
the Physiotherapist Mr.Philip Taree Community Healthcare Centre,
pultnery st, taree NSW, Aus 5100. Request him to provide
instructions on using a spirometer and practising the exercises
prescribed to Ms.Alma to be communicated to the below address :
St. Basil’s home for Aged Fawkner VIC 3060, Aus 4281. As per
Ms.Alma’s request

In your answer:

Do not use note form

Use compound sentences
Use letter format

Writing task: 24

Elaborate the information given in the above case notes using

complex sentences and write a letter to Mr.Andrew Vascular
Surgeon Darwin hospital Tiwi NT, Aus 6213.

In your answer:

Summarise Ms.Alma’s health history and existing

complaints
Mention her symptoms and complaints to seek follow-up
advice
Do not use note form, use letter format not more than 180-
200 words

Question-16 Case study

Hospital: Osborne Park Hospital

Social background:
Mr. Isaac is 56 years old and widowed. He is a retired librarian. He
has two sons, one is married and lives in Vegas with his wife and
children, and another son is doing his education at– university.
Mr.Isaac lives alone. Financially independent. The primary source of
emergency contact is his son who lives at the blue address and
contact details
Mr.Paul
Alphington VIC 3078 Aus

Patient details:
A 56 year old male arrived in the early morning in an ambulance
from home after having an accidental fall on stairs, he had
complained of abdominal pain since last night, he has a past history
of varicose vein

Allergies: not known

Airway patent: yes
S/P: Wound debridement right leg 2.21 pulse: 112 BP:
150/90 Rest rate: 20 SpO2:94% Capital GCS score – 15/15
Open eyes spontaneously
Utters inappropriate words
Seems confused and disoriented
Abnormal flexion to painful stimuli- decorticate response
Flexion withdrawal too painful stimuli
Motor and verbal: makes no sounds and movements
Oriented, converses normally
Obeys commands
Localizes painful stimuli
No FND

Admission date: 17 April 2022

Discharge date: 19 April 2022
Provisional Diagnosis:
Atypical/aspiration with OSA
DCLD with portal HTN
constipation
Past History:
Varicose vein- hasn’t followed up and irregular with medications
No other ailments
Medications:
ORS
Medical Progress:
Reports given - CBC, Creatinine, electrolyte, ABG, PT-INR, FT,
BUN/CA ++/Mg++, blood C/S to be followed up
Discharge plan:

Follow-up care and management

No diagnosis
No improvement
Report on SOS

Writing task: 25
Using the case notes provided, write a letter to the Endovascular
Specialist at Austin Hospital to follow up on Mr. Isaac’s past history
of varicose vein. In your letter mention his current complaints and
summarize his health history.
In your answer:

Do not use note form

Use complex sentences
Use letter format

Question-17 Case study

Hospital: Alfred hospital

Patient details: 61 years old female patient Mrs. Jane was
transferred to the ward after undergoing treatment from the ENT
department. She has undergone FESS and Microdebrider I GA

Allergies: nil
Imaging studies/admission labs: Nil
Initial assessment score for which fixed parameters will not
change (1-20)-02
 Interpretation of Caprini risk score: 2-moderate
Vital sign: stable
Temp: febrile
Ration mobility status: Active independent

Complaints of breathing discomfort. Breathing exercises to

be taught and techniques to be explained to improve
breathing
BP: 130/80 MM Hg
Temperature: afebrile
height: 167 cm
weight – 63.4 Kg

Social background:
Mrs.jane 61 years, widowed, lives with her daughter Sera. Sera is
married and has two kids. Jane’s daughter is her primary financial
resource and her single point of contact. Sera has requested a home
visit of the physiotherapist along with written instruction on the
breathing techniques to be followed by Mrs.Jane so that she can
follow it up.
Admission date: 15 April 2022
Discharge date: 20 April 2022
Diagnosis: Sinonasal polyposis
Past History: KICIO Hypertension-four years epilepsy, thyroid.
Normal bowel and bladder habits. Disturbed sleep. Addictions none

Medical Progress:
Deviated nasal septum left, B/L nasal cavities P.glistening doesn’t
bleed on touch, insensitive to pain
Discharge plan:

Continue Nasal drops prescribed in case of block

Breathing exercises to be learnt and practiced
Follow up in one week

Writing task:26
 Using the information provided in the case notes, write a letter to
Ms.Melita physiotherapist at TLC community aged healthcare centre
Kilda road Melbourne VAC 3004, Aus who will be providing home
care visits for Mrs.Jane. In your letter, elaborate on Mrs.Jane’s
health history and procedures undergone along with mentioning her
breathing complaints. Request a home visit for Mrs. Jane to explain
breathing exercises along with her written version of the same to be
posted to her daughter

In your answer:

Your letter should be 180 to 200 words and not more

Use complex sentences
Do not use note form

Writing task: 27
Write a letter to Miss. Ruth’s Home nurse who will be providing
follow-up care for Mrs.Jane. Elaborate on her health history
summarizing her complaints and procedures undergone. State
parameters to be monitored along with her breathing exercises.
In your answer:

Use letter Format

Your letter should be 180 to 200 words and not more

Use complex sentences
Do not use note form

Question-18 Case study

Hospital: Mater hospital

Patient details:
Five year old child Matthew Robbins was bought with 4-5 episodes
of seizures, each lasting 2-3 minutes in the form of jerky movements
of both UL and IL, twitching eyelids, no involuntary
defecation/urination, loss of consciousness

H/O Postictal drowsiness-30 minutes

Drug compliance good
Recognizes and responds to sound
Mother felt tightness of chest at times
Not able to control bladder and bowel at times
H/O sleep disturbances uses melatonin syrup up at night

Admission date: 4 March 2022

Discharge date: 10 March 2022
Past History:

Taken to the nearest community healthcare centre, given

lorazepam with fosphenytoin. Referred for further treatment
Had similar episodes in the past

Medications:

Syp Valproate 10ml BD

Syp Lenetoracetum 4ml

Physical examination:

Add entry less on the right side

No Tracheal denation
SpO2-100% with 4LO2
Musculoskeletal system, genitourinary system – NAD
Soft no Organomegaly /tenderness

Discharge plan:
Evaluation needed for further management and diagnosis, to be
followed up with pediatrician in a tertiary centre
Writing task: 28
Write a letter to the pediatrician Mr.Jones in a Palmerston tertiary
centre at the below address to evaluate the case for further
diagnosis of the problem. Summarize the health history and
complaints of Mathew Robbins
Palmerston teriary healthcare centre
Palmerston City, NT, AUS
In your answer:

Do not use Note form

Elaborate on the complaints of the child in complex
sentences
Use letter format

Question-19 Case study

Hospital: Greenslopes hospital

Social background:
Mrs.Celin is a homemaker. Lives with her husband Thomas, who is a
retired bus driver. She has a daughter who works at the embassy,
her daughter Mrs. Lucas is the primary caregiver. The husband’s
contact details are provided below
Mr.Thomas
Parramatta, Kilda st
4532, Aus
+61 456382
Patient details:

Food and drug allergy: nil

C/O difficulty swallowing foods *7m
C/O cough with expectoration *3m
C/O swelling of L forearm *1w

History of present illness:

Patient was apparently asymptomatic seven months back

she developed difficulty swallowing solid foods
Not associated with pain
Was able to take liquid diet but progressively worsened
 Loss of appetite, loss of weight + around 30 KGs in seven
months
C/O swelling of left forearm not associated with pain
Hematemesis Melena no C/O jaundice, seizures, fractures

Admission date: 7, Jan 2022

Discharge date: 10, Jan 2022
Past History:

K/C/O type two diabetes mellitus * 5yrs On OHA insulin

Hypertension for five years - not taking medications for the
past four months
H/O tubal sterilization – 35 years ago
H/O nasal surgery 15 years ago
Menstrual history: attained menopause 15 years ago
Marital history: married for 40 years second-degree
consanguineous marriage
Family history: mother K/C/O T2DM no history of similar
complaints

Physical examination:

Temperature: Afebrile
Pulse:96/M
BP: 120/70 pallor+ pedal edema +
Documentation of review: the case of distal esophageal
tumor for further evaluation

Provisional diagnosis: Carcinoma esophagus.

Planned intervention:

Evaluate and proceed

Measurable goal: curative
Test reports: biopsy shows growth MD-SCC at the distal
esophagus
CT neck: Soft tissue at post ovoid region malign
B/L deep cervical CN positive
 FNAL of neck node, PET CT - awaited

Discharge plan:

To be followed up after cross checking awaited reports

Oncologist advice to be consulted

Writing task:29
Using the case notes with the information provided, write a letter to
Mr. Vincent oncologist at Royal Melbourne Hospital.
In your answer:

Explain the case reports of Mrs.Celin

Elaborate details of her reports using complex sentences
Use letter format
Do not use note form

Question-20 Case study

Hospital: Alice springs hospital

Social background:
Mrs. Lynn married for 1.5 years and has undergone a divorce in the
last three months is due for a check-up. She lives with a friend at W.
Sydney Square. The emergency contact information of her friend is
as follows
Reena John
PU 506 W Sydney square
Patient details:

LMP-February 12 2022
EDD: 19 November 2022
C/O late booked elderly preemie, 32W +6D
Hyperthyroid on T.thyronorm 87.5mcg OD
Anemia on oral iron BD
Fibroid complicating pregnancy 11.4 *9.2 *6 cm
Left lateral wall subserosal fibroid
Came with a complaint of breathlessness
 No C/O pain abdominal, bleeding P/V, leaking B/V

Past History:

No history of increased BP, sugar

Started T.susten in the 5th month
Anomaly scan done-anomalies ruled out
BP: 170/100mmhg
Inj.Lobet 20ng Iv
Regular menstrual cycle, normal bowel and bladder habits
Primigravida
History of twins’ paternal uncle
Uterus - 34–36 weeks relaxed, cephalic clinically liquor N

Medications:
T.folic acid taken
Inj. TT -2 doses
T.fe, ca

Management:

Steroid and MGS 04 coverage in case of premature labor

Measurable goal: patient and baby well-being
Discharge plan: Follow up in one week
Continue iron, folic acid, Thyronorm
Contact secession in any case of other symptoms

Writing task: 30
Write a letter to the social worker who checks on Mrs. Lynn to
monitor symptomatic changes and her well-being. Elaborate on her
present complaints and measures to be taken
In your answer:

Elaborate details of her reports using complex sentences

Use letter format
Do not use note form
 Question-21 Case study

Hospital: South Perth hospital

Patient details:

KICIO HTN
Pulse:88 BO:140/90mmhg
Resp rate:22 SPO2:98%
Temp: Afebrile
Present complaint: Since today afternoon unable to pass
urine
No burning micturition
No H/O frequency, urgency
Menstrual cycle regular
No other symptoms
GCS-15/15

Social background:
Anna 55 year old female who lives alone. Lost her husband 5 years
ago. A social worker visits once a week to look after her and check
her well-being. She has no children. Her relative is the informant and
source of contact in case of emergency.
Provisional Diagnosis: UTI
Past History: HTN 2 years
Medications:
T.Metacard 125 mg 1-0-0

Discharge plan:

Ongoing medications to be continued

Increase hydration
BP to be checked and followed up regarding meditation
dosage
Urine culture test and routine to be repeated after one week
and followed up with the community healthcare centre

Writing task:31
Using the information provided in the above case sheet, write a letter
to Ms.Jean the social worker who will be taking care of Anna on a
weekly/alternative day's visit. Elaborate on her post-discharge advice
and follow-up care that needs to be taken care of

In your answer:

Summarize the post-discharge advice that needs to be

taken care of using complex sentences
Do not use note form
Follow letter format, your letter should not be more than
180–200 words

Writing task:32
Write a letter to the physician Mr. Alexander, who will be taking care
of Mrs. Anna‘s follow-up care at the St. Mary’s community
Healthcare Facility, Gidley, NSW, 2740 AUS. Summarize her health
history and the tests to be followed up in a week.
In your answer:

Do not use note form

Follow letter format, your letter should not be more than
180–200 words

Question-22 Case study

Hospital: Calvary Public Hospital

Social background:
Melvin a 45 year old male, who works at the central cafeteria walked
in with a complaint of abdominal pain. He says that he has had
occasional instances of chest pain too. He feels if it will be related to
his cardio health. He wants a diagnosis and temporary relief for the
same.
 Patient details:

C/O abdominal pain, vomiting, nausea for three days C/C/O

GERD
SPo2-99%
Temperature: Afebrile
GCS:15/15
Pulse:77
Heart:S1S2 + Chest/lungs:B/L AE +
Abdomen: soft tendens over epigastric and umbilical region

Admission date: 7 January 2022

Discharge date: 8 January 2022
Provisional Diagnosis:

Acute gastroenteritis
AGE with mild dehydration
Past History: K/C/O rheumatoid arthritis not on Rx

Medications:

T.PAN 40
Inj.tremedol 50mg
Inj.pantop 4mg
Inj.Ondansetron 40mg

Discharge plan:

Follow up and review after 15 days

Review needed with a specialist for arthritis.
The medication which is prescribed needs to be continued.

Writing task:33
Using the information provided in the case notes above write a letter
to Dr.Augustine, Rheumatologist at Wales healthcare centre, Lathlain
St, Belconnen ACT, 2617, AUS.
In your answer:
 Summarize the health history of Mr. Melvin
Mention that he has not been consistent on his medicines
for rheumatoid arthritis and follow-up care is needed
Do not use note form. Use complex sentences to frame
your sentences

Question-23 Case study

Hospital: Liverpool hospital

Social background:
Mr.Luke a 50 year old male got admitted with a complaint of
chest pain, he says he has had similar episodes occasionally on a
mild note however, this time it was severe and did not subside.
Mr.Luke is a divorcee, he lives alone with his friends. He is mobile
and financially independent.
Patient details:

C/O chest pain retrosternal since 30 minutes

No rad-associated symptoms
No family history and data contributing factors
H/O Nor metrogyl taken yesterday for AGE
BP:140/90 Pulse:88 GCS-15/15 Temp:97.5
Resp rate:21

Admission date: 8 March 2022

Discharge date: 10 March 2022
Past History: Nil
Medications:

t. Pan 40 1-0-1-5 days

T.ojava 1gm SOS
Syr.Mucaine gel 10ml 1-1-1 -2 days
Tests:
Trop-s-awaited
ECG-NSE
 Discharge advises:

Follow physician if symptoms persist

Cardiologist advise should to be taken with the new reports
that needs follow-up

Writing task:34
Write a letter to the Cardiologist at Osborne Hospital, who will be
following up with Mr.Luke’s reports to evaluate and advise him based
on his health history and reports.
In your answer:

Do not use note form

Use letter format
Your letter should be not more than 180-200 words

Question-24 Case study

Hospital: Townville University Hospital

Social background: Ms.Margret 17 years old had a fall accidentally
when she was playing football, she was bought to the emergency
department as she had unbearable pain. She studies literature at
St.George Brown University. Her father works at the ATM and her
mother is a homemaker. Her contact details are as mentioned below.
Being a football player Margret requests home physiotherapy care
once her cast is removed to ensure that it doesn’t affect her
upcoming team matches.
Mrs. Glory
Nepean Parkdale
VIC 3915 AUS
+ 62 746452
Patient details:

N/O slip and fall accidentally when playing football

C/O pain in the right forearm
Tenderness above wrist joint
Abdomen soft nontender
 Immunization history up to date

Admission date: 10 June 2022

Discharge date: 12 June 2022
Diagnosis:
#R Radius undisplaced
Past History: nil
Medications:

T.pykiatsic 500mg 1-0-1

T.pan 1-0-1

Special instruction:

POP application
B/E slab applied
X-ray reports findings: R wrist fracture distal radius

Discharge plan:

Pain medications to be continued on SOS

Review in 10 days to remove the cast and monitor healing

Writing task:35
Write a letter to the home Nurse who will be looking after
Ms.Margret post-discharge. Mention her follow-up care and visit
dates.
In your answer:

Do not use note form

Use letter format
Your letter should be not more than 180-200 words

Writing task:36
Write a letter to Mr.Darwin,
Physiotherapist at Central brigade healthcare services,
Sebastopol VIC 3356, AUS.
 regarding follow-up home care visits, to ensure mobilization of
Ms. Margret. Mention her requests and goal to acquire complete
mobility.
In your answer:

Do not use note form

Elaborate on her medical history with her current mobility
status, healing progress, and symptoms
Use letter format
Your letter should be not more than 180-200 words.
 9. SAMPLE LETTERS
Letter-1 writing task- 2

7/3/22

Ms.Susan,
Registered dietician
Grand River Community Health Centre
Brantford ON.

Dear Susan,
RE: Ms.Ela Rose
I am writing this letter with regard to refer Ms.Ela Rose who requires
a healthy diet plan to overcome and manage her obsessive eating
habits and anemia.
Ms.Ela Rose lives with her friend and her parents live in CA. She has
the habit of drinking alcohol, cigarette smoking, and substance drug
use. Medical records show that she has endometriosis and anemia.
Ms.Ela Rose was presented to the hospital for overcoming
substance abuse problem. Eventually, she also claims to have sugar
cravings and obsessive eating habits. She also has anemia for which
she needs dietary changes. Moreover, she is also suffering with
hormonal imbalance.
Based on the given information, it would be greatly appreciated if
you could find the cause for obsessive eating and also provide her
with a healthy diet plan which suits for anemia as well as reduce the
sugar cravings.

Yours sincerely,
Registered nurse
Royal Jubilee Hospital

Letter-2 Writing task- 3

7/3/22
The Gynecologist
Grand river community health Centre
Brantford, CA

Re: Ms.Ela Rose Age 25 years.

I am writing this with regard to refer miss Ella Rose who has a
history of endometriosis and over bleeding due to endometrial
thickening and will require your further evaluation and assessment.
Ms. Ela Rose was admitted on 5-3-22
with chief complaints of over bleeding and endometriosis. She also
has anemia which is managed by Iron supplements. Subsequently,
she claims to have sugar cravings. Medical records show that she
has the habit of alcohol consumption, cigarette smoking, and
substance drug abuse. She has been monitored and investigations
such as blood tests and other hormonal markers were done. Her
ultrasound reports show endometrial thickening.
Socially she lives with her friend because her parents live in CA,
hence she meets them occasionally.
Based on the given information, it would be greatly appreciated if
you could assist her condition and deliver the treatment.
If you require further information, please do not hesitate to contact
me.

Yours sincerely,
Registered nurse
Royal Jubilee Hospital

Letter-3 writing task- 6

13.4.22
Lactation consultant
Breastfeeding support Centre
Eastern Ontario
Dear Doctor,
Re: Baby Lara
D.O.B:9/4:22
I am writing this with regard to refer baby Lara who has frequent
episodes of constipation and dehydration. She requires your expert
assistance to improve her condition and also her mother needs
education regarding breastfeeding techniques.
Mother Beneta had a normal Vaginal delivery and delivered a girl
baby weighing 300 gms. There are no prenatal and postnatal
complications.
Following the review, Beneta complains that her Baby is not latching
and feeding. Which leads to weight loss, decreased urination, and
constipation. Since she has a complaint of inverted nipples and
decreased milk supply, baby is getting formula fed. Though she is
using a nipple shield, the baby has trouble latching.
Based on the given information, it would be greatly appreciated if
you could educate her regarding the proper preparation of formula
feed and also ways to increase breast milk supply, and techniques to
feed the baby properly by enabling latching. Please ensure that baby
Lara has a follow-up review in two days.
If you require any further information, please do not hesitate to
contact me.

Yours truly,
Registered nurse

Letter-4 Writing task - 1

9.2.22

The community Nurse Head

Community Health Centre

Pinecrest
 Ottawa

Dear Head Nurse,

I am writing this with regard to refer Mr. Tony Robbinson

Who is diagnosed with prostate cancer and will require your post-
discharge care and management

Mr.Tony Robbinson is a retired teacher who lost his wife 15 years

ago. Past medical history shows that he has type-2 Diabetes
Mellitus, which is managed by Insulin. Since he is widowed, his
daughter should be contacted in case of emergency.

Mr.Robinson was admitted on 6.2.22 and was diagnosed with

prostate cancer. He underwent surgery and a skin biopsy was sent
for pathological study. Following his surgery, he is stable and post
operative pain is managed by analgesics.

Based on the given information it would be greatly appreciated if

you could observe for any complications associated with the surgery.
Moreover, he has to continue with insulin and analgesics as
prescribed.

If you require further information, please do not hesitate to

contact me.

Yours truly,

Charge Nurse

Abbotford regional hospital and Cancer Centre

Letter-5 Writing task - 12

March 21, 2022,
To,
Allendale homecare agency,
Milton, Ontario, CA

Dear In-charge (Allendale homecare agency),

Regarding: Mr. Victor Alice
I am writing this on behalf of Mr. Victor Alice who is diagnosed with
wheezing and will require your family support post-discharge care
and management.
Mr. Victor Alice had an episode of wheezing on January 10, 2022, for
which he was treated with nebulization. He has a habit of smoking,
and currently he smokes 5 to 10 cigarettes per day. Since he is
alone, he usually eats takeaway foods that have high calories.
Mr. Victor Alice was admitted again on January 1, 2022, as his
health condition worsened and ended up with breathlessness. He
has elevated blood pressure for which he was advised to be on a
low-fat diet. Moreover, he has to continue with the medication, deep
breathing exercises, and nicotine patches.
Based on the given information it would be greatly appreciated if you
could pay a visit and assist him with nutrition and also watch for side
effects of the medication. Most importantly, he has to give up
smoking to improve his condition.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse community center

Letter-6 Writing task - 13

21 March 2022
The dietitian
Ridge Meadows hospital

Dear dietitian,
Re:: Mr. Victor Alice
Age: 60 Years
I am writing this letter to request dietary suggestions for Mr. Victor
Alice who has complains of obesity and wheezing.
Mr.Victor Alice is in charge of the community activities and attends
the local community center. Since he lives alone, he usually eats
takeaway food. He also has a habit of smoking.
Mr. Victor Alice has been admitted with the chief complaints of
wheezing and dyspnea. On examination, he was found to have high
blood pressure and also increased respiratory rate which is treated
with nebulization.
As he eats high calorie foods, he is obese with a BMI off – –
Based on the given information, it would be greatly appreciated if
you could provide dietary suggestions to overcome obesity. In
addition to this, kindly provide a diet plan which helps to reduce
inflammation.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse

Letter-7 Writing task - 9

January 8, 2022
Miss Shelley Alfred
Senior nurse
Elkhart nursing and rehabilitation center

Dear Miss Shelley Alfred

Re:: Mr. Bob Haston

I am writing this with regard to referring Mr. Bob Haston who has
undergone total knee replacement and will require your post-
discharge care and management.
Mr. Bob Haston lives alone because his wife is out of the country to
assist their daughter on her delivery. He is a known case of
hypertension for 10 years which is managed by anti-hypertensive
medication. Additionally, he has vitamin D and B12 deficiencies
which are managed by using patches and medication.
Mister Bob Haston was admitted on 5 January 2022 for total knee
replacement surgery. Following the surgery, he was stable and post
operative progress was good. Since he has good progress, he tries
to walk independently. Post operative blood reports show that he has
normal vitamin D and B12 levels.
In addition to this, he is prescribed analgesics and daily dressing
which needs to be done in order to prevent infection.
Based on the given information, it would be greatly appreciated if
you could continue to care for Mr. Haston with pain reliever
medication (hyfenac) and also dressing which should be changed
daily.
Kindly recommend him to use a Wheelie/walker while ambulation.
Please ensure that he is taking the Physiotherapist’s opinion and
practicing mobilization exercises post his follow-up visit.
Moreover, he has a follow-up review in one week to repeat the blood
test.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse
Burnaby hospital

Letter-8 Writing task - 15

February 9, 2022
Miss Regina Chris
Community nurse

Dear Regina
Re:: Mr. Donald Rodriguez
I am writing this with regard to refer Mr. Donald Rodriguez who is
diagnosed with pneumonia and will require your post-discharge care
and management.
Mr. Donald Rodriguez who lives alone is a retired cab driver.
Following his wife’s death, he became weak and he eats only take-
away foods. Medical records show that he’s a known case of
diabetes mellitus and hypertension which are managed by
medication.
Mr. Donna Rodriguez was admitted on February 2, 2022, with chief
complaints of breathlessness, fever, generalized tiredness, and
sleeplessness. He underwent several investigations, which confirms
the diagnosis of pneumonia. Initially, he was treated with antibiotics
and antipyretics. Since he shows good progress, he is set for
discharge.
Based on the given information, it would be greatly appreciated if
you provide post-discharge care and management. Please
encourage him to take oral fluids and a nutritious diet.
In addition to this, monitor medication compliance. Also, encourage
him to do deep breathing exercises which are recommended by the
physiotherapist.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse
Mission Memorial Hospital

Letter-9 Writing task - 14

June 12, 2022
The director
Department of the Navy veteran Affairs
7700 Charlotte town
BF CIA space 8M9

Dear director
Re:: Mr. Jimmy Bernard Age: 72 years
I am writing this letter on behalf of Mr. Jimmy Bernard who requires
your assistance in seeking community healthcare fund and home
help. He is set to be discharged on 12 June 2022.
Mr. Jimmy Bernard who lives in his own house is a retired Navy
professional and receives a pension. He’s a known case of diabetes
mellitus since 2002 which is managed by insulin injection.
Mr. Jimmy Bernard has undergone umbilical hernia repair. Following
his surgery, he was stable but Mrs. Jimmy is concerned about the
mobility of her husband, also since he was advised to avoid lifting
heavy weights and strenuous activities. He is not able to do day-to-
day activities and other works. Although Mr.Jimmy has good health,
he has difficulty with his vision.
In addition to this Mrs. Jimmy is worried as they are not able to afford
a driver. Moreover, she is quite unaware of the procedure to seek
assistance regarding pension eligibility and home help so she sought
our help.
Based on the given information, it would be greatly appreciated if
you could arrange a home visit and address their concerns regarding
pension and home assistance.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Registered nurse

Letter-10 Writing task - 7

5, July 2021
Miss Syneta Dein
Senior living nursing home
Heartland

Dear Miss Syneta Dein

Re:: Mr. Auther Wilson Age:55 years
I am writing this with regard to refer Mr. Auther Wilson who
underwent femur implant removal surgery and will require your post-
discharge care and management.
Mr. Auther Wilson has a history of femur fracture which was
corrected by shaft and implant insertion surgery. Following the
surgery, he was stable and has good progress. So, he has been
planned for femur implant removal.

Mr. Auther Wilson was admitted on 3, July 2021 for femur implant
removal. He had low blood pressure which was managed by IV
fluids. The surgical wound has been secured with daily dressing to
prevent infection. Since he has progressive recovery, he is said to be
discharged on 5 July 2021.
Based on the given information, it would be greatly appreciated if
you could provide daily dressings and BP monitoring. Please ensure
that he is taking the physiotherapist’s opinion to continue
mobilization post his follow-up review, which is scheduled after 10
days.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Registered nurse
Peace Arch hospital

Letter-11 Writing task - 8

14, September 2022
Miss Bethesa Melita
Physiotherapist
Regent Park Physiotherapy center
Toronto

Dear Miss Bethesa Melita

Regarding: Miss Joy Matthew Age:22 years
I am writing this with regard to refer Miss Joy Matthew who is
diagnosed with an intercondylar comminuted fracture of the distal
humerus and will require your advice and assistance in improving
her mobility. She is said to be discharged on 14 September 2022.
Miss Joy Matthew was apparently normal until she accidentally fell
during her sports activity. She was admitted on 4, September 2022
with the chief complaints of superficial abrasion, swelling over the
ankle, and wound over the forehead and elbow.
She underwent an x-ray, which confirmed the fracture of the
humerus. Minor injuries approximated using sutures and fractured
limb was reduced using POP slab. Additionally, the wound has been
secured with a dressing. Post-procedural pain has been managed
with analgesics.
Based on the given information it would be greatly appreciated if you
could pay a home visit to provide her with exercises and also assist
her with ambulation post POP slab removal.
If you require further information, please do not hesitate to contact
me
Yours faithfully,
Registered nurse
Fraser Canyon hospital

Letter-12. Writing task - 17

10 May 2022
Miss Sharon Joey
staff nurse
Maynard nursing home
Toronto Ontario

Dear Miss Sharon Joey

Re: Ms. Alice Benedict
I am writing this letter to refer Miss Alice Benedict who underwent
open reduction and internal fixation of the pelvis and will require your
post-discharge care as well as management.
Socially, she lives alone because she’s been a widower for 11 years.
As per medical records, she is not taking any medication and there is
no previous history of any chronic illness.
Alice was admitted with the chief complaints of accidental fall and
incapability to move.
She underwent an x-ray which reveals a right acetabular fracture
and left interior pubic Rami fracture. Subsequently, the fracture was
treated with surgical intervention, ORIS-open reduction, and internal
fixation. Post operatively, she has pain which is managed with
analgesics. The wound has been secured with an aseptic dressing
which has to be changed daily.
Since she has good progress, stretching exercises has been
recommended.
Based on the given information, it would be greatly appreciated if
you could assist her with her daily dressing and mobilization. Kindly
advise her to use a walker and raised toilet seat. In addition to this,
encourage her to do stretching exercises. Please ensure that she is
taking oral medication which is prescribed for pain relief.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse

Letter-13 Writing task - 18

March 25, 2022
To
The orthopedist
Carlington community health care centre

Dear Doctor,
Regarding: Mrs. Rita Joseph Age: 32 years
I am writing this letter to refer Mrs. Rita Joseph who is suspected to
have a ligament tear and will require your further evaluation and
assessment.
Mrs. Rita Joseph has reported severe pain in the right foot and ankle
as she had a fall from the chair and her ankle got hurt and twisted.
Since she has a history of fractures in the same ankle, she is
anxious if it might affect her mobility. She underwent an x-ray but
there is no evidence of fracture or damage. She has severe pain
which is managed by intravenous diclofenac. Additionally, she was
prescribed T.hyfenac for five days.
Based on the given information it would be greatly appreciated if you
could provide further assessment and evaluation. If you require
further information, please do not hesitate to contact me.
Yours faithfully,
Charge Nurse

Letter-14. Writing task - 19

27 July 2022
The department of physiotherapy
Lions gate hospital
North Vancouver

Dear physiotherapist
Regarding: Mrs. Catherine Fernandes
Age: 35 years
I am writing this letter to refer Mrs. Catherine who has pregnancy-
related pelvic pain and will require your expert opinion and advice
regarding pain management and improving mobility.
Mrs. Katherine Fernandes lives with her husband and family and
works in a bank. She is an active member of the social welfare
program.
Mrs.Catherine has delivered a baby through a C section. She had a
complaint of pelvic pain throughout her pregnancy which seems to
be worsening post-delivery. Though she is receiving analgesics, she
is concerned about her aggravating pain. Moreover, she is worried
about improving her mobility and daily routine.
Based on the given information, it would be greatly appreciated if
you could educate her about exercises and supporting aids which
helps to give back support. Also kindly recommend ways to improve
her mobility. If you require further information, please feel free to
contact me.
Yours faithfully,
Church nurse
Lionsgate Hospital
North Vancouver

Letter-15. Writing task - 20

13 April 2022
To Mr. Philip
Project manager
Sydney Metro West rail Corp
PO box K659
Haymarket
NSW 1240
Dear Mr. Philip
Regarding: Mr. Derik
Age: 49 years
I am writing this letter on behalf of Mr. Derik who underwent
laparoscopic umbilical mesh plasty and will require your permission
for an extension of medical leave.
Mr. Derik who works for the Sydney Metro rail project is a field
engineer and technician. He lives with his family. Though he had
noticed swelling over the umbilical region for the past six months, he
didn’t pay attention due to his demanding work pressure. As the
symptoms got worsened, he was reported to the hospital.
Mr. Derik was admitted with chief complaints of swelling associated
with pain over the umbilical region. He underwent several
investigations which confirmed the diagnosis of umbilical hernia.
Eventually, he underwent laparoscopic umbilical meshplasty which
requires adequate rest and sleep for better healing. Since he has
only one week of medical leave, his wife is afraid that his work can
delay his healing. Moreover, he is not advised to do physical work.
But his work involves a lot of physical activity and strain.
Based on the given information it would be greatly appreciated if you
give permission for the extension of medical leave which would help
him for better healing.
If you require further information, please do not hesitate to contact
me.
Yours truly,
Charge Nurse

Letter-16 Writing task – 21

July 7, 2022
To
Dr. Henry
Cardiologist
The Royal Melbourne hospital
Parkville VIC
AUS 1840
Dear Dr. Henry
I am writing this letter to refer Mr. Allen who has the symptoms of
generalized weakness with dyspnea, giddiness, chest pain, and
functional rhythm and will require your urgent assessment and
evaluation.
Mr.Allen follows a routine lifestyle which includes exercises and
workouts. He is a known case of hypertension which is managed by
Tab. Telnet. He is also a known case of hyperthyroidism which is
managed by Tab. thyronorm.
Mr.Allen was admitted on 4.6.2022 with the chief complaints of
giddiness, chest pain, palpitation, shortness of breath, chest
discomfort, and arm pain.
He underwent investigations such as CBC, creatinine, electrolytes,
trop-T, PKMB amylase, lipase, urine, and blood culture, and reports
are awaited.
On examination, he has edema, lymphadenopathy, and cyanosis.
Following this, he was admitted to the ICU and vital parameters were
monitored.
Based on the given information it would be greatly appreciated if you
could do further assessment and management. If you require the
information, please feel free to contact me.
Yours truly,
Charge nurse

Letter-17. Writing task - 29

17, Jan 2022
To
Dr. Vincent
Oncologist
Royal Melbourne Hospital

Dear Dr. Vincent

Re: Mrs.Celin
I am writing this letter to refer Mrs.Celin whose biopsy shows a distal
esophagal tumor that requires further evaluation and management.
Mrs.Celin lives with her husband who is a retired bus driver. She is a
known case of diabetes mellitus which is managed by insulin
injection. She also has a history of hypertension for which she has
not been taking medication for the past 4 months. Past medical
history shows that she has had tubal sterilization and nasal surgery.
Her medical history shows that she has a second-degree
consanguineous marriage. She has attained menopause 15 years
ago.
Mrs. Celin was admitted with chief complaints of difficulty in
swallowing foods, cough with expectoration, swelling in the left
forearm, loss of appetite, and loss of weight. She underwent a
biopsy which shows abnormal cell growth in the distal esophagus.
She also underwent a CT neck which shows soft tissue in the post
ovoid region. Additionally, she underwent PET CT and FNAC of the
neck, for which results are awaited.
Based on the given information it would be greatly appreciated if you
could access and evaluate her condition for further treatment and
management.
If you require any other information, please do not hesitate to contact
me.
Your’s truly,
Charge Nurse
Greenslopes hospital

Letter-18. Writing task - 28

10, March 2022
To
Dr.Jones
Palmerstone tertiary Center
Palmerstone City N7, AUS
Dear Dr. Jones,
Re: Mathew Robbins Age:5 years
I am writing this letter to refer child Mathew Robbins who had 5
episodes of seizures and will require your further assessment and
management.
Mathew Robbins was admitted on 4, March 2022 with chief
complaints of seizures which lasts for 2-3 minutes in the form of
Jerky movements of both upper limb and lower limb and twitching
eyelids. Following the 5 episodes of seizure activity, he had
drowsiness which lasted for 30 minutes. On examination, he has
reduced air entry on the right side and he responds to sound.
Eventually, he was treated with syrup valproate and syrup
lenetoacetum.
Medical history reveals that he has past history of seizures which
were treated with lorazepam and fosphenytoin. In addition to this, he
also has a history of sleep disturbances which are managed with
melatonin syrup.
Based on the given information it would be greatly appreciated if you
could access his condition and evaluate it for further management
and diagnosis.
If you require any other information, please do not hesitate to contact
me.
Yours truly,
Charge Nurse
Mater hospital

Letter-19. Writing task - 25

19.4.2022
To The Endovascular Specialist
Austin Hospital
Dear, Sir/Madam
Re: Mr.Isaac Age:56 years
I am writing this letter to refer Mr.Isaac who has a past history of
varicose veins and will require your further evaluation and
assessment.
Mr.Isaac who lives alone is a retired librarian and he is financially
independent. He has two sons but both live away from him. For the
emergency purpose, he has given his son’s contact number who
lives in Alphington VIC 3018. Medical records show that he has a
medical history of the varicose vein which is untreated.
Mr. Isaac was admitted on April 17, 2022, with chief complaints of an
accidental fall on the stairs. On examination, he obeys commands
but he had abnormal flexion to plain painful stimuli. He underwent
investigations such as CBC, electrolyte, ABG, PTINR, and reports
are to be followed up.
Though he is aware of his varicose vein, he left it untreated and
there was no follow-up.
Based on the given information it would be greatly appreciated if you
could provide further evaluation and assessment regarding his
health condition.
If you require further information, please do not hesitate to contact
me.
Yours sincerely,
Registered nurse
Osborne Park Hospital

Letter-20. Writing task - 23

6 April 2022
Mr. Philip Terree
The physiotherapist
Community healthcare Centre
NSW AUS 5100

Dear Mr. Philip

Regarding: Miss Alma
Age: 65 years
I am writing this letter to request instructions regarding the
spirometer and practicing exercises that are prescribed to Miss.
Alma to manage her condition of bronchial asthma.
Miss Alma who receives a pension is a retired professor and she is
financially independent. She lives with her friends and she has one
daughter who is married and lives in Texas. Medical records show
that she is a known case of DCLD with portal hypertension which is
managed by medication. She also has a history of atypical
pneumonia and anemia in the past.
Based on the given information, it would be greatly appreciated if
you could educate her about exercises and supporting aids that help
to give back support. Also kindly recommend to her the ways to
improve her mobility.
If you require further information, please do not hesitate to contact
me.
Yours faithfully,
Charge nurse
 10. DO’S AND DON’T’S
1. Do not write anything within the first five minutes which is
specially to read the question. However, you can underline
or scribble in the question paper if needed
2. Provide all information the reader needs to know clearly
3. Do not mention any irrelevant information which is not
needed
4. Mention the test date as the date in your letter if the date is
not given in the question
5. Avoid over usage of short forms for medical terminologies.
Mention full form wherever needed.
6. Re-read your letter and check for possible errors in the last
five minutes.
7. Use correct punctuation wherever needed.
8. Organize all the ideas and details which you need to
mention in the letter roughly in key points before you start
writing your letter.
 11. GLOSSARY & ABBREVIATIONS
1. UA- Urine Analysis
2. PT-Prothrombin Time
3. PTT- Partial Thromboplastin time
4. INR- International Normalized ratio
5. CAD-Coronary artery disease
6. HTN-Hypertension
7. DM-Diabetes Mellitus
8. CHF-Congestive Heart failure
9. COPD-Chronic Obstructive Pulmonary disease
10. MI-Myocardial Infarction
11. PE-Pulmonary Embolism
12. PNA-Pneumonia
13. TIA- Transient Ischemic Attack
14. CVA- Cerebrovascular Accident
15. ARDS- Adult Respiratory disease
16. CKD- Chronic kidney disease
17. AKI- Acute kidney disease
18. ARF- Acute Renal failure
19. ESRD- End stage renal disease
20. CF- Cystic Fibrosis
21. CP- Cerebral palsy
22. IBD- Inflammatory Bowel disease
23. IBS- Irritable bowel syndrome
24. UC- Ulcerative Colitis
25. CBC- Complete blood count
26. WBC-White blood cells
27. RBC- Red blood cells
28. Plt- Platelets
29. BMP-Basic Metabolic Panel
30. CMP- Comprehensive Metabolic Panel
31. LFT- Liver function test
32. H&H-Hemoglobin and hematocrit
33. Hb/HGB- Hemoglobin
34. HCT-Hematocrit
35. CXR-Chest X-ray
36. ABX-Abdominal X-ray
37. US-Ultrasound
38. MRI-Magnetic Resonance Imaging
39. CT-Computed Tomography
40. EKG/ECG-Electrocardiogram
41. EEG-Electroencephalogram
42. KUB-Kidney, ureter, bladder (x-ray)
43. PFT-Pulmonary Function Test
44. CEA-Carcinoembryonic antigen
45. AFP-Alpha fetoprotein
46. B2M-Beta 2-microglobulin
47. PSA-Prostrate specific antigen
48. Beta-hcG- Beta-human chorionic gonadotropin
49. Calcitonin
50. NSAIDsAIDS- Nonsteroidal anti-inflammatory drugs
51. ABG-Arterial blood gas analysis
52. URI- Upper respiratory infection
53. ESR-Erythrocyte sedimentation rate
54. BCG-Bacille Calmette Guerin
55. CT- Computed tomography
56. COPD-Chronic obstructive pulmonary disease
57. TB-Tuberculosis
58. RSV-Respiratory Syncytial Virus
59. BMR-Basal Metabolic Rate
60. CHF-Congestive heart failure
61. ARDS-Acute respiratory distress syndrome
62. HSV-Herpes Simplex Virus
63. GERD-Gastro Esophageal reflux disease
64. PPI-Proton pump inhibitors
65. DOC-Drug of choice
66. SGOT-Serum Glutamic oral acetic transaminase
67. FNAC-find needle aspiration cytology
68. NG-Nasogastric
 69. TPR-Temperature, pulse, respiration
70. SOB-Shortness of breath
71. CK-Creatinine kinase
72. PET-Position emission tomography
73. GFR-Glomerular filtration rate
74. ADH-antidiuretic hormone
75. MCV-mean corpuscular volume
76. AAA-Abdominal I’ll take an aneurysm
77. ELISA-Enzyme linked immunosorbent assay
78. PGs-prostaglandin
79. IOP-Intraocular pressure
80. PMS-Premenstrual syndrome
81. DUB-Dysfunctional uterine bleeding
82. PID-Pelvic inflammatory disease
83. HRT-Harmony replacement therapy
84. STD-Sexually transmitted disease
85. IUD-intrauterine devices
86. GTT-Glucose tolerance test
87. MCH-Mean corpuscular hemoglobin
88. MVR-Mitral valve replacement
89. OPV-Oral polio vaccine
90. ORT-Oral rehydration therapy
91. THR-Total hip replacement
92. TKR-Total knee replacement
93. I&D-incision and drainage
94. COAD-Continuous positive airway pressure
95. IVIG-Intravenous immunoglobulin
96. PCOD-Polycystic ovary disease
97. MLC-Medico legal cases
98. GA-General anesthesia
99. RA-Regional anesthesia
100. SA-spinal anesthesia
101. EA-epidural anesthesia
102. LA-Local anesthesia
103. PPE-Personal protective equipments
104. EO sterilization-Ethelyn oxide gas sterilization
105. PACU-Post anesthesia care unit
106. DVT-Deep vein thrombosis
107. AMBU-Artificial manual breathing unit
108. AED-automated external defibrillator
109. LP-Lumbar puncture
110. TBCA-total body surface area
111. CPR-Cardiopulmonary resuscitation
112. BSE-breast self-examination
113. BKA-below knee amputation
114. AKA-Above knee amputation
115. SCID-severe combined immunodeficiency
disease
116. CDC-Center for disease control and prevention
117. NICU-neonatal intensive care unit
118. PICU-Pediatric intensive care unit
119. CCU-Coronary care unit

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 Acknowledgement

My heartfelt gratitude
To every student, who inspired me to write this, to every single
person in the medical fraternity for helping me in providing inputs
with the medical terminologies and details. A special thanks to my
editor Oviya Kulasekaran. Last but not the least to the entire team of
Wordsmith, without which this wouldn’t have been possible.
 About The Author
Shamini Mary

Shamini Mary is an internationally acclaimed OET trainer,

entrepreneur and author. She has successfully coached 1000+
nurses across varied work experiences to improve their
communication skills. She has been recognized especially for her
skills in OET training by the Cambridge Language Assessment. She
is the Director and OET speaking course specialist at Wordsmith
Training and Consulting LLP. Wordsmith is also listed as the leading
institute for OET Training in Bangalore.

She has been working on coaching individuals from different

backgrounds in terms of their language, soft skills and
communication in the English language for more than 8 years. She
has enabled several Nurses to crack OET with grade A/B in their first
attempt and pursue their dream jobs in dream locations. She is also
an author, currently working on different competencies of
communication and self help.
 Books By This Author
OET SPEAKING FOR NURSES

Are you a healthcare professional who is looking forward to crack

your Occupational English Test (OET) speaking section with the best
possible score A/B? Then this book is all you need. This book is an
overall guide that will coach you right from the basics of the exam,
while addressing your practical difficulties in preparation parallelly. It
also has insights and analogies for scoring. The methods mentioned
in this book are not only designed to improve your speaking but to
improve your language elaborately, enabling a confident
communication pattern.
This book has:
-17 sample conversations
-18 practice questions
- methods to prepare
- tips and techniques to get grade A/B easily
- ways to tackle challenges in communication

JUST A MESSAGE AWAY

Tara is 32, Mom to a six-year-old and married to the love of her life.
When everything seems so perfect in reality, things start falling apart.
Something feels wrong, she starts questioning her purpose in life.
Her discoveries lead to an encounter of love, disappointments and
regrets that hold her in the present. She confronts her family
members and then stalks her high school crush Mithran after reading
her old diary.

What does she discover.? Will she find answers to all her
unanswered questions?
This short story explores the world of love, hate, disappointments
and emotional baggages which many tend to ignore in every
relationship, while pretending that it does not exist.

THE MARITAL PARADOX

Marriage is one of the most special events in a person’s lifetime. The
modern era of Indian marriages and matchmaking have made it
nothing less than an online shopping. Choosing your partner in a
click and getting to know them virtually have become the new norm.
A helpless anxious state generally prevails between two strangers
who try to choose their better halves at their best while prioritizing
their family’s preferences too.

The marital paradox is a roadmap to assist you choose and

understand your partner mindfully. With ideas and analogies to get
comfortable and develop an emotionally healthy relationship.
Involving a practical approach to efficiently deal with challenges and
crisis in relationships. Enabling you to get prepared for your big day
happily.

Overall, this book aims in making the process of finding your ideal
partner; a truly meaningful experience to define your relationship.