MR ROBERTS .WRITE A LETTER AND SUBMIT

Notes

Hospital:                The Royal Adelaide Hospital  Patient Name: Mr Robert                                                    

DOB: 02/06/52                                                     

Marital Status:Married                                                    

Next to kin: Wife 

Admission Date:1 October 2011 

Discharge Date:26 November 2011 

Reason for admission:            Chronic cough, hoarseness, difficulty breathing upon exertion

 Diagnosis:                                 Squamous Cell Carcinoma of left lung confirmed by CT scan 

Past Medical History:             HT diagnosed June 2008             Frequent episodes of bronchitis              Heavy smoker-40 years (1-1 ½ pack/day)             Non- drinker  

Social History:  

Lawyer                                         

Supportive wife                                                 

2 married daughters in regular contact. One is 6 months pregnant  

Medical Progress:                  Resection of the lung

Chemotherapy and radiotherapy   Ineffective 

treatment: metastases in liver  and spine  Cancer in terminal stages-Mr Jones wishes to return home  

Nursing Management:  Fluid management    Oxygen therapy     Patient comfortable 

Pain management:                Morphine sulfate 40mg 4 hourly / 20mg dose as needed.  

Discharge Plan: Monitor pain status   Manage symptoms             Check need for assistance with mobility / bathing    Daughters want father to stay in hospital for further treatment    - provide family with emotional support

Writing Task -Using the information given in the case notes, write a letter to Marry Watson, Palliative Care Manager, Royal District Nursing Service (RDNS) about the patient. 

In your answer: • expand the relevant case notes into complete sentences • do not use note form • use letter format The body of the letter should be approximately 180-200 words.