C10011656 / invoice 10000

Reason: 36Attendees:History: Admitted by KAR - Walk in PT started vocalising at 0230 and unsettled, PT had a stretch/downward dog this morning x1O was taking PT outside throughout the night to see if will toilet, O concerned he is constipated - has passed 3-4 nuggets since sx PT has been receiving 1/2 500mg panadol BID PT eating, urinating as norm, O adv drinking slightly lessNo V+ but was found eating grass Bright Alert ResponsiveBody condition score 6.5Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 1Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR wnlLungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – caudal abdominal painFAST scan- no free fluid present, moderate gas, hyperechoic mesentryXray- faeces on colon, gas in SILimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – erythema along abdomen (clipper blade reaction and reaction to fixamol tape site), some bruising notedNails – fineAnal glands – not scootingTemperature – wnlGenital region - no masses or swellingsLaboratory?:CBC - WBC 20.23, Neutro 16.20, Mono 1.35, MPV 14CHEM - WNL Panc - WNLAssessment:Abdominal pain- responsive to methadone PR inj- comfortable in pm but not wanting to eat in clinicSkin reactionCannot r/o constipation, some faeces in colon but unsure if firm/ hard based on palpationTreatment:Paracetamol 13.8mg/kg oralMethadone 0.2mg/kg SQPlan: FUC daysNurse notes: KaraReweighed today 36, from 37.9kg (sx day)Temp 37.5 - didnt tolerate well PM +++ <1 nasueas? HR 100 no murm norm rythRR panting clearQARCollected blood from LCV in house PAS LYTES Panc - WNL , inflammation elevation on cbcPainful on palpation - cranial abdo Skin irritation +++ , removed fixamol from sx siteNeocort appliedAfast performed no FF, inflammed cranial abdoMethadone 0.2mg/kg SC @0905Panadol 250mg PO @1000 10/03/2026 09:24:17 KAR: client contact Don - Adv that the bloods are ok, no panc elevation. We will review his PR management, believes his a bit uncomfortable whether the fentanyl patch is becoming weaker and with the skin irritation around the site contributing to discomfort, O wanted to check his not constipated. Adv will reassess his abdo once pain is controlled. Will keep him here for a couple of hours to reasses. O happy with plan.1037- Prevomax 1mg/kg SC given1x Lat Arad performed Toilet walk - urinated ++ Placed neocort around surgery site on irritated skin, PT extremely reactive to incision site above penis, red and inflammed.1130 - Offered gastro refused11.55 - Panadol 10mg/kg PO given 1200 TPRPM<1HR 88RR light shallow pantingQAR, < BAR outside pulling about Urinated +++ Offered chicken licked but didnt eat10/03/2026 14:01:14 KAR: TTC LVM - to confirm D/C with CP @163010/03/2026 14:04:30 KAR: Don called back, confirmed D/C with CP and got verbal consent to place a new fentanyl patch. Adv he is much more comfortable with extra PR onboard and we performed FOC xray to see if he is constipated - there is stools in there but hard to gauge is soft or firm but likely things are moving through slowly due to GA, FB and illius. Can add in steamed pumpkin 1/2 cup to each meal or metamucil ( NOT flavoured) for a couple of meals to help move things through.1620 - Methadone 0.2mg/kg SC    Vital Signs    Weight: 36;