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QQ-3568. Mrs Charlotte Prince - Nursing – Nycy Mathew – Mild Concussion


 

04 December 2018


Ms Leyla Ward

Community Nurse

Ashton Health Centre

Somerville


Dear Ms Ward,


Re: Mrs Charlotte Prince, DOB: 04 August 1932


I am referring Mrs Charlotte Prince, who has been diagnosed with mild concussion and right toe infection. She requires on going care and definitive management from your service following her discharge today.


On 02 December 2018, Mrs Prince was admitted with the complaints of mild concussion owing to a fall. On examination, concussion tests were displayed normal and she was kept for 48 hours precautionary admission. Ramipril 10mg,amoxicillin 500mg and ibuprofen have been administered. Dressing of the right toe has been performed. Currently, she has made a good prognosis and ready to be discharged.


Mrs Prince, a widow, has two children and lives independently.She is reluctant to socialize, refuses meal delivery services as well as disagree to consult general practitioner.She has had hypertension and mild scoliosis;therefore, she exhibits fall risk and uses walking stick.She drinks occasionally and smokes heavily whereas,she has urinary incontinence.


Pertaining to the above details, it would be profoundly beneficial if you could conduct home visits for Ms Ward twice weekly and provide assistance in dressing, showering, advice regarding hand and food hygiene. It is essential to monitor medication compliance especially amoxicillin and Ramipril. Kindly ensure adequate rest and render dressing on the right toe twice weekly to facilitate wound healing.


In case, any additional information is required, please do not hesitate to contact me.


Yours sincerely,


Registered Nurse



 

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