OET Writing practice · Nursing
COPD exacerbation in a smoker – practice nurse follow-up
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your discharge letter in 40 minutes, about 180–200 words in the body.
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Case notes
NURSING — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 11/09/2026 Patient: Mr Kwame Mensah, DOB 02/02/1960 (66 yrs) Respiratory Ward 2, Westmoor General Hospital, Westmoor Admission date: 05/09/2026 Discharge date: 11/09/2026 Social background: - Born in Ghana. Lives with wife (Ama, 63) in 2nd-floor flat, lift available - Retired taxi driver. Grandchildren (aged 4 and 7) stay at weekends - Smoker: 20 cigarettes/day × 45 yrs. Previous quit attempt 2022 (3 weeks, nicotine gum) - Alcohol: 2–3 beers/week - Football fan, watches matches at local pub Medical history: - COPD (dx 2019); 2 exacerbations in past 12 months (Jan and May 2026) - Hypertension, amlodipine 10 mg daily - Gout (last flare 2024), allopurinol 100 mg daily - R inguinal hernia repair 2015 - Influenza vaccine not received 2025; pneumococcal vaccine 2020 - NKDA Nursing management and progress: 05/09 Admitted via ED: increased SOB × 4 days, green sputum, wheeze. RR 28, SpO2 86% on air, T 37.9°C. ABG: mild hypercapnia. CXR: hyperinflation, no consolidation - Controlled O2 via Venturi mask 28%, target SpO2 88–92% - Nebulised salbutamol + ipratropium 4-hrly; prednisolone 40 mg daily; oral doxycycline 06/09 Pt requesting to go outside to smoke → nicotine patch 21 mg/24 hrs commenced 07/09 SpO2 90% on 24% O2. Sputum becoming clear. BGL 11.2 mmol/L (steroid-related), monitoring 08/09 O2 ceased, SpO2 90% on air. Changed to inhalers. Technique poor: not holding breath, not using spacer 09/09 Walks 60 m with 1 rest (SOB on exertion). BGLs within normal range - Pt states he wants to quit smoking "for the grandchildren". Agreed to quitline referral (sent) 10/09 Inhaler technique improved with spacer after 3 education sessions; still needs prompting - Mild pain R big toe, resolved without treatment - Pt unsure when to start COPD rescue pack 11/09 Afebrile. SpO2 91% on air at rest. Chest: scattered wheeze Medications on discharge: - Tiotropium/olodaterol inhaler 2 puffs daily - Salbutamol MDI 100 mcg 2 puffs PRN via spacer - Prednisolone 40 mg daily until 12/09 (7-day course) - Doxycycline 100 mg daily until 12/09 - Nicotine patch 21 mg/24 hrs + nicotine lozenge 2 mg PRN - Amlodipine 10 mg daily; allopurinol 100 mg daily - COPD rescue pack (prednisolone + doxycycline) supplied with written action plan Discharge plan: - Practice nurse review within 1 week: inhaler technique, smoking cessation support, COPD action plan including rescue pack use - Influenza vaccination due - Pulmonary rehabilitation referral sent (waiting list approx. 6 weeks) - Spirometry in 6 weeks when stable - GP review in 2 weeks Writing Task: Using the information in the case notes, write a letter to Ms Priya Nandakumar, Practice Nurse, Linden Street Medical Centre, 88 Linden Street, Westmoor, who will be following up Mr Mensah after discharge. 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.
How to approach this discharge letter
- The reader takes over care after discharge. Open with who the patient is, why they were in hospital and that they are going home, then say what you need the reader to do.
- Give the current condition, medication changes and the follow-up plan. Summarise the hospital stay instead of retelling it day by day.
- Leave out resolved problems and background that does not change care at home.
Members also get the model answer, the note-selection table and task-specific tips for this task.