Foundation · Discharge · Nursing
Leg cellulitis and a new blood test result
This case practises: Purpose up front · Putting the care plan where the reader acts on it · Leaving out what the reader doesn't need
Writing task
Today's date: 19 November 2026. You are the registered nurse on Ward 4 (Acute Medicine), St Anne's Hospital. Write a letter to Ms Priya Nair, Practice Nurse, Hilltop Medical Centre, 18 Church Street, Hilltop, who will see Mr Kerr at the practice 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 Thomas Kerr, DOB 11/06/1962 (64 y.o.) - 7 Rowan Avenue, Hilltop - Admitted 16/11/2026, Ward 4; discharge 19/11/2026 Social background - Retired postman; lives with wife - Walks his dog daily; 3 grandchildren - Ex-smoker (stopped 2010); drinks 4-6 units/week - Plays bowls at local club on Saturdays Medical history - Osteoarthritis both knees - GORD - omeprazole 20 mg OD - Hearing aid R ear - No known allergies Admission - Scratched L lower leg while gardening 13/11 - 16/11: L lower leg red, hot, swollen; T 38.4 °C; CRP 96 - Dx: cellulitis L lower leg - IV flucloxacillin x 3 days; redness now well inside skin-pen markings - Incidental HbA1c 44 mmol/mol (pre-diabetes range) - not known before - BMI 31 Current status - Afebrile 48 h; CRP 21 - Small healing scratch L shin, no discharge - Mobilising independently Medications on discharge - Flucloxacillin 500 mg QID orally until 24/11/2026 - Omeprazole 20 mg OD Discharge plan - Practice nurse: review leg on 22/11 - check redness and swelling are still settling - Advise leg elevation when sitting - Pt to return to GP urgently if fever or redness spreads - Practice: lifestyle advice for pre-diabetes; repeat HbA1c in 3 months
Write your letter
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Model answer Try writing your own letter first
Ms Priya Nair Practice Nurse Hilltop Medical Centre 18 Church Street Hilltop 19 November 2026 Dear Ms Nair, Re: Mr Thomas Kerr, DOB 11/06/1962 I am writing to update you on Mr Kerr, who is being discharged home today after treatment for cellulitis of his left lower leg. He requires a leg review on 22 November and follow-up of a newly identified pre-diabetes result. Mr Kerr was admitted on 16 November with a red, hot and swollen left lower leg and a fever, three days after scratching his shin while gardening. He received intravenous flucloxacillin for three days. He has now been afebrile for 48 hours, his CRP has fallen from 96 to 21, and the redness is well within the skin markings. The scratch is healing with no discharge. He will continue oral flucloxacillin 500 mg four times daily until 24 November. I would be grateful if you could review his leg on 22 November to confirm that the redness and swelling are still settling, and encourage him to elevate the leg when sitting. He knows to seek urgent review if he develops a fever or the redness spreads. In addition, his HbA1c was 44 mmol/mol, which is in the pre-diabetes range, and his BMI is 31. Please provide lifestyle advice and arrange a repeat HbA1c in three months. Yours sincerely, Registered Nurse Ward 4, Acute Medicine St Anne's Hospital
What the reader needs
- Discharged today after IV antibiotics for left lower-leg cellulitis
- Oral flucloxacillin 500 mg four times daily until 24 November
- Leg review on 22 November to check redness and swelling are settling
- New finding: HbA1c 44 mmol/mol, in the pre-diabetes range
- Lifestyle advice and repeat HbA1c in 3 months
- Return urgently if fever or spreading redness
Details to leave out
- Retired postman
- Dog walking and grandchildren
- Smoking and alcohol history
- Knee osteoarthritis
- GORD
- Bowls club
- Hearing aid
One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.