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Exam standard · Discharge · Nursing

Back to her care home after a hip fracture

This case practises: Writing for what the reader already knows · Putting the care plan where the reader acts on it · Choosing which medicines to mention

Writing task

Today's date: 26 November 2026. You are the charge nurse on the Orthopaedic Ward, Westvale General Hospital. Write a letter to Ms Joanne Pereira, Care Manager, Willowbrook Aged Care, 9 Orchard Road, Westvale, where Mrs Lindqvist, a long-term resident, is returning today after surgery. 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
- Mrs Margaret Lindqvist, DOB 14/02/1938 (88 y.o.)
- Resident of Willowbrook Aged Care since 2023
- Admitted 15/11/2026; discharge back to Willowbrook 26/11/2026

Social background (known to facility)
- Widow; daughter lives in Perth, phones weekly
- Former piano teacher; enjoys radio quizzes
- Prefers tea with lunch; vegetarian

Medical history
- Alzheimer's dementia, moderate (K/C/O since 2021) - donepezil 10 mg nocte
- Hypertension - amlodipine 5 mg OD
- Osteoporosis - calcium + vitamin D OD
- Bilateral cataract surgery 2018

Admission
- 15/11: fall in her room at Willowbrook; unable to weight-bear
- X-ray: R neck of femur fracture
- 16/11: R hip hemiarthroplasty, uncomplicated
- 17-18/11: post-op delirium - resolved; now back to baseline cognition
- Hb 98 g/L on 20/11 - no transfusion required

Progress
- 19/11: stage 1 pressure injury (redness) over sacrum - pressure-relieving mattress + 2-hourly repositioning; skin now improving
- Wound: 14 staples, clean and dry
- Walking 15 m with frame + 1 assist; transfers with 1 assist
- BP 95-110 systolic since surgery - amlodipine stopped 18/11
- Eating 3/4 of meals; bowels normal

Medications on discharge
- NEW: apixaban 2.5 mg BD until 21/12/2026 (VTE prevention)
- NEW: paracetamol 1 g QID regular; oxycodone 2.5 mg PRN (using once daily)
- STOPPED: amlodipine
- Continue donepezil, calcium + vitamin D

Discharge plan
- Remove staples 30/11/2026
- Continue pressure-relieving mattress + 2-hourly repositioning
- Physio at facility 3 x/week; mobilise with frame + 1 assist
- Monitor for bleeding/bruising while on apixaban
- GP review of BP within 1 week - decide on restarting amlodipine
- Orthopaedic clinic 28/12/2026

Write your letter

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Model answer Try writing your own letter first
Ms Joanne Pereira
Care Manager
Willowbrook Aged Care
9 Orchard Road
Westvale

26 November 2026

Dear Ms Pereira,

Re: Mrs Margaret Lindqvist, DOB 14/02/1938

I am writing to hand back the care of Mrs Lindqvist, who returns to Willowbrook today after a right hip hemiarthroplasty, as she now needs a new anticoagulant, pressure-area care and more help with mobility.

Following her fall on 15 November, Mrs Lindqvist underwent an uncomplicated hemiarthroplasty the next day. A brief post-operative delirium has resolved, and her cognition is back to baseline. She is eating three-quarters of her meals.

She has been started on apixaban 2.5 mg twice daily until 21 December, so please monitor her for bleeding or bruising. She also takes paracetamol 1 g four times a day, with oxycodone 2.5 mg as needed, which she uses about once a day. Her amlodipine was stopped because her systolic blood pressure has been 95–110 mmHg; please arrange a GP review within a week to decide whether to restart it.

I would be grateful if you could remove her staples on 30 November and continue the pressure-relieving mattress and two-hourly repositioning for an improving stage 1 sacral pressure injury. She walks with a frame and one assist and needs physiotherapy three times a week. Her orthopaedic clinic appointment is on 28 December.

Yours sincerely,

Charge Nurse
Orthopaedic Ward
Westvale General Hospital

What the reader needs

  • Right hip hemiarthroplasty on 16 November after a fall on 15 November
  • Remove staples on 30 November
  • New apixaban 2.5 mg twice daily until 21 December; watch for bleeding
  • Stage 1 sacral pressure injury: pressure-relieving mattress and 2-hourly repositioning
  • Walks with a frame and one assist; physiotherapy three times a week
  • Amlodipine stopped because of low blood pressure; GP review within a week
  • New regular paracetamol and oxycodone as needed

Details to leave out

  • Daughter in Perth
  • Former piano teacher and radio quizzes
  • Food preferences
  • Cataract surgery
  • Dementia history and donepezil (known to the facility)
  • Year she moved into the facility
  • X-ray and haemoglobin details
  • Calcium and vitamin D (unchanged)
  • Bowels normal

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