The task
Assume that today's date is 5 November 2026. Mr Carragher is recovering at home and has attended the clinic for a nursing review today. This is original independent practice material.
You are a registered nurse at the clinic where Mr Zachary Carragher is receiving treatment. Using the case notes, write a letter to his agreed friend, Ms Kirstin Lunny, explaining the clinician's recorded review arrangements and instructions for obtaining urgent and emergency help. Also answer her questions about catching cellulitis during visits and briefly explain how he can reduce future skin infections. Keep preventive actions directed to Mr Carragher and preserve her agreed practical role without assigning clinical duties or responsibility for monitoring him. Address the letter to Ms Kirstin Lunny, 18 Orchard Road, SW1V 2AB, United Kingdom. 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.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Advice letter.
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Which case notes belong in this letter?
Cellulitis: visiting, follow-up and safety advice
You are a registered nurse at the clinic where Mr Zachary Carragher is receiving treatment. Using the case notes, write a letter to his agreed friend, Ms Kirstin Lunny, explaining the clinician's recorded review arrangements and instructions for obtaining urgent and emergency help. Also answer her questions about catching cellulitis during visits and briefly explain how he can reduce future skin infections. Keep preventive actions directed to Mr Carragher and preserve her agreed practical role without assigning clinical duties or responsibility for monitoring him. Address the letter to Ms Kirstin Lunny, 18 Orchard Road, SW1V 2AB, United Kingdom. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Zachary Carragher
- DOB: 14/02/1969 (57 yrs)
- Lives alone; independently manages washing, dressing and medicines
Social background
- Consent: share recovery and prevention advice with friend Ms Kirstin Lunny; agreed grocery deliveries, check-ins and transport to review
- Friend's role: practical support only; no medicine administration, wound care or nursing assessment requested
- Friend's questions: stop visits to avoid catching cellulitis? What can pt do to prevent another episode?
- Retired bus driver; enjoys collecting vintage railway tickets
- Sister privately described pt as selfish during a dispute over inheritance
- Complained that receptionist was rude about parking arrangements
Medical history
- Mild eczema; occasional dry skin on legs
- Appendicectomy aged 19; uncomplicated recovery
- No diabetes or immunosuppressive treatment
- No known medicine allergies
Assessment and progress
- 03/11/26: painful, red, swollen L lower leg; attended clinic
- Small gardening scratch preceded symptoms; now closed
- Clinician diagnosed cellulitis; no abscess identified
- Oral antibiotics started 03/11; supplied with complete dispensing instructions
- 05/11 nurse review: afebrile, feels well, eating/drinking normally
- Pain/swelling ↓; redness no longer spreading
- Skin intact; no discharge or dressing required
- Nurse explanation: infection in deeper skin; not passed person to person; no need to stop ordinary social visits because of cellulitis
Treatment and prevention advice
- Clinician's instruction: finish prescribed antibiotic course, even when feeling better
- Recovery advice: elevate leg on pillows when sitting/lying to reduce swelling
- Bacteria may enter through small skin breaks; prevention: keep skin clean, moisturise dry areas regularly, continue usual eczema care; reduces risk, not a guarantee
- Future minor cuts/grazes: pt to wash hands → rinse wound with clean water → cover with sterile plaster/dressing; redness, swelling or ↑ pain → urgent GP/111
Follow-up and safety plan
- Clinician booked review: same clinic, 06/11/26, 10:00; attend even if improving; friend driving
- Urgent advice: spreading redness or worsening pain/swelling → urgent GP appointment or 111; do not await review
- Emergency advice: 999 immediately for very high temperature/shivering, fast breathing, confusion, fainting or cold, clammy skin
- Future gardening: gloves, protective clothing and suitable footwear to reduce cuts/scrapes
- Pt has clinic contact details and written treatment, review and escalation advice; verbal advice understood
Who is reading, and what do they need?
Ms Kirstin Lunny is an agreed friend receiving advice with Mr Carragher's consent. She needs the review date, time and transport arrangement, instructions for urgent help without waiting for review, and the symptoms requiring an immediate 999 call. She also fears catching cellulitis during visits and wants to understand prevention. Use plain language and direct preventive actions to him. Her agreed help covers groceries, check-ins and transport; she has not agreed to administer medicines, dress wounds, assess his condition or monitor his recovery.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Consent to share recovery and prevention advice; agreed grocery deliveries, check-ins and transport to review | Establishes authorised communication and the practical help Ms Lunny has accepted, including driving him to the booked review. |
| Practical support only; no medicine administration, wound care or nursing assessment requested | Explaining when to obtain medical help must not turn Ms Lunny into a clinical carer or make her responsible for monitoring him. |
| Cellulitis affects deeper skin and is not passed person to person; ordinary visits need not stop | Directly resolves her transmission concern. Intact skin may provide context, but it is not the reason cellulitis is not caught through ordinary visits. |
| Bacteria may enter small skin breaks; keep skin clean, moisturise dry areas and continue usual eczema care | Useful concise prevention advice for him to follow. Select enough to answer her question without displacing the review and safety instructions or promising complete prevention. |
| Future minor cuts: wash hands, rinse with clean water and cover with a sterile plaster or dressing; urgent GP/111 advice for redness, swelling or increasing pain | An optional prevention example. If selected, keep the care directed to him and retain the infection signs and advice route; a full minor-wound paragraph is unnecessary. |
| Gardening scratch now closed; gloves, protective clothing and suitable footwear for future gardening | Protective clothing is an optional, personalised prevention example. The earlier scratch does not prove where this infection began. |
| Review at the same clinic on 6 November 2026 at 10:00; attend even if improving; Ms Lunny to drive | Gives her the complete appointment arrangement and makes clear that improvement does not cancel the planned review. |
| Spreading redness or worsening pain or swelling: urgent GP appointment or 111; do not wait for the booked review | Explains which deterioration needs urgent help and prevents the next-day appointment from delaying assessment. |
| Very high temperature or shivering, fast breathing, confusion, fainting, or cold, clammy skin: call 999 immediately | Communicates every recorded emergency trigger with its immediate action, without asking the friend to diagnose or assess severity. |
| Written treatment, review and escalation advice already supplied; finish the prescribed antibiotic course even when feeling better | Antibiotic completion or written instructions may be acknowledged briefly. Neither substitutes for communicating the appointment and urgent and emergency instructions in this letter. |
| Pain and swelling reduced; redness no longer spreading; currently well with intact skin | A short progress summary can orient Ms Lunny, but individual observations are optional and do not remove the need for safety advice. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired bus driver; collects vintage railway tickets | Neither detail helps explain visits, prevention, the review arrangement or when to obtain medical help. |
| Sister's private inheritance criticism; complaint about receptionist's parking response | These remarks are unrelated to the authorised advice and would introduce inappropriate personal or administrative material. |
| Full attendance chronology and exact antibiotic start date | Detailed chronology can be left out because Ms Lunny needs usable advice and arrangements rather than a treatment history. |
| Appendicectomy aged 19; uncomplicated recovery | Remote surgery has no stated connection to his current skin care or her concerns. |
| No diabetes, immunosuppressive treatment or known medicine allergies | These clinical negatives do not change the recorded advice or help her carry out the agreed practical support. |
| Elevating the leg on pillows to reduce current swelling | Prefer omitting this optional recovery advice to preserve space for the appointment, help-seeking instructions and her questions. It may be included briefly as an action for Mr Carragher if those priorities remain complete. |
A paragraph plan for this case
Open with consent and the purpose of explaining follow-up and safety instructions while answering Ms Lunny's questions. Give the same-clinic review on 6 November at 10:00, attendance despite improvement and her agreed transport role. Clearly separate urgent GP/111 advice for spreading redness or worsening pain or swelling, without waiting for review, from every recorded emergency symptom requiring an immediate 999 call. Reassure her about ordinary visits and add brief patient-led prevention advice. Preserve her practical role and avoid assigning monitoring or clinical duties. Progress and existing written instructions are optional context.
Where candidates slip on this task
- Use 5 November 2026 as the letter date. Communicate the same-clinic review on 6 November at 10:00, attendance even if improving and Ms Lunny's agreed transport. Keep 111 and 999 because this case is set in the United Kingdom.
- Do not promise that skin care eliminates recurrence or state that the gardening scratch definitely caused this episode. Do not add an antibiotic, dose, duration or new eczema treatment.
- Separate advice for future minor cuts from today's intact skin. Do not imply that he currently needs dressings or that Ms Lunny must provide wound care, nursing assessments, medicine administration or monitoring.
- Do not replace the recorded safety instructions with a statement that written advice is available. Include spreading redness and worsening pain or swelling with urgent GP/111 action without waiting for review, and all recorded emergency symptoms with immediate 999 action.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Nursing letter tasks
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Must the letter communicate the booked review and urgent and emergency instructions?
Yes. State the same-clinic review on 6 November at 10:00, attendance even if improving and her agreed transport. Explain that spreading redness or worsening pain or swelling requires an urgent GP appointment or 111 without waiting for review. Retain every recorded emergency symptom: very high temperature or shivering, fast breathing, confusion, fainting, or cold, clammy skin means calling 999 immediately. Existing written advice does not replace these explanations, and sharing them does not assign her monitoring or clinical duties.
Does saying that cellulitis is not passed person to person mean future wounds need no care?
No. Reassurance about ordinary visits answers the transmission concern. Cleaning and covering future minor cuts protects damaged skin, while redness, swelling or increasing pain calls for urgent GP or 111 advice. This is an optional prevention example; daily skin care or gardening protection may provide a brief answer instead. See NHS cellulitis guidance and NHS cuts and grazes guidance.
Sources
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