C09978838 / invoice 10000

Reason: Sedation for bloods History: See admit historySedation: Zoletil 0.06ml IM - not enough, topped up with 0.04ml IM - good sedationExamination: Sedated examination:MMpink, CRT<2HR200RRwnlT: wnlOral: grade 2 ddChest ausc: NADAbdo palp: long faecal column, compressible and normal width but backed up and curled around all the way to diaphragmLaboratory: Blood drawn for TAHPAssessment: 1. Suspect chronic constipation Previous findings:1. Sub-optimal concentrated urine - ddx. Early CKD? Await blood results 2. Protein, blood ++ - ddx. Secondary to cystocentesis vs. UTI related given clinical symptoms 3. Bacteruria - ddx. True UTI given symptoms (resistant to initial abx course/recurrent) vs. Subclinical bacteuria 4. Urinary retention secondary to spinal issues 5. Struvite crystalluria - equivocal given sample sent to lab, however likely benefit from urinary or K/D diet (await bloods) Client Communication:  - Summary of discussion topics: Update on Mars post-sedation for blood collection. Discussion regarding constipation and management plan. - discussed risk of Chronic constipation: can lead to megacolon.  - To improve stool consistency and prevent recurrence, starting Osmolax powder is recommended.  - discussed can trial showing owner how to palpate for faecal column to monitor  Treatment: Consent has been given by the client to proceed with this treatment  -  YESMicrolax PRStart Osmolax at a quarter of a teaspoon once daily mixed with lactulose, titrating up as needed while monitoring for diarrhoeaClomav scriptAmoxyclav 62.5mg PO BID 7 days (inital course from ARH was this but 5 days, with recc. To revisit with RV prior to stopping). Plan:- await blood and culture results - continue pain relief and start abx in meantime, owner understands may change- start osmolax--- 03/03/2026 12:26:56 JNA:# of items Dispensed:Rx:	……………CLOMIPRAMINE 5mg tablets………………….........Mitte:	………………100 tablets………………............................................Directions:                   …………Give ONE tablet orally ONCE daily. ………………………………………………….                                        …..…………………………………………………………TWO REPEATS    Vital Signs    Weight: 4.68;