I am writing to refer the aforementioned patient and request your institution for continuity of care. Mrs.

Green was admitted to our institution last 1 January and was diagnosed with low grade
adenocarcinoma. Hence, right hemicolectomy was done as part of her treatment plan. At present, She
has made steady progress and is now due for discharge today.

Postoperatively, Mrs. Green had developed metabolic and respiratory acidosis within 5 hours of
anesthesia infusion. Therefore, she was admitted to intensive care unit for close monitoring. After 4
days, she was transferred to thoracic ward for further management. During confinement, she had a
regular oxygen support of 2 liters and a 4 wheeled walker for mobilization . However, she still
experienced difficulty of breathing in changing her position and required full assistance. In addition, she
lose 5 kilos after the procedure due to decrease in appetite. Thus, regular evaluation of the dietitian was
done as well as monitoring and revision of her diet. Her post operation medications consist of
paracetamol 1 gram, to be given four times a day and as necessary as well as Endone 2.5mg ( max dose
20mg ) for pain control. Apart from this, Colxyl and Senna two tabs two times a day were commenced to
promote regular bowel movement. Moreover, she has been suffering from involuntary passage of urine
and utilizes pull up pad to manage her condition. On January 30, 2018, oxygen support was decreased to
1 liter to facilitate weaning but she was reluctant to the change and quite anxious about doing her
selfcare needs After 5 days, the oxygen support was brought down successfully at 1liter with oxygen
saturation of 91%. However, it was increased during mobilization to 2 liters because she still have
episodes of difficulty of breathing. She has made steady progress as evidenced by increased in appetite
and better mood, as well as she is able to utilize single point stick for mobilization and decreased
episode of incontinence

In terms of medical history, Mrs. Green is a smoker for 20 years but she recently stopped. In addition
she is a COPD patient since 2004, for which she takes tiotropium inhaler 1 puff daily as well as
fluticasone and salmeterol. She also has history of hypertension since 1993, which is manage by
amlodipine 5mg daily for blood pressure control. Moreover, she have anxiety and depression disorder,
with oxazepam 15mg every night and citalopram 10mg daily as her medications.

In terms of social history, Mrs. Green is a widow with no children that lives independently in a single
storey house but she has a sister that lives nearby for family support. She utilizes community benefits
for her everyday needs.

Given the above information, it would benefit Mrs. Green if you could monitor her utilization of oxygen
and mood changes. In addition, regular dressing needs to be done for 3 days more on her incision site to
prevent complication. Please ensure that her oxygen saturation is around 88-91 % and facilitate weaning
her oxygen support at 1 liter. Kindly note that supply of oxygen should be adequate and hand rails
should be present in her bathroom. Lastly, her sister will be responsible in collecting Mrs. Green for
discharge.

Should you have any queries, please do not hesitate to contact me.

Yours faithfully,

Registered Nurse