Ms Geargine Ponsford
Resident Community Nurse
Community Retirement home
103 Light Street
Dear Ms Ponsford,
Re: Mr Lionel Ramamurthy, aged 63
I am writing to update you regarding Mr Ramamurthy who was admitted on 03/02/2019 with the diagnosis of pneumonia. He is ready for discharge back into your facility.
On admission, he was experiencing a fever and rigours as well as suffered with shortness of breath , wheezing and sleepessness .He had chest and abdominal pain due to prolonged persistent cough . He was able to walk with the help of a frame and assisted with activities of daily living such as showering and dressing etc.
After a week in hospital , he has stabilised and his breathing problems are now resolved ;however , he is still experiencing some chest and abdominal pain with a dry cough. On assessment, he can walk independently. In addition, he can use the toilet and get a shower without assistance. He gained weight; therefore, he was reviewed by dietition.
Given the above, it would be greatly appreciated if you could encourage him for oral fluids and give him a properly nutritious diet. He needs to ambulate regularly and continue his deep breathing and coughing exercises. Please ensure he sits up rather than lies down to ensure postural drainage. Paracetamol can be given if needed for pain .kindly he should be kept warm
Should you require any information, please do not hesitate to contact me