The task
Original independent practice. Assume that today's date is 4 November 2026. Mrs Reihana is returning to her residential care facility today. Allow 5 minutes for reading and 40 minutes for writing.
You are a registered nurse on a medical ward. Using the case notes, write a discharge letter to Ms Pare Karena, Residential Care Nurse, Residential Care Facility, 18 Park Road, NSW 2000, Australia. Request continued nursing care for Mrs Reihana and explain her documented infection-control plan, including protection of vulnerable contacts. 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?
Shingles during recovery from admission: discharge
You are a registered nurse on a medical ward. Using the case notes, write a discharge letter to Ms Pare Karena, Residential Care Nurse, Residential Care Facility, 18 Park Road, NSW 2000, Australia. Request continued nursing care for Mrs Reihana and explain her documented infection-control plan, including protection of vulnerable contacts. 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: Mrs Teata Reihana
- DOB: 18/03/1944 (82 yrs)
- Usual residence: residential care facility; returning to same room
- Admitted 24/10/26; discharge 04/11/26
- Anxious about returning while rash persists; seeks reassurance
Social background
- Alert, orientated; understands explanations and requests reassurance about infecting others
- Mobilises with four-wheeled frame; baseline assistance with showering
- Daughter plans visit with newborn tomorrow; patient requests advice
- Complained that ward staff served weak tea
Medical history
- Hand osteoarthritis; staff usually assist with skin care
- No immunosuppressive illness or treatment
- Cataract surgery 2019; no current visual concerns
Admission and progress
- 24/10: gastroenteritis/dehydration; vomiting/diarrhoea resolved, oral intake recovered by 27/10
- 26/10: painful left-trunk vesicles; treating doctor diagnosed localised shingles
- Prescribed antiviral course completed 02/11; no further antiviral ordered
- 03/11: pain settled; sleep restored; eating usual meals
- 04/11: rash confined to left trunk; several moist blisters remain
- No facial lesions, fever or new lesions elsewhere
- Loose cotton clothing comfortable; needs assistance applying dressing
Documented infection-control and discharge plan
- 04/11 IPC review: standard + contact precautions until fully crusted; no airborne precautions for current localised, non-immunocompromised presentation
- Clean/dry rash; cover completely with non-adherent dressing; inspect daily; hand hygiene, gloves/gown for direct contact
- Until all lesions dry/crusted: avoid immunocompromised contacts, pregnant contacts without chickenpox immunity and babies <1 month
- Allocate care staff with verified chickenpox immunity
- Possible vulnerable-contact exposure → promptly contact infection-control team for assessment
- Rash spreads/cannot remain covered → separate from residents; urgent IPC reassessment
- Fever or worsening pain → contact GP for review
- Facility nurse: resume care today; daily rash review until crusted
- GP review booked 06/11
- Patient prefers morning shower before breakfast
- No other changes to existing residential care plan
Who is reading, and what do they need?
Ms Karena is resuming care for a resident whose baseline mobility and showering needs are already familiar. She needs the present rash status, dressing assistance, exact IPC instructions and protection of vulnerable contacts. Hand osteoarthritis helps explain skin-care assistance; alertness and understanding support direct explanations and reassurance about infecting others. Historical detail should remain subordinate to today's care requirements.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 04/11: rash confined to left trunk; several moist blisters remain. | The receiving nurse needs the current lesion state to understand why precautions and daily care remain necessary. |
| IPC: standard/contact precautions until fully crusted; no airborne precautions for localised, non-immunocompromised presentation. | This defines the documented precautions and their endpoint without imposing a different isolation category. |
| Clean/dry rash; cover completely with non-adherent dressing; inspect daily; hand hygiene, gloves/gown for direct contact. | These instructions translate the discharge plan into the facility nurse's immediate dressing and contact-care responsibilities. |
| Until dry/crusted: avoid immunocompromised contacts, non-immune pregnant contacts and babies under one month. | All three groups require protection under the documented plan; covering the rash does not remove these restrictions. |
| Allocate care staff with verified chickenpox immunity. | The facility needs this staffing instruction when allocating direct care. |
| Spreading/uncoverable rash: separate from residents and obtain urgent IPC reassessment. | This specifies the immediate response when the current containment arrangements no longer apply. |
| Resume nursing today; daily rash review until crusted; GP review booked 06/11. | This assigns continuing care and gives the receiving nurse the arranged medical follow-up. |
| Daughter plans newborn visit tomorrow; patient seeks advice and reassurance. | The imminent visit makes the vulnerable-contact restriction immediately actionable and identifies a specific counselling need. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Complaint about weak ward tea. | This service complaint does not affect residential nursing care or infection control. |
| Cataract surgery in 2019; no current visual concerns. | The resolved eye history adds no action for this discharge. |
| Prefers morning shower before breakfast. | A familiar scheduling preference can remain within routine residential care rather than displacing the infection-control handover. |
| Gastroenteritis/dehydration resolved; oral intake recovered by 27/10. | Compress the original admission problem if context is useful; its resolution creates no new continuing-care request. |
| Pain settled, sleep restored and usual meals resumed on 03/11. | A brief recovery summary is sufficient; these improvements do not determine whether contact precautions can stop. |
A paragraph plan for this case
Open with patient identification, return to her usual facility today and the request for resumed nursing care, briefly naming the localised shingles diagnosis. Use the main paragraph for the current moist lesions, dressing assistance, precautions, immune staffing and every vulnerable-contact restriction, connecting these to the planned newborn visit. Close with the complete documented escalation sequence, the 6 November GP appointment and reassurance, compressing unchanged baseline care.
Where candidates slip on this task
- Do not equate completed antivirals with ended infectiousness: several moist blisters remain on 4 November, so the documented precautions continue until all lesions are dry/crusted.
- Preserve the IPC distinction: standard and contact precautions apply to this localised, non-immunocompromised presentation; airborne precautions are not ordered, and verified staff immunity remains a separate requirement.
- Possible vulnerable-contact exposure requires prompt IPC assessment; spreading or uncoverable rash requires separation from residents and urgent IPC reassessment; fever or worsening pain requires GP review.
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
How much detail belongs on the original gastroenteritis admission?
Use only a brief resolved-admission summary if it helps explain the hospital stay. The receiving nurse's main task concerns the remaining moist shingles lesions and continuing precautions, so the vomiting, diarrhoea and recovered intake should not consume a separate detailed paragraph.
Can the planned newborn visit be treated as safe if the rash is covered?
No. The notes separately require avoiding immunocompromised contacts, pregnant contacts without chickenpox immunity and babies under one month until all lesions are dry/crusted. The planned newborn visit makes that restriction especially relevant; complete covering does not cancel the documented avoidance requirement.
Sources
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