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Exam standard · Letter to a carer or family member · Nursing

Home oxygen: advice for a carer

This case practises: Plain words for a non-clinical reader · Leaving out what the reader doesn't need · Professional tone

Writing task

Today's date: 2 December 2026. You are the respiratory nurse on the Respiratory Ward, Kingsport Hospital. Write a letter to Ms Teresa Doyle, daughter and main carer of Mr Frank Doyle, 21 Harbour View, Kingsport, who has no medical training, to advise her on caring for her father at home with oxygen after his discharge today. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.

Case notes

In the test you get 5 minutes to read, then 40 minutes to write.

Patient details
- Mr Frank Doyle, DOB 30/10/1952 (74 y.o.)
- Lives with daughter Teresa (main carer) at 21 Harbour View, Kingsport
- Admitted 24/11/2026; discharge 02/12/2026

Social background
- Retired coal miner
- Ex-smoker - stopped 2015; Teresa smokes, says she will smoke outside only
- Grandchildren visit at weekends
- Keeps a gas fire in the living room; gas cooker in kitchen
- Supports local football club
- Plays bingo at the community centre on Fridays
- Has a budgie; likes listening to the radio

Medical history
- COPD (severe), diagnosed 2016
- Atrial fibrillation - apixaban 5 mg BD
- Cataracts, awaiting surgery

Admission
- 24/11: infective exacerbation of COPD
- ABG on admission: pH 7.31, raised CO2 - NIV for 2 days
- IV antibiotics then oral; steroids 5 days
- SpO2 now 88-92% on 2 L/min O2; 84% on air
- Assessed for long-term oxygen therapy - qualifies

Medications / equipment on discharge
- Home oxygen 2 L/min via nasal cannula, at least 15 h/day including overnight (concentrator delivered 01/12)
- NEW: tiotropium inhaler 1 puff OD (in addition to existing inhaler)
- Salbutamol inhaler via spacer PRN
- Rescue pack at home: prednisolone + amoxicillin - start if flare-up and contact GP same day
- Apixaban 5 mg BD (unchanged)

Advice to give carer
- No smoking or naked flames in the house while oxygen is used; keep oxygen 3 m from gas fire and cooker
- Use water-based creams, not oil-based (e.g. petroleum jelly), on face/lips
- Do not increase oxygen flow above 2 L/min - too much can make him drowsy
- Signs of a flare-up: more breathless, cough with more or darker sputum → start rescue pack, call GP
- Very drowsy, confused, blue lips or severe breathlessness → call 999
- Respiratory nurse home visit 08/12/2026; pulmonary rehabilitation invitation to follow

Write your letter

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Model answer Try writing your own letter first
Ms Teresa Doyle
21 Harbour View
Kingsport

2 December 2026

Dear Ms Doyle,

Re: Mr Frank Doyle, DOB 30/10/1952

I am writing to advise you on caring for your father at home now that he needs oxygen, following his stay in hospital with a chest infection that made his lung disease worse.

Your father should use his oxygen at 2 litres a minute through the nose tubes for at least 15 hours a day, including overnight. Please do not turn it higher, as too much oxygen can make him drowsy.

Oxygen makes fires burn very easily, so nobody should smoke or use matches in the house, and the oxygen must be kept 3 metres from the gas fire and cooker. Please use only water-based creams on his face and lips, not oily ones such as petroleum jelly.

He has a new inhaler to take once a day, as well as his reliever inhaler. If he becomes more breathless or coughs up more or darker phlegm, please start his rescue pack and call his GP that day. If he becomes very drowsy or confused, or his lips turn blue, please call 999.

I will visit you both on 8 December. Please contact me if you have any concerns.

Yours sincerely,

Respiratory Nurse
Respiratory Ward
Kingsport Hospital

What the reader needs

  • Oxygen at 2 litres a minute through the nose tubes for at least 15 hours a day, including overnight
  • No smoking or open flames in the house; keep oxygen 3 metres from the gas fire and cooker
  • Do not turn the oxygen above 2 litres; too much can make him drowsy
  • Water-based, not oil-based, creams on his face and lips
  • New once-daily inhaler as well as his reliever inhaler
  • Flare-up signs: start the rescue pack and contact the GP the same day
  • Very drowsy, confused, blue lips or severe breathlessness: call 999

Details to leave out

  • Blood gas results and non-invasive ventilation
  • Oxygen saturation numbers
  • Former job
  • Football club
  • Bingo, budgie and radio
  • Cataracts
  • Atrial fibrillation and apixaban (unchanged)

One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.