OET Nurses Coaching

Time allowed:

Reading Time: 05 Minutes 

Writing: 40 Minutes 

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

Case Notes: 

You are a Charge Nurse at the hospital where Mrs Lawrence was treated. She is due for discharge. 

Patient Details: 

Name: Janifer Lawrence 

DOB: 14/ 10/ 1965

Admission Date: 13 October 2012

Discharge Date: 10 November 2012 

Diagnosis: Lower limb amputation following a car accident. 

Hobbies: Trading on the stock market, reading

Social Background: worked as Financial Securities Advisor 1970 – 2000.

Married, 1 daughter (aged 20) student in the United States, husband retired (Cancer Patient)

No Pensioner

Husband leaves – America for treatment next month.

Limited exercise can walk with aid. 

Medical History: 

1982- Appendix removed 

High BP – management ongoing, Diabetes Mellites Type 2, no other known medical history.  No signs of dementia.

Medication:

Medications Aspirin (100mg), Ramipril 5mg, Metformin 500 mg orally once day

Nursing Management: 

12/10

Pre-amputation

HbA1c: 6.7, Fasting: 130 mg/dl, PP- 172 mg /dl, BP – 150/ 90, Good control

Bowel and bladder function normally, Nutritional status  good 

13/10

Post amputation

HbA1c: 7.6, Fasting: 165 mg/dl, PP: 260 mg/dl, BP 180/100, Given 3 units of insulin, Atenolol, Catheter and IV fluid, pain relief medications 

14/10

Pain, analgesia given, Compression socks to heal the wound quickly, metformin increased  to 1000 mg post-operatively  

28/10

Able to walk to the bathroom with a walker, Catheter removed, Vicodin 7.5 mg (thrice daily) for pain (orally) 

10/11

Reading at discharge 

130 mg /dl, PP: 150 mg/dl Pain described as 6/10. Increases after walking for 10 minutes (8/10) 

Can walk approximately 80 to 100 steps with the aid.

Daily compressive dressing required. 

Staples removed in one month 12/12

Monitor BP and sugar level  

Wound site healing well. 

Discharge Plan: 

Prompt, uncomplicated wound healing, Compressive wound dressings to control of oedema, control of postoperative pain, prevention of joint contractures and rapid rehabilitation to optimum levels of activity.- team to  how to wash and take care of your residual limb

Rehab begins soon for a few weeks – a range of motion and strengthening exercise – upper body strength and maintain range of motion in remaining limb – physiotherapist assistance. 

Balance exercises – decrease the risk of falling. 

Learning to walk with on a level surface

Learning to walk up and down ramps and stairs

Sitting down or standing up.

Fall training

To make her able to do her daily activities her own and to live independently.

Occupational therapy: complete a home hazard assessment since she will be living alone. Cop up with the loss of limp, physically and mentally. 

Discussed with the patient: Non-slip mat for a bathroom? Rails  

Refer for  prosthetic fitting 

Writing Task:

Write a referral letter to physiotherapist Mr Daniel Craig, Physiotherapist, 3 Ard glass, Clive Street, Grangetown, Cardiff, CF117HJ who will be responsible for providing postoperative rehabilitation during her early recovery period.

MODEL ANSWER

Mr Daniel Craig, 

Physiotherapist, 3 Ard glass, Clive Street,  Grangetown, Cardiff, CF117HJ.

(Today’s date)

Re: Mrs Janifer Lawrence, DOB: 14/ 10/ 1965

Dear Mrs Lawrence, 

I am writing to refer this patient for post-operative rehabilitation during early recovery after a lower limb amputation following a car accident. She is being discharged today. 

Mrs Lawrence needs to undergo balance exercises to help decrease the risk of falls and be trained to move through different surfaces such as ramps, stairs, and level surfaces, especially since she will be managing herself as her husband is moving overseas for treatment month. 

Mrs Lawrence also requires a range of motion exercises to strengthen the remaining limb. (The possibility of a non-slip bath mat and rails was discussed with Mrs Lawrence). 

Mrs Janifer was able to walk to the bathroom with a walker after two weeks following surgery. She can now walk 80–100 steps with her walker but is experiencing moderate pain (6/10), which increases after she walks for 10 minutes (8/10). Vicodin 7.5 mg (thrice daily) has been prescribed to manage pain. Caution needs to be exercised as her moderate level of pain increases after continued walking. However, her wound site is healing well. 

Yours sincerely,

Charge Nurse