The task
This is original independent practice material. Assume that today's date is 5 November 2026. Mr Heriberto Cuervo has been assessed at your general practice today.
You are a registered nurse at a general practice. Using the case notes, write a referral letter to Ms Mar Carbonell, Wound-care Community Nurse, Home Dressing Service, 18 Park Road, SW1V 2AB. Request home dressing visits for Mr Heriberto Cuervo, communicating the documented vascular findings, outstanding assessment and interim care instructions. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. 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: Referral letter.
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Which case notes belong in this letter?
Venous leg ulcer: referral
You are a registered nurse at a general practice. Using the case notes, write a referral letter to Ms Mar Carbonell, Wound-care Community Nurse, Home Dressing Service, 18 Park Road, SW1V 2AB. Request home dressing visits for Mr Heriberto Cuervo, communicating the documented vascular findings, outstanding assessment and interim care instructions. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. 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 Heriberto Cuervo
- DOB: 12/03/1948 (78 yrs)
- Home: 7 Grove Street, SW1V 2AB
- Practice nurse assessment: 05/11/26
Social background
- Lives alone; hip stiffness prevents reaching ulcer for dressing changes
- Daughter available for clinic transport, not dressings; visits at weekends
- Retired tailor; enjoys radio quizzes
- Daughter privately complained about a family inheritance dispute
Medical history
- Bilateral hip osteoarthritis; walks independently indoors; uses stick outdoors
- Longstanding varicose veins; recurrent ankle swelling
- No known diabetes or previous arterial disease
- Appendicectomy in early adulthood; uncomplicated
- Allergies: nil known
Assessment and investigations
- Ulcer present 6/52 following minor scratch
- L medial ankle: 3 × 2 cm, shallow
- Granulating base; moderate exudate; surrounding skin intact
- No spreading erythema, fever or systemic illness
- L ankle oedema; brown pigmentation surrounding ulcer
- Venous duplex 29/10: superficial venous reflux documented
- Pedal pulses palpable; arterial Doppler assessment/ABPI not yet completed
- No rest pain; foot warm; no reported numbness
- Treating team's working diagnosis: venous leg ulcer
- Complained that receptionist spoke too quickly
Treatment and plan
- Team's interim order: saline cleanse; non-adherent absorbent dressing 3 times weekly; earlier if saturated/displaced
- Each visit: record wound size, exudate and surrounding skin condition
- Team instruction: no compression bandages/stockings pending arterial assessment and documented compression prescription
- Refer for home dressing visits from 06/11; patient unable to self-dress
- Leg ulcer clinic 09/11, 10:00: arterial assessment and treatment planning; daughter providing transport
- Team escalation instructions: spreading redness/↑pain/fever → same-day GP; sudden severe limb pain with cold/pale foot → immediate emergency assessment
- Dressings supplied for initial visits; written interim instructions accompany referral
- Patient agrees to referral; understands clinic attendance remains necessary
Who is reading, and what do they need?
Ms Carbonell is the community nurse taking over home dressings and needs actionable orders, vascular findings and follow-up arrangements. Mr Cuervo’s name, birth date and Grove Street address support identification and visit coordination; the assessment date and allergy status provide context. Wound measurements and appearance establish a baseline, while negative observations must not imply arterial clearance.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Home dressings from 06/11; lives alone; hip stiffness prevents reaching ulcer. | Establishes the requested service, start date and functional reason home nursing is necessary. |
| Pedal pulses palpable; arterial Doppler assessment/ABPI not yet completed. | Identifies the outstanding assessment and prevents palpable pulses being mistaken for permission to start compression. |
| Saline cleanse; non-adherent absorbent dressing three times weekly, earlier if saturated/displaced. | Provides the complete interim dressing order needed to organise visits and respond when a dressing requires earlier replacement. |
| No compression bandages/stockings pending arterial assessment and documented compression prescription. | Communicates the treatment restriction and both prerequisites for changing it. |
| Leg ulcer clinic 09/11, 10:00: arterial assessment and treatment planning; daughter providing transport. | Coordinates the outstanding investigation and makes clear that home visits do not replace specialist attendance. |
| Spreading redness/increased pain/fever: same-day GP; sudden severe limb pain with cold/pale foot: immediate emergency assessment. | Preserves every documented escalation trigger and distinguishes same-day review from an immediate emergency response. |
| Working diagnosis: venous leg ulcer; superficial venous reflux documented on duplex 29/10. | Explains the clinical context without presenting the working diagnosis as proof of adequate arterial circulation. |
| Left medial ankle: 3 × 2 cm, shallow, granulating, moderate exudate; surrounding skin intact. | Gives the receiving nurse a concise baseline for dressing care and subsequent wound comparison. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired tailor; enjoys radio quizzes. | These personal details do not help arrange visits, assess the ulcer or implement the interim treatment. |
| Daughter privately complained about a family inheritance dispute. | This confidential family complaint has no documented bearing on consent, dressing support or transport. |
| Appendicectomy in early adulthood; uncomplicated. | The resolved operation does not inform the current wound-care handover. |
| Complained that receptionist spoke too quickly. | An isolated reception complaint does not establish a communication impairment or change the requested nursing care. |
| No known diabetes or previous arterial disease. | This apparently reassuring history is optional and cannot establish arterial suitability while the required assessment remains outstanding. |
A paragraph plan for this case
Open with the home-visit request and limitations from hip osteoarthritis and stiffness, briefly recording consent if useful; keep identification outside the main clinical narrative. Use the clinical paragraph for the wound baseline, reflux and unresolved arterial assessment, compressing the six-week scratch history, varicose veins, recurrent swelling, oedema and pigmentation where useful. Finish with interim orders, recording wound size/exudate/surrounding skin at each visit, supplied dressings and accompanying instructions, then the clinic appointment and daughter’s transport; retain the escalation instructions explicitly.
Where candidates slip on this task
- Keep arterial assessment and a documented compression prescription as separate prerequisites; palpable pedal pulses and documented venous reflux do not override the team’s instruction against compression.
- Use 5 November 2026 as the assessment and referral date, 6 November as the requested home-care start, and 9 November at 10:00 as the clinic appointment.
- If retaining no spreading erythema, fever or systemic illness, or no rest pain, a warm foot and no reported numbness, preserve observations without claiming arterial disease is excluded.
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
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Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
How should the escalation instructions be handled?
Retain spreading redness/increased pain/fever → same-day GP; sudden severe limb pain with cold/pale foot → immediate emergency assessment. As supplementary clinical background, general acute-ischaemia warnings also include absent pulses, tingling/numbness and paralysis: call 999 for suspected acute limb ischaemia in this UK setting; do not await clinic review or apply compression. This supplementary advice is not required content for the letter; retain the treating team's documented instructions in n29. Guidance: NSW Emergency Care Institute, NHS emergency guidance. Checked on 5 November 2026.
Does the venous duplex result justify starting compression?
The selection must distinguish documented superficial venous reflux from the outstanding arterial Doppler assessment/ABPI. The team specifically requires both arterial assessment and a documented compression prescription before compression bandages or stockings. Retain that restriction alongside the interim dressing order; do not turn the working diagnosis into treatment authorisation.
Sources
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