The task
Assume that today's date is 22 October 2026. Wen Song is being discharged home this afternoon.
You are a registered nurse on the paediatric ward of the children's hospital. Using the information in the case notes, write a letter to Ms Chiamaka Ekanayake, the school nurse at Wen's school, informing her of Wen's diagnosis and her seizure management plan, and requesting support with her care and safety when she returns to school. Address the letter to Ms Chiamaka Ekanayake, School Nurse, Health Office, Primary School Campus, 22 Banksia Street. 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: Discharge letter.
Case notes
Patient details
- Name: Wen Song
- DOB: 14/03/2017 (9 yrs)
- Address: 14 Acacia Avenue
- Admitted: 19/10/26; discharge: 22/10/26
Social background
- Lives with mother & younger brother (5 yrs); father lives interstate, contact during school holidays
- Year 4 student; school swimming program Thurs afternoons this term
- Enjoys piano; plays in school netball team
- Mother works full-time, contactable by mobile during school hours
- Mother told staff that pt's father 'never takes her health seriously'
Medical history
- Tonsillectomy age 5
- Mild asthma — salbutamol inhaler PRN (kept at school); last used 1/12 ago
- Immunisations up to date
- Allergies: nil known
- Maternal grandmother 'had fits as a child' — no further details
- Teacher reported brief 'daydreaming' episodes in class over last 3/12; mother noticed 2 episodes of staring + lip-smacking at home
Admission
- 19/10: generalised tonic-clonic seizure at home on waking, approx. 20 min; paramedics gave midazolam → seizure stopped
- Drowsy approx. 3 hrs post-seizure, then back to normal; no further seizures in hospital
- Bloods (incl. glucose, electrolytes) NAD
- EEG 20/10: focal epileptiform discharges (L temporal region)
- MRI brain 21/10: normal
- Dx (paediatric neurology): focal epilepsy; 'daydreaming' episodes likely focal seizures
- Possible trigger: sleep deprivation (sleepover night before seizure)
Treatment
- Levetiracetam oral BD commenced 20/10 — given at home 07:00 & 19:00; no doses needed at school
- Possible SEs: drowsiness, irritability, mood/behaviour changes — report to mother
- Rescue med: buccal midazolam, dose & instructions as per Emergency Medication Management Plan; supply for school provided by mother
- Give midazolam if tonic-clonic seizure lasts ≥ 5 min; call ambulance (000) if tonic-clonic seizure reaches 5 min (even if midazolam unavailable) or whenever midazolam given; call 000 immediately if seizure in water, injury, breathing difficulty, or repeated seizures without recovery between; recovery position once jerking stops & monitor breathing
- Mother trained in midazolam administration on ward 21/10
- Pt complained hospital food 'disgusting'; ate mainly snacks brought from home
Discharge plan
- Return to school Mon 26/10/26
- Epilepsy Management Plan + Emergency Medication Management Plan enclosed for school; staff supervising pt need accredited epilepsy & midazolam training before return
- Swimming only with constant 1:1 adult supervision in water; avoid unsupervised climbing at heights
- Record any seizures/'daydreaming' episodes (time, duration, description) & inform mother same day
- Regular sleep routine advised
- Paediatric neurology clinic f/u in 6/52 (Dr Rohit Yadav)
- School camp in Nov (before f/u) — contact Dr Yadav before camp for individual risk assessment & camp mgmt advice
Who is reading, and what do they need?
Ms Ekanayake is the school nurse who will support Wen's return on 26/10 and brief staff. She needs the diagnosis, how seizures may look, what medicine is given where, the complete emergency steps, activity restrictions, recording and the camp issue. She does not need investigations or family dynamics.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Focal epilepsy after tonic-clonic seizure 19/10; 'daydreaming' episodes likely focal seizures | The school needs the diagnosis and to recognise that the staring episodes may be seizures. |
| Staring and lip-smacking episodes at home; teacher saw 'daydreaming' over 3 months | Helps staff recognise the brief episodes, which are not as obvious as a convulsion. |
| Return Mon 26/10; staff need accredited epilepsy and midazolam training before return | A specific condition for the school to meet, alongside the enclosed Epilepsy and Emergency Medication Management Plans. |
| Levetiracetam given at home 07:00 and 19:00; none at school; side effects | Clarifies that no school dosing is needed, and that drowsiness, irritability or behaviour changes are reported to the mother. |
| Buccal midazolam per plan; give at 5 min; full 000 criteria; recovery position | Emergency actions must be complete: when to give midazolam, every ambulance trigger and recovery position once jerking stops with breathing monitored. |
| Swimming only with constant 1:1 adult supervision in water; no unsupervised climbing at heights | Activity safety is the school's responsibility, and swimming is on Thursday afternoons this term. |
| Record seizures/episodes (time, duration, description); inform mother same day | Gives the school a clear monitoring task and reporting path to the mother, who is contactable by mobile. |
| School camp in Nov; contact Dr Yadav before camp | Camp falls before the neurology follow-up, so an individual risk assessment must be arranged beforehand. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Father 'never takes her health seriously' | A comment about a parent that is private and irrelevant to school care. |
| Hospital food 'disgusting'; ate snacks from home | A ward complaint with no relevance to the school. |
| Maternal grandmother 'had fits as a child' | Trap: family history looks relevant to epilepsy, but the detail is vague and the school cannot act on it. |
| EEG, MRI and blood results | The school needs the diagnosis, not the investigation detail. |
| Tonsillectomy age 5; piano and netball | Remote history and hobbies with no restrictions given in the notes. |
| Mild asthma; salbutamol kept at school | No change to the asthma plan is noted, so it adds nothing to the epilepsy request. |
A paragraph plan for this case
Start with the purpose, Wen's diagnosis and the return date. Then cover her treatment and what the school does and does not give, the complete emergency instructions, and activity precautions, recording and the camp request.
Where candidates slip on this task
- Give the complete midazolam and 000 criteria, including calling an ambulance at 5 minutes even without midazolam and whenever it is given. Do not invent doses; refer to the Emergency Medication Management Plan.
- State that staff need accredited epilepsy and midazolam training before she returns on 26/10, and that both plans are enclosed. Do not imply training is optional or already done.
- Say the daydreaming episodes are likely focal seizures, not certain. Make clear levetiracetam is given at home only, and that side effects are reported to her mother.
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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- Postnatal discharge to a child and family health nurse: feeding concerns after gestational diabetes discharge letter
- Discharge to the community nurse: new colostomy in an older man living alone discharge letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Do I include the EEG and MRI findings?
Only the outcome that matters: the neurology diagnosis of focal epilepsy. The school needs to recognise and manage seizures, not interpret tests, so the detailed results can be left out.
Why mention the November camp?
Camp occurs before the 6-week neurology review, so the notes require contact with Dr Yadav beforehand for an individual risk assessment and camp advice. The school nurse needs to act on this early.
Sources
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