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Nicholas Brihman

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Rithu Santhosh
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34 views

Nicholas Brihman

Uploaded by

Rithu Santhosh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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05 -NICHOLASBRIHMAN

OCCUPATIONAL ENGLISH TEST


WRITING SUB-TEST: Nursing
READING TIME: 5 MINUTES |
WRITING TIME: 40 MINUTES

Read the case notes below and


complete the writing task which
follows.
NOTES
 Nicholas Brihman, 61-year-old
man, presents to his primary
care provider Dr Maria Jones,
complaining of recent, recurrent
episodes of angioedema. You are
a charge nurse at this facility.
Patient Details
 Mr Nicholas Brihman, 61
 Traveller and blogger, not
married, next of kin - brother
 Lifestyle: Sedentary, sleeps less,
active
 The patient lives in the Southeast
and when questioned about tick
exposure, he confirms having
removed a tick about a year
previously, after a long day spent
outdoors.
Diet
 Meat-heavy meals (including
steak and barbecued pork).
 Eats heavy meals at night.
 Occasionally alcoholic, cigar
smoking
 Up to date on all immunizations.
Medical History
 High blood pressure (since 2001)
 On medication - Lisinopril,
perindopril and ramipril,
ibuprofen
 Negative for rashes, changes in
skin color, sores or new lesions,
and headaches.
 A history of persistent mild
childhood asthma and
intermittent adult asthma.
16/08/2019
 Emergency department for facial
swelling.
 Diagnosed as angioedema
(related to stress and eating spicy
foods).
 Advised to eliminate spicy foods
and other triggers.
 Prescribed epinephrine auto-
injector, diphenhydramine 50
mg.
20/06/2020
 Revisits with complaints of 4
episodes of severe angioedema
over an 8-month period.
 Reported irritation of the left
eye, sinus pressure, numbness
and tingling in the mouth, and
swelling of the lips, throat, and
tongue (3 to 4 hours after he eats
a large meal)
 Expresses concern that his
symptoms will progress to
anaphylaxis.
 Important! Has not needed the
epinephrine auto-injector.
 Complains of constricted airway
during his reactions.
 Denies shortness of breath,
coughing, and wheezing.
21/06/2020
 Tested positive for seasonal
allergies (grasses, trees, and cat
dander) but has no history of
food or drug allergies.
 Bilateral swelling in the lips,
cheeks, and soft tissue under the
jaw.
 The left side of face more
severely swollen than right.
 Difficulty closing mouth (due to
swelling).
 Mild periorbital swelling, and the
sclera of both eyes are mildly
pink and watery.
 No chemosis present, no
noticeable skin change, redness,
or urticaria on the face, trunk, or
limbs.
 IgE skin prick test (SPT) ordered
to rule out new allergies to
protein in his diet.
22/06/2020
 SPT is performed for commercial
extracts of beef, pork, lamb,
chicken, turkey, and milk, as well
as cat and dog dander.
 The patient tests positive for
hypersensitivity reaction to cat
dander, revealing a 3 - to 5 mm
wheal with flare.
 All other SPT results negative.
 These results, along with the
patient’s history of tick bite and
angioedema after high-protein
meals, confirm a diagnosis of red
meat allergy, or α-gal syndrome.
 Blood samples collected for
immunoassay to detect IgE to
galactose-α-1, 3-galactose (α-
gal).
 The patient tests positive for IgE
antibodies to α-gal with the
serum assay.
Writing Task
As Dr Jones is under house quarantine
for Covid19 from today, 22nd June,
2020, Mr Brihman needs to be referred
to Dr Mathias Brown, Royal Lake
Hospital, Yamba Dr, Garran ACT 2605,
Canberra, Australia +61351240000. As
charge nurse, write this letter detailing
Mr Brihman's concerns.
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.

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