HEENT pt 1 (study alongside notes)

Inspect the head for __________, __________, __________, and __________.

size, shape, symmetry, position

The head should be __________, __________, __________, and __________ to body size based on age.

symmetrical, rounded, erect, proportional

In newborns and infants, the __________ bones are not fused at birth.

cranial

The anterior fontanel (soft spot) typically fuses at about __________ months.

18

The posterior fontanel usually fuses at about __________ weeks.

8

When inspecting the face, note the __________ and whether facial features are __________. Also check for any __________ facial movements.

facial expression; symmetrical; abnormal

Inspect the head and scalp for __________, __________, and __________.

color, distribution, infestations

Palpate the __________ and __________ for masses and tenderness.

head, scalp

Expected findings: the scalp should be __________, __________, and __________.

non-tender, relatively smooth, symmetrical

Palpate the __________ for texture.

hair

Palpate the __________ for symmetry, tenderness, muscle tone, and __________ function.

face; temporomandibular joint (TMJ)

Expected findings: movement should be __________, __________, and without __________, __________, or __________ of the jaw.

smooth, symmetrical, pain, crepitus, clicking

Inspect the __________ structures of the eyes for general appearance, color, and alignment.

external

Observe the position of the eyes and note any abnormalities in __________ or __________.

color; alignment

Inspect the __________ for lesions, edema, or __________ (drooping of the eyelid).

eyelids; lid lag (ptosis)

A __________ is also known as a stye.

hordeolum

The __________ __________ is the area between the open eyelids.

palpebral fissure

Inspect the __________ for symmetry and even __________.

eyelashes; distribution

Assess the __________ ducts and glands for edema, excessive tearing, or drainage.

lacrimal

The __________ should be inspected for color, moisture, and contour.

conjunctivae

Use a __________ to examine the __________ and __________, which should appear clear, smooth, and glistening.

penlight; cornea; lens

__________ vision is tested to assess cranial nerve II (optic nerve) function.

Visual

Use a __________ eye chart or picture chart (for preschoolers).

Snellen

If the client wears __________ lenses, they should be worn during the exam.

corrective

Have the client stand __________ feet from the chart.

20

Instruct the client to cover one eye and read the __________ line of print they can see clearly.

smallest

A line is considered correct if the client makes no more than ______ mistakes on that line.

two

Repeat the test with the ______ eye, then both eyes together.

opposite

The expected finding is __________ vision in both eyes.

20/20

__________ is diminished distant vision, also known as nearsightedness.

Myopia

__________ is diminished near vision, also known as farsightedness.

Hyperopia

__________ is a change in vision associated with aging (over 40) that causes nearsightedness.

Presbyopia

__________ vision tests the ability to differentiate color patterns.

Color

__________ vision is tested by having the client cover one eye and fix their gaze straight ahead while you bring an object from the periphery to the center of their visual field.

Peripheral

__________ (crossed eyes) occurs when one or both eyes deviate from the object being focused on.

Strabismus

__________ (lazy eye) is caused by constant strabismus.

Amblyopia

__________ movements control the movement of the eyes and eyelids.

Extraocular

The corneal light reflex test checks for parallel alignment by shining a penlight at the __________ of the nose and noting where the light reflects on the cornea.

bridge

The corneal light reflex should appear at the ______ in each eye.

same position

The six cardinal fields of gaze test assesses eye muscle movement controlled by cranial nerves ______, ______, and ______.

III, IV, VI

When performing the six cardinal fields of gaze test, the eyes should move…

smoothly through all six gaze positions.

In the cover/uncover test, a shift in gaze when the eye is uncovered indicates…

weak eye muscles.

A ____________ reflex (CN ___) is tested by touching the cornea with a wisp of sterile cotton or using a needleless syringe to shoot a small amount of air over the cornea.

corneal; V

The corneal reflex test is not routinely performed on a ____________ person.

conscious or cooperative

Failure to blink during a corneal reflex test may indicate ____________ deficits.

neurosensory

When inspecting the iris and pupils, note their ____________, ____________, ____________, and ____________.

Color, size, shape, symmetry

Pupils should normally be ____________ and of ____________ size.

round; equal

Unequal pupils may result from ____________ damage, ____________, brain ____________, or increased ____________.

CN III; stroke; herniation; intracranial pressure (ICP)

Enlarged pupils are called ____________.

mydriasis

Constricted pupils are called ____________.

myosis

To test pupillary reaction (CN ___), dim the light and use a ____________.

III; penlight

When testing pupillary reaction, the client should look ____________ ____________ while the penlight is brought in from the ____________.

straight ahead; side

The nurse should note the pupils’ reaction, ____________, and ____________ of response in both eyes.

size; equality

The response in the same eye that the light is shined into is called the ____________ response.

equality; speed

The response in the opposite eye is called the ____________ response.

direct

An ophthalmoscope exam is considered an ____________ ____________ assessment.

advanced practice

Pupillary constriction occurs through the ____________ pathway.

parasympathetic

A ____________ response results in 100% pupillary constriction in the same eye the light is shined into.

direct pupillary light

A ____________ response results in approximately 50% pupillary constriction in the opposite eye.

consensual

The ____________ pathway is responsible for causing the pupils to constrict.

parasympathetic

The acronym PERRLA stands for ____________, ____________, ____________, ____________, ____________, and ____________.

Pupils, Equal, Round, Reactive to Light, and Accommodation

The P in PERRLA means the pupils should be ____________.

clear

The E in PERRLA means the pupils should be ____________ in size and between __-__ mm.

equal; 3-5

The first R in PERRLA means the pupils should be ____________ in shape.

round

The second R in PERRLA refers to pupils being ____________ to ____________ both directly and consensually when a light is directed into one pupil and then the other.

reactive; light

The A in PERRLA stands for ____________, which is the pupils’ ability to ____________ when looking at far and near objects.

accommodation; adjust

During accommodation, the pupils ____________ to look at a far object and ____________ to focus on a near object.

dilate; constrict

To test accommodation, have the patient look straight ahead and focus on an object about ___ inches from the face.

12

When testing accommodation, slowly bring the object ____________ the patient’s eyes.

toward

A normal pupil is slightly ____________ when exposed to moderate light.

dilated

____________ refers to constriction of the pupil.

Miosis

____________ refers to dilation of the pupil.

Mydriasis