OET Writing practice · Nursing

Laparotomy wound with delayed healing – community wound clinic

NursingReferral letterReader: Clinical nurse consultant, community wound clinicChallenging

An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral 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 Nadia Haddad, DOB 11/06/1964 (62 yrs)
General Surgical Ward 8, Queen Adelaide Hospital, Fairhaven
Admission date: 20/08/2026   Discharge date: 14/09/2026

Social background:
- Born in Lebanon. Part-time office administrator; off work until surgical review
- Lives with husband (Karim, 65, retired) and adult son. Husband supportive, drives
- Smoker 15 cigarettes/day; reduced to 5/day since admission. Declined nicotine patches
- No alcohol
- Enjoys cooking for extended family; sings in community choir

Medical history:
- Type 2 diabetes (dx 2015), metformin + gliclazide; HbA1c 72 mmol/mol (21/08/2026)
- Obesity, BMI 38
- Rheumatoid arthritis, methotrexate 15 mg weekly (withheld since admission; rheumatology aware)
- Laparoscopic cholecystectomy 2012
- Iron-deficiency anaemia 2024 (treated)
- NKDA

Nursing management and progress:
20/08 Admitted via ED: small bowel obstruction. NG tube, IV fluids
22/08 Emergency laparotomy: adhesiolysis + small bowel resection (40 cm), primary anastomosis. Midline wound 18 cm, staples
25/08 Diet commenced
27/08 Wound: erythema, purulent discharge lower third. T 38.1°C. Swab: E. coli + Enterococcus. CT: no intra-abdominal collection, anastomosis intact
- Lower staples removed, wound opened and irrigated. IV piperacillin/tazobactam (7 days)
29/08 Superficial dehiscence lower third; fascia intact (surgical review)
31/08 Negative pressure wound therapy (NPWT) commenced: 125 mmHg continuous, changes 3×/week
03/09 Afebrile, antibiotics completed. Remaining staples removed; upper wound healed
05/09 BGLs 10–16 mmol/L → insulin glargine 10 units nocte added. Pt competent with insulin pen
08/09 Wound (lower third): 8.0 × 3.5 cm, depth 2.5 cm
- Albumin 29 g/L → dietitian: high-protein supplement drinks BD
10/09 Changed to portable NPWT unit; pt education completed. Husband observed dressing change
11/09 Wound: 7.5 × 3.0 cm, depth 2.0 cm. 60% granulation, 40% slough, moderate serous exudate. Periwound: mild maceration
12/09 Pt tearful re body image and wound odour; social work referral declined
13/09 Tolerating full diet, bowels opening daily
14/09 NPWT dressing changed today. Pain 2/10 at dressing changes with paracetamol

Medications on discharge:
- Metformin 1 g BD; gliclazide MR 60 mg mane; insulin glargine 10 units nocte
- Paracetamol 1 g QID PRN
- Enoxaparin 40 mg SC daily until 19/09
- Methotrexate: withheld until surgical/rheumatology review

Discharge plan:
- Community wound clinic: NPWT dressing changes 3×/week (Mon/Wed/Fri), next 16/09
- Protect periwound skin (barrier film)
- Monitor for signs of infection
- Ongoing smoking cessation advice
- Surgical outpatient review 28/09/2026
- Rheumatology phone review re restarting methotrexate once wound healing

Writing Task:
Using the information in the case notes, write a letter to Ms Helena Kowalczyk, Clinical Nurse Consultant, Fairhaven Community Wound Clinic, 67 Harbour Parade, Fairhaven, referring Mrs Haddad for ongoing wound management.

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 referral letter

• The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
• Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
• End with what you are asking the reader to do, and any action you have already taken.

Members also get the model answer, the note-selection table and task-specific tips for this task.

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