C09996121 / invoice 10000

NURSE:
HISTORY: Since Friday Louie will not leave her alone at all. Licking ears constantly
EDFU normally

Current Meds: none
-Insurance?
SUBJECTIVE: BAR
OBJECTIVE: T=  MM pink CRT <2 sec HR = 108bpm FP RR panting RESP: normal lung sounds bilaterally 
BEHAVIOUR ASSESSMENT: Lovely 
BCS: 5/9
GIT: NAD
U/G:NAd
NEURO:NAd 
M/S: NAd
SKIN: NAD
OPHTH: L ear clear. R ear significant purulent infection down canal Cocci of different sizes ++++++ inflammatory cells. Does look a little inflammed at section where polyp was previously removed
OTIC:  NAD
LYMPH/N: Normal peripheral LNs
ASSESSMENT: R ear infection recurrent. Cocci +++
Tx OPTIONS: 1. MC&S swab 2. continue symptomatic care 3. referral
TREATMENT: Swab taken for MC&S. Home with PMP ointment and cephalexin oral antibiotics
PLAN: Recheck 2 weeks, earlier if concerned
DISCUSSION: Discussed option for more meds (fluox) for Louie to help him settle with her
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DISCHARGE Poppy has been seen for a recurrent ear infection. We are sending a swab to the lab for culture and will treat with ear drops and oral antibiotics in the meantime. We recommend a recheck in 2 weeks, earlier if you have any concerns.  If you have any concerns or queries please do not hesitate to contact the clinic 

recheck ears 
HISTORY: poly[p removed, no scratching, back to normal. her brother leaving ears alone now
EDDU normally
No v/d/c/s. 
Diet: lyka half hallf RC
Current medications: none
Parasite control: advantage 

EXAM:
BAR - sweet girl
MM pink and moist, CRT <2s, 
Teeth  good, dental grade 2 /4
Eyes, nose NAD
ears: OD: some discharge present; OS: clean and clear. cytology: no significant findings for OS or OD
Hydration good
HR 90  , no murmur auscultated, normal rhythm, normokinetic and synchronous femoral pulses
RR 30 , lungs clear, normal effort
Peripheral LNs WNLs 
Comfortable on abdominal palpation, 
BCS 5 /9
MSK – NAD
Integument – NAD
Neuro - NAD

ASSESSMENT: cleared otitis externa 

PLAN: otoflush 

DISCHARGE: 
We saw the lovely Poppy today for an ear recheck today. There does not appear to be any infection which is great news! She did have a bit of debris in her right ear so to avoid any future infections, please clean her ears 2-3 times a week for 2 weeks then 1-2 times a week.

Other than that she looks happy and healthy. 

 If you have any concerns or queries please do not hesitate to contact the clinic 

Recheck post surgery. Louie is still constantly sniffing her ear. 
BAR, mm-pink, CRT<2s, HR 108bpm no murmurs or arrhythmias no irritation under her arms, abdomen comfortable, Temp 38.7
Ear looks like it is a bit inflammed but healing well. Clear down canal and TM appears in tact. Can still see some residual ointment in canal. 
Reswab 4 weeks post surgery.