OET letter for a heart failure patient: weights, fluid restriction and diuretics
In an OET Nursing letter about a heart failure patient, state why the patient was admitted and how they are now, then give the reader the monitoring plan in plain terms: target or discharge weight, when to act on a weight gain, any fluid or salt restriction, and which medicines were started or changed. Leave out daily observation charts and normal results, and finish with a clear request, such as daily weights or a medicine review.
What the reader needs to know
Heart failure case notes are full of numbers: daily weights, fluid balance charts, blood pressure, heart rate, oxygen saturations, kidney results and medicine changes. The reader of your letter, usually a community nurse, a GP practice nurse, a heart failure nurse or a residential facility, needs only the numbers that change what they do next.
Ask three questions while reading the notes:
- Why was the patient admitted, and how are they now? One or two sentences.
- What must the reader monitor? Usually weight, breathlessness, swelling, and sometimes blood pressure or blood tests.
- What has changed? New or adjusted medicines, a fluid or salt limit, new equipment, a new appointment.
Everything else is background, and most of it can go. See how to select case notes for the general method.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Reason for admission in one sentence (for example, worsening breathlessness and ankle swelling) | Hour-by-hour observations |
| Admission and discharge weight, or total weight change | Every daily weight |
| Threshold for action if the notes give one (for example, a gain of 2 kg in 3 days) | Normal blood results |
| Fluid and salt restriction, in plain words | Detailed fluid balance totals |
| New or changed medicines, with doses | Medicines that are unchanged and unrelated to the plan |
| Results the reader must recheck (for example, potassium after a diuretic change) | Results that need no action |
| Current mobility and breathlessness on exertion | Routine hospital tasks |
| Patient's understanding, adherence concerns, social support | Unrelated past history |
| Follow-up appointments and the request | Polite comments with no clinical value |
Turning heart failure notes into sentences
| Notes | Letter sentence |
|---|---|
| Wt 84.2 kg on adm → 79.6 kg d/c | "Her weight has fallen from 84.2 kg on admission to 79.6 kg today." |
| FR 1.5 L/day, low Na diet | "She has been advised to limit her fluid intake to 1.5 litres a day and to reduce salt." |
| Furosemide ↑ 40 → 80 mg mane | "Her furosemide has been increased from 40 mg to 80 mg each morning." |
| K+ 3.4, recheck 1/52 | "Her potassium was slightly low at 3.4 mmol/L and should be rechecked in one week." |
| SOB on 1 flight stairs | "She becomes breathless after climbing one flight of stairs." |
| Pitting oedema to mid-shin, now ankles | "The swelling in her legs has reduced from mid-shin to the ankles." |
| Pt unsure re: daily wts, no scales at home | "She does not own scales and is unsure why daily weighing matters." |
Copy medicine names, doses and limits exactly. Rounding "1.5 litres" to "about a litre" or changing a dose could cause harm and also costs Content marks. For layout of numbers, see vital signs and test results in letters and medications in OET letters.
Adjusting for the reader
The same patient produces different letters for different readers:
- Community or heart failure nurse: weights, threshold for action, medicine changes, blood test due, education needs.
- GP: medicine changes, results to recheck, follow-up appointments, any concern about adherence.
- Residential facility: daily weighing routine, fluid limit and how to support it, what to report and to whom.
- Patient or carer: plain words, no abbreviations, what to do each day and when to seek help. See writing to a non-clinical reader.
Worked example (invented case)
Case summary (invented): Mrs Rosa Delgado, 78, widow, lives alone in a ground-floor flat; daughter visits twice a week. Admitted 14 March with increasing breathlessness and leg swelling over 10 days. Known heart failure, high blood pressure, osteoarthritis of knees. Weight on admission 84.2 kg; today 79.6 kg. Swelling now only around ankles. Breathless after one flight of stairs (could not walk to the kitchen on admission). Furosemide increased from 40 mg to 80 mg in the morning. New: spironolactone 25 mg daily. Potassium 3.4 mmol/L on 20 March; recheck in one week. Advised fluid limit 1.5 L/day and low-salt diet. Does not own scales; not sure why daily weighing matters. Cataract surgery 2015. Enjoys crosswords. Discharge 21 March. Task: write to the community nurse who will visit her at home.
Selection decisions:
- In: reason for admission, weight change, current breathlessness and swelling, both medicine changes, potassium recheck, fluid and salt advice, no scales and limited understanding, lives alone with daughter visiting.
- Out: cataract surgery, crosswords, osteoarthritis (no effect on the plan here), detailed admission observations.
Sample letter body:
Dear Community Nurse,
Re: Mrs Rosa Delgado, aged 78
I am writing to refer Mrs Delgado, who is being discharged home today following treatment for worsening heart failure, for home monitoring and education.
Mrs Delgado was admitted on 14 March with increasing breathlessness and leg swelling. With treatment, her weight has fallen from 84.2 kg to 79.6 kg, and the swelling is now limited to her ankles. She still becomes breathless after climbing one flight of stairs.
Her furosemide has been increased from 40 mg to 80 mg each morning, and spironolactone 25 mg daily has been started. Her potassium was slightly low at 3.4 mmol/L on 20 March and should be rechecked in one week. She has been advised to limit her fluids to 1.5 litres a day and to reduce her salt intake.
Mrs Delgado lives alone, and her daughter visits twice a week. She does not own scales and is unsure why daily weighing is important.
I would be grateful if you could arrange scales for her, teach her to weigh herself each morning and record the result, and arrange the potassium recheck. Please do not hesitate to contact me if you require further information.
Yours sincerely,
Notice that the letter gives two weights, not ten, and that the request matches the problems raised earlier in the letter: no scales, low understanding, a blood test due.
Practise a full case under timed conditions at /writing/, or check a letter you have written to see an estimated mark for each criterion.
Mistakes to avoid
- Copying the weight chart. Summarise the change; keep only numbers the reader acts on.
- Vague medicine changes. "Diuretic adjusted" does not tell the reader what to give.
- Forgetting the blood test. A recheck the notes request belongs in the letter and often in the request.
- Clinical shorthand for a lay reader. "FR 1.5 L" means nothing to most carers.
- A request that ignores the problem. If the notes say the patient has no scales, ask the reader to solve that.
Related: discharge and transfer letters, OET closing paragraph examples and conciseness and clarity.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines, doses and results are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.