The task
Assume that today's date is 5 November 2026. Ms Rizvi is returning home after assessment in the postnatal assessment unit. This is original independent practice material.
You are a registered nurse in the postnatal assessment unit. Using the case notes, write a discharge letter to Ms Delia Yabut, Community Midwife, Postnatal Home Service, 24 Station Road, SW1V 2AB, United Kingdom. Request continued feeding support and communicate the agreed assessment and medical review arrangements for Ms Asma Rizvi. 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.
Free · no sign-up · nursing
Which case notes belong in this letter?
Mastitis after medical review: discharge
You are a registered nurse in the postnatal assessment unit. Using the case notes, write a discharge letter to Ms Delia Yabut, Community Midwife, Postnatal Home Service, 24 Station Road, SW1V 2AB, United Kingdom. Request continued feeding support and communicate the agreed assessment and medical review arrangements for Ms Asma Rizvi. 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: Ms Asma Rizvi
- DOB: 18/07/1996 (30 yrs)
- Home: 8 Park Road, SW1V 2AD, United Kingdom
- Assessment unit attendance/discharge: 05/11/26; medical review completed 09:00
Social background
- First baby born 24/10/26; uncomplicated vaginal birth
- Enjoys gardening; previously attended a weekly craft group
- Partner at home this week; helping with meals
- Supermarket employee; currently on maternity leave
- Complained receptionist was unfriendly; requested this be recorded
Medical history
- Appendicectomy in childhood; no ongoing problems
- No known drug allergies; no regular medicines
- Exclusively breastfeeding; no previous mastitis
Assessment
- L breast pain/redness began overnight; no prior self-treatment
- Clinician assessment today: mild lactational mastitis; suitable for home care
- Localised warm, tender area L breast; no discrete lump
- Afebrile; observations stable; alert, drinking normally; no systemic illness
- After supported feed: discomfort ↓; residual tenderness remains
- Wishes to breastfeed; asks whether stopping would help recovery
- Shallow attachment observed; repositioning improved comfort; needs further practice
Agreed feeding support
- Continue breastfeeding responsively, including affected breast; do not stop suddenly
- If affected-side feeding too painful: hand express enough for baby; avoid extra pumping to empty breast
- Avoid firm breast pressure or deep massage
- Cold compresses and rest advised for comfort
Discharge plan
- Clinician plan: supportive care from 09:00 today; no antibiotic; GP review 06/11, 09:00, for treatment decision
- Agreed midwife home visit 06/11, 08:00; relay findings to GP before review
- Midwife: reassess breast symptoms; observe feed; support positioning/attachment; reinforce feeding advice
- Worsening symptoms → urgent GP advice; NHS 111 if unavailable; do not await appointments
- New confusion or severe breathing difficulty → ambulance, 999
- Baby feeding well after support; usual wet nappies
- Routine postnatal follow-up already arranged by recipient
Who is reading, and what do they need?
Ms Delia Yabut is the community midwife who has already arranged routine postnatal follow-up. She needs the assessment outcome, agreed feeding measures, specific home-visit duties, and timed handover to the GP. Prioritise actionable continuity and escalation information; compress supportive background and avoid assuming she already knows today’s findings.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Mild lactational mastitis; home care suitable; shallow attachment; repositioning improved comfort; further practice needed. | Establishes the assessed problem and directs the recipient’s feeding support without implying that attachment difficulties or mastitis have resolved. |
| Continue responsive breastfeeding, including the affected breast; do not stop suddenly. | Preserves the agreed feeding approach that the midwife needs to reinforce. |
| If feeding too painful: hand express enough for baby; avoid extra pumping to empty breast. | Provides the conditional alternative needed to continue the agreed feeding support without changing its limits. |
| Supportive care from 05/11, 09:00; no antibiotic; GP treatment review 06/11, 09:00. | Defines current management and the exact medical reassessment point, preventing assumptions about antibiotics or an open-ended wait. |
| Midwife home visit 06/11, 08:00; relay findings to GP before review. | Makes the agreed visit and its handover deadline actionable before the GP’s treatment decision. |
| Reassess breast symptoms; observe feed; support positioning/attachment; reinforce feeding advice. | Specifies all requested home-visit duties so the recipient can continue care and provide useful findings to the GP. |
| Worsening symptoms: urgent GP advice; NHS 111 if unavailable; do not await appointments. | Preserves the escalation route that overrides scheduled follow-up if symptoms deteriorate. |
| New confusion or severe breathing difficulty: ambulance, 999. | Distinguishes the recorded emergency triggers from problems requiring urgent GP advice. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys gardening; previously attended a weekly craft group. | These interests do not help the midwife deliver the requested feeding assessment or coordinate medical review. |
| Supermarket employee; currently on maternity leave. | Employment details do not change the immediate home-visit duties or agreed feeding plan. |
| Complaint about the receptionist; requested recording. | The service complaint belongs in the appropriate administrative record and does not advance this clinical handover. |
| Childhood appendicectomy without ongoing problems. | This resolved surgical history has no stated connection to the current mastitis or feeding support. |
| Routine postnatal follow-up already arranged by recipient. | Although it resembles a follow-up action, it adds no new instruction for the midwife who arranged it. |
| Partner at home this week, helping with meals. | Optional practical-support context; omit or compress unless it helps the recipient understand the available help during home care. |
A paragraph plan for this case
Opening paragraph: foreground continued feeding support after today’s assessment, with Ms Rizvi’s name and DOB, 18 July 1996, kept brief; use the home address, 8 Park Road, only where needed for identification or the visit, and treat the first birth on 24 October as optional context. Middle paragraph: summarise overnight left-breast pain/redness, the assessment and attachment findings, selecting useful supporting detail from local warmth/tenderness without a discrete lump, all recorded reassuring observations, reduced discomfort with residual tenderness, exclusive breastfeeding without previous mastitis, her wish to continue and question about stopping, the baby’s feeding/usual wet nappies, no known drug allergies/no regular medicines, and the pressure/massage, cold-compress and rest advice. Final paragraph: organise current management, both timed appointments, reassessment duties and communication to the GP, keeping both levels of the recorded escalation advice together.
Where candidates slip on this task
- Preserve the timeline: supportive care began at 09:00 on 5 November; the 08:00 midwife visit precedes the 09:00 GP treatment decision on 6 November.
- State that no antibiotic was prescribed after medical review; do not turn the next day’s GP treatment decision into a promise of antibiotics or an optional appointment.
- Do not interpret improved comfort after repositioning as resolved mastitis or established feeding competence; residual tenderness and further attachment practice remain relevant to the requested support.
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
- Discharge to the community nursing service: new insulin and diabetic foot ulcer discharge letter
- 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
Which feeding instructions need priority over optional comfort measures?
Prioritise responsive breastfeeding, including the affected breast, without sudden cessation. Preserve the alternative for feeding that is too painful: hand express enough for the baby, avoiding extra pumping to empty the breast. Advice against firm pressure/deep massage, plus cold compresses and rest, can support this core handover.
How should the escalation advice be handled in this UK case?
Keep the recorded pathway together: worsening symptoms require urgent GP advice, NHS 111 if unavailable, without awaiting appointments; new confusion or severe breathing difficulty requires an ambulance on 999. Preserve the UK numbers. NHS emergency guidance supports 999 for sudden confusion or severe breathing difficulty.
Sources
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