You are a nurse at a boarding school. John Anderson is a male student at your school and has come to
you complaining of eczema and associated depression.
Patient details
Name: John Anderson
DOB:
20.08.1995 (18 y.o.)
Address:
School: Westernbay Boarding School, Greerton
Social Background:
Student at boarding school for past 8 years
Parents work and live abroad
Father (Eczema – onset in 50s)
Mother (depression – onset in 40s)
Non-smoker; 20 units alcohol/wk
Karate black bet; champion swimmer
Presenting complaints: Eczema – hands and feet from 13 y.o.; intermittent cycles (extreme dryness and
normal skin); aetiology not confirmed – various possibilities
? Depression
Treatment summary:
Aug 2008:
School clinic – presented with extreme dryness of skin in patches;
anxiety ? onset – school bullying incident, Pt said ‘not a major thing’
Referral to dermatology specialist
Oct 2008:
Dermatologist: no aetiology established; possibly exacerbated by stress
Prescribed steroid cream (betamethasone dipropionate 0.05% cream 1-2x/day
for 3 months personality changes, aggression + sleep loss
Medication discontinued
2009-2013:
No further skin dryness
June 2013:
Return of anxiety and pronounced eczema
General health check – 6 kg over last 2 months
Recommended to see Dr re eczema, anxiety, weight loss. Student reluctant,
asked about natural remedies, e.g. homeopathy. Discussion re efficacy, student
still keen to try
Aug 2013:
No results + cost implications of homeopathic treatment (kalium carbonicum
and silicea)  student  distress and low mood
Problems forming/maintaining peer relationships
Affecting sports participation
Sept 2013:
Referred to school counselor – did not attend
Nov 2013:
Check-up:  alcohol consumption, min 28 units/wk
Dec 2013 – Jan 2014:
Exam time – extreme anxiety (necessary to arrange separate exam room)
-  skin dryness
Feb 2013:
Student concerned about transition to university shortly and independent living
Advisory letter to university medical practice;
-
Monitor
Organise special exam arrangements
Writing Task
Using the information given in the case notes, write an advisory letter to Mrs Taylone, a university head
nurse. In your letter, briefly outline John Anderson’s history and your concerns. Address your letter to
Amanda Taylor, Head Nurse, University of Waikato Health Centre, Hilcrest Rd, Waikato
Amanda Taylor
Head Nurse
University of Waikato Health Centre
Hilcrest Rd,
Waikato
20 February 2019
Re: Mr John Anderson
Dear Mrs Taylor,
Mr Anderson has been a student at Westernbay Boarding School and will be enrolling at your university
shortly. Some of his health issues may require your intervention and monitoring.
Mr Anderson has a prolonged history of eczema that was first noticed about five years ago. Though the
trigger had not been identified then, it could have been due to anxiety that he developed following an
incident of bullying at school. Initially he was treated with a steroid cream, which was discontinued
following episodes of aggression and sleep deprivation. There were no noticeable flare-ups until last
June when he was found to have anxiety and a relapse of eczema. He lost about six kilos in a span of two
months. He was reluctant to consult a doctor and was eager to try homeopathy treatment.
Two months later, Mr Anderson noticed that the treatment had not worked despite the expensive
medication. He was found to be withdrawn from social interactions and participation in sports. He was
even more anxious during school examinations which worsened matters.
Mr Anderson is now concerned about his move to the university. He will have to be monitored at the
university and your prudent interventions might be a respite for him. Please note that he may require
special arrangements for exams.
Kind regards,
School Nurse