C10032308 / invoice 10000

Appointment Notes: bandage removal  ***MRSP BARRIER NURSING***Last Changed & Who by >> KS 25/01Todays Change Done by >> ALAHistory:Doing well at homeFinished last dose of marbofloxacin today, no v+ or d+, EDUD fineObjective: Bandage dryDressing clean, no discharge Digit amputation site looking good, previous region of scabbing has closed over, no deficit, mild crust over wound but healed underneath. Sutures intact.Treatment: Sedation: butorphanol 10mg/mL 1mL + medetomidine 1mg/mL 0.3mL IM at 8:35amRemoved bandageCleaned with aqueous chlorhexidine and driedMupiricin ointment applied around wound. Bandage left off. Sutures left in place. Nails trimmedReversed atipamezole 0.3mL IM 9:05am Assessment: Wound healed well (despite MRSP + pseudomonas aeruginosa culture)Treatment:Mupiricin ointment to skin around wound until hair grows back (for max 3wks)Synbiotic capsules 1 SID Plan: Ecollar if showing any interest in licking the wound (also sent home with melolin+fixomul for a temporary dressing if needed). Continue mupiricin ointment BID until crust is gone and fur is growing back  R/c if any concerns    Vital Signs    

Reason: bandage changeTreatment:Given butorphanol (10mg/ml) 1ml + medetomidine (1mg/ml) 0.3ml IM at 9:50am >heavy sedationRemoved bandage; erythematous and moist around surgical site but holding; cleaned with chlorhexReplaced bandage; melolin over wound, cotton wool between toes, padding with swabs, softban, elastoplastRecc cover base with some duct/gaffa type to protect from bandage and moisture at homeGiven atipamaezole (5mg/ml) 0.3ml IM at 10:10amGiven cytopoint 60mg sc at 10:10amApplied dermotic to both earsContinue/finish oral medsPlan:Opted to send digit for histo nowBandage change in 5daysRepeat cytopoint in 4weeks+; can increase to 70-80mg sc pending on responseaccount checked PH     Vital Signs