C10013241 / invoice 10000

HISTORY:- Re-presentation for assessment of straining to urinate (stranguria).- Presented on Saturday and monday for similar clinical signs and was discharged on medication. He urinated last night and early this morning, but has since been observed straining to urinate on approximately three occasions this afternoon without producing any urine. The last dose of his current medication was administered this morning. (already on gaba and bupe)- He has a history of a urinary obstruction in 2025 which required management.- Standard diet, no recent changes mentioned.- no V+ D+ otherwise and still eatingPHYSICAL EXAM:TRIAGE:HR: 160RR: 24Temp: 37.7 Mm:  pmCrt:  <2sMentation: BAR Pain Scale (0-4): 1/4 Hydration status (%): eu EXAMINATION:Body Condition Score: 5/9Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score : 1/4- Abdominal: The urinary bladder is large on palpation but remains soft and non-painful. Otherwise nsf- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: peripheral lymph nodes normalEyes: clear cornea, no blepharospasm, no redness, white sclera, no discharge PROBLEM LIST:1. StranguriaDIFFERENTIALS:FLUTD crystaluria vs UTI vs FICDIAGNOSTICS- urine cytology (cysto) : RBCs+. no crystals or bacteriaASSESSMENT:- FLUTD FICTREATMENT:- medetomidine 10 mg/kg IM. Reversed atipamezole- patient voided bladder himself after sedation- TGH monitoring and continue medsPLAN:- INI may need unblocking and U-cath placement- consider long term management as per discharge notes    Vital Signs