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

Time allowed: 40 minutes

You are a registered nurse in Ramsay healthcare, Colman Hill, Halesowen B632AH

Name: Johnsy Dickson – 65 years old
Admitted: 12 March 2013

To be discharged: 17 March 2013

Diagnosis: Pleurisy

Social background:

Mrs Dickson has been widowed 20 years. Has been an active member of the community all her life. Is the current President of social club. She with her husband ran the Evertons Newsagency until his death at which time she retired. Attends the local Community Centre two times a week to play Chess. Has been a smoker all her life (since 20 years of age). Current smoking 15 a day.


12 Mar 2013

Overweight: BMI 30 Had CXR; IV Ampicillin with supplementary O2 Advised to give up smoking.
BP 160/80 Pulse 94 Slightly raised temperature: 38.7oC Breathless

14 Mar 2013

On low-dairy diet Advised about Nicotine patches.

Productive cough – sputum culture done Atorvastatin 20mg/day and Celebrex 100mg/day

15 Mar 2013

  • Deep breathing exercises started. Is keeping to a non-smoking regime.
  • Using Nicotine patches and Zyban (150mg b.i.d).
  • To be discharged 17Mar 2013.


  • Support Mrs Dickson – needs monitoring for medication compliance
  • Needs help with nutritious meals (Meals on Wheels) and house keeping (Council Home Help) – Assistance with shopping
  • Monitor her quit-smoking plans – watch for side effects from Zyban such as dry mouth and difficulty in sleeping. If side effects occur Zyban should be stopped. Zyban to be withdrawn after 2 months. Nicotine patches to continue until smoking addiction is under control.


Write a letter of referral to Suffolk Care Clinic, 43 Spencer Road, Halesowen B632AH requesting monitoring and ongoing care be arranged for Mrs Dickson. Community Nurse to make sure Mrs Dickson continues her cessation of smoking – with the help of Nicotine patches and Zyban. Zyban tablets to cease as soon as side effects occur (if any). Both Zyban and Nicotine to cease as soon as craving for cigarettes has stopped.

Letter should be 180 to 200 words long / only the first 25 lines will be considered.

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