OET Writing practice · Nursing
Heart failure with fluid restriction – HF nurse specialist
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: 14/09/2026 Patient: Mrs Ingrid Johansson, DOB 30/10/1951 (74 yrs) Cardiology Ward 5A, Northgate Hospital, Northgate Admission date: 04/09/2026 Discharge date: 14/09/2026 Social background: - Born in Sweden. Retired librarian - Lives with husband (Lars, 78, early Parkinson's disease) in bungalow - Husband does the cooking, tends to add salt. Pt drinks "lots of tea" (approx. 8 cups/day) - Non-smoker. Occasional glass of wine - Member of monthly book club. Son lives in Stockholm, phones weekly Medical history: - Heart failure with reduced ejection fraction (HFrEF), dx 2024 - Ischaemic heart disease: MI 2021, stent to LAD - Atrial fibrillation, apixaban 5 mg BD - Type 2 diabetes, diet-controlled - Hysterectomy 1995 - Allergy: ACE inhibitors (angioedema 2021) Nursing management and progress: 04/09 Admitted via ED: SOB on minimal exertion, orthopnoea (3 pillows), bilateral leg oedema to knees. Wt 78.4 kg (usual dry weight approx. 72 kg). BNP markedly raised. CXR: pulmonary oedema, bilateral small effusions - IV furosemide 80 mg BD. Fluid restriction 1.5 L/day. Daily weights, strict fluid balance chart 05/09 Urine output 2.8 L/24 hrs. Pt found drinking extra tea brought in by husband → education re fluid restriction 07/09 Echo: LVEF 30%. K+ 3.3 mmol/L → oral potassium supplement 08/09 Wt 74.9 kg. Oedema to ankles. Sleeping on 2 pillows 09/09 Changed to oral furosemide 40 mg BD. Sacubitril/valsartan not suitable (angioedema history) → candesartan 4 mg daily commenced. Dapagliflozin 10 mg daily commenced 10/09 Creatinine 118 µmol/L (baseline 98). K+ 4.1 mmol/L, potassium supplement ceased 11/09 BP 104/62, mild dizziness on standing, no falls 12/09 Wt 72.6 kg. Walks 80 m on ward, mild SOB. Pt says she "feels much better" - Pt does not own bathroom scales 13/09 Furosemide reduced to 40 mg mane - Dietitian: low-salt diet (< 2 g sodium/day) education to pt and husband. Husband forgetful at times 14/09 Wt 72.3 kg. Chest clear, trace ankle oedema Medications on discharge: - Furosemide 40 mg mane - Bisoprolol 2.5 mg daily - Candesartan 4 mg daily (new) - Dapagliflozin 10 mg daily (new) - Spironolactone 25 mg daily - Apixaban 5 mg BD; atorvastatin 40 mg nocte Discharge plan: - Fluid restriction 1.5 L/day; low-salt diet - Daily weights (same time, after voiding); report weight gain > 2 kg in 3 days - Bathroom scales ordered online by son, delivery approx. 17/09 - HF nurse specialist home visit within 1 week: weight, fluid status, BP; titrate candesartan and bisoprolol per protocol - U&E 21/09 - Cardiology outpatient review 6 weeks - Cardiac rehabilitation discussed; pt undecided Writing Task: Using the information in the case notes, write a letter to Mr Oliver Brennan, Heart Failure Nurse Specialist, Northgate Community Heart Failure Service, 3 Fenwick Road, Northgate, who will be monitoring Mrs Johansson at home. 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.
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