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The vulvar vaginal diseases service sees referrals to help women with short--and long--term problems of the outer genital area (vulva), vagina and pelvic floor muscles including: Vulvar vaginal burning, itching, irritation and pain Vulvar Vestibulitis Pain with intercourse Discharge Yeast infections Bacterial vaginosis Pelvic floor muscle dysfunction A patient must be referred by her local health care provider. Services include: Skin care education Examinations-Your healthcare provider will examine you and talk with you about recommendations for treatment and/or management of your symptoms. Some vulvar diseases require a biopsy to diagnose the condition. Referrals-Your healthcare team may refer you to other specialists, including physical therapists or health psychologists. Separate insurance authorization is necessary for these services. The clinic staff provides general education and support to help women cope with these very personal health problems. Following a clinic visit, a letter is promptly sent to your local health care provider. The letter provides the results of your exam and the plan of care.

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If a patient comes to you with a painful, throbbing, swollen, red face (a ''fat face'), perhaps with fever, trismus and lymphadenitis, he is probably suffering from an acute dental or oral infection, most probably an alveolar abscess. He may have: (1) An alveolar abscess begins as an infection in the bone around a non-vital infected tooth. He has severe pain, which becomes less as pus is released into more superficial tissues and his face starts to swell. After 36 hours of cellulitis he usually has a fluctuant abscess which needs draining. If drainage is delayed, the pus in his abscess discharges spontaneously through a sinus (26-8) in his gum or face, which may become chronic. First, control infection with antibiotics, and then drain the abscess, either by incising it where it is pointing, or by removing the infected tooth, which acts as a cork to prevent the pus escaping, or by doing both these things. If you remove a tooth before you have controlled the infection with antibiotics, and while his face is still severely swollen, you may spread the infection; your task will also be more difficult. (2) A periodontal abscess at the side of a tooth, caused by spread from an infected gum. (3) A pericoronal abscess caused by infection of the gum over the crown of an unerupted and impacted tooth, usually a lower third molar (''an infected wisdom tooth'). Often, an abscess does not form, and the gum round the tooth is merely inflamed.

Rectal Examination

The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.

Rotator cuff repair is surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (open) incision or with shoulder arthroscopy, which uses small buttonhole-sized incisions.

A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected.

Thoracentesis (THOR-ah-sen-TE-sis) is a procedure to remove excess fluid in the space between the lungs and the chest wall. This space is called the pleural space. Normally, the pleural space is filled with a small amount of fluid—about 4 teaspoons full.

Take your left leg and place your ankle against the knee. Hold the position for a moment before changing legs. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve causing pain. Repeat by switching sides and doing the same exercise with the other leg.

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Lip augmentation is a cosmetic procedure that can give you fuller, plumper lips. These days, an injectable dermal filler is the most commonly used method of lip augmentation. There are many types of dermal fillers that can be injected in your lips and around your mouth.

When is endoscopy used? Endoscopes were first developed to look at parts of the body that couldn’t be seen any other way. This is still a common reason to use them, but endoscopy now has many other uses too. It’s often used in the prevention, early detection, diagnosis, staging, and treatment of cancer. To prevent and screen for cancer Some types of endoscopes are used to look for cancer in people who have no symptoms. For example, colonoscopy (KO-lun-AH-skuh-pee) and sigmoidoscopy (SIG-moid-AH-skuh-pee) are used to screen for colon and rectal cancer. These procedures can also help prevent cancer because they let doctors find and remove polyps (growths) that might become cancer if left alone. To find cancer early Endoscopy can sometimes be used to find cancer early, before it has had a chance to grow or spread. Looking for causes of symptoms When people go to the doctor with certain symptoms, endoscopy can sometimes be used to help find a cause. For instance: Laryngoscopy to look at the vocal cords in people with long-term hoarseness Upper endoscopy in people having trouble swallowing Colonoscopy in people with anemia (low red blood cell counts) with an unknown cause Colonoscopy in people with blood in their stool Looking at problems found on imaging tests Imaging tests such as x-rays and CT scans can sometimes show physical changes within the body. But these tests may only give information about the size, shape, and location of the problem. Doctors use endoscopes to see more details, like color and surface texture, when trying to find out what’s going on. Newer methods of endoscopy that include high magnification are being tested to find out whether they are more useful in detecting cancer and other abnormal cells on the inner surfaces of the body. To diagnose and find out the stage (extent) of cancer To get a tissue sample Going one step further, most types of endoscopes have tools on the end that the doctor can use to take out small tissue samples. This procedure is called a biopsy (BY-op-see). Samples can be taken from suspicious areas and then looked at under a microscope or tested in other ways to see if cancer is there. A biopsy is usually the best way to find out if a growth or change is cancer or something else. Getting a closer look In some cases endoscopes are used to help find out how far a cancer has spread. Thoracoscopy (THOR-uh-KAHS -kuh-pee) and laparoscopy (LAP-uh-RAHS-kuh-pee) can be very useful in finding out if cancer has spread into the thorax (chest) or abdomen (belly). The surgeon can look into these places making only a small incision (cut) in the skin.

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cardiac massage intermittent compression of the heart by pressure applied either over the sternum (closed cardiac massage) or directly to the heart through an opening in the chest wall (open cardiac massage). simple massage in the nursing interventions classification, a nursing intervention defined as stimulation of the skin and underlying tissues with varying degrees of hand pressure to decrease pain, produce relaxation, and/or improve circulation.

To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine.

A gastroscopy is a procedure where a thin, flexible tube called an endoscope is used to look inside the oesophagus (gullet), stomach and first part of the small intestine (duodenum). It's also sometimes referred to as an upper gastrointestinal endoscopy. The endoscope has a light and a camera at one end.

A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes. This topic covers a blockage caused by tumors, scar tissue, or twisting or narrowing of the intestines. It does not cover ileus, which most commonly happens after surgery on the belly (abdominal surgery). What causes a bowel obstruction? Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstructions . In the small intestine, scar tissue is most often the cause. Other causes include hernias and Crohn's disease, which can twist or narrow the intestine, and tumors, which can block the intestine. A blockage also can happen if one part of the intestine folds like a telescope into another part, which is called intussusception.

Colorectal cancer (also known as colon cancer, rectal cancer or bowel cancer) is the development of cancer in the colon or rectum (parts of the large intestine). It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. People with HNPCC tend to develop colon cancer before age 50. Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly increased risk of developing colon cancer before age 40.

Comprehensive physical examination

Prostate biopsy is a procedure in which small hollow needle-core samples are removed from a man's prostate gland to be examined microscopically for the presence of cancer. It is typically performed when the result from a PSA blood test rises to a level that is associated with the possible presence of prostate cancer.