Assessment of eyes and ears (EXAM 5)

Nursing health hx:

1. do you use _______ or _______

2. last visit to ______ or _______

3. current use of ______ or ______ eye meds

1. contacts or glasses

2. ophthalmologist or optometrist

3. prescription or OTC

Nursing health hx:

We want to know the pt. and family’s hx of what 7 things

1. diabetes

2. hypertension

3. migranes

4. strokes

5. eye disease

6. eye injury

7. eye surgery

Nursing health hx EYES:

What 3 diseases may we want to know if the pt. has a hx of, or family hx of?

1. glaucoma

2. cataracts

3. color blindness

define presbyopia

diminished ability to see close objects / small print

define diplopia

double vision

define exophthalamos

eyes bulging

define strabismus

eyes crossing

We inspect eyes for (2)

1. symmetry

2. alignment

We inspect eyebrows for (3)

1. hair

2. distribution

3. symmetry

We inspect eyelids for (6)

1. position / symmetry

2. drooping

3. lesions

4. redness

5. edema

6. closure (do they close all the way?)

define ptosis

eyelid drooping

A normal conjunctiva appears

shiny and clear

What is the thin, transparent, and continuous membrane covering the eye and inside of eyelids?

conjunctiva

Normal color of sclera

white to pale ivory

4 ways a sclera can appear abnormal

1. jaundiced

2. excessively pale

3. reddened

4. lesions / nodules

How does a normal iris appear

round, flat, evenly colored

A normal cornea should appear

transparent, shiny, smooth

An abnormal cornea may appear

opaque, not smooth

During a Cardinal Fields of Vision test, the eyes should

1. move ______

2. remain ______ during movement

3. return to ______ between directions

1. smoothly

2. parallel

3. midline

What does the Snellen Eye Chart measure?

distance vision

What kind of eye chart is used for children, non-english verbal, illiterate, or non-english reading pt.’s w/ english as 2nd language?

E chart

SNELLEN EYE CHART:

Pt. stands ____ft. from chart, covers ___ eye, and reads down progressively ______ lines until he can no longer read all the letters

20, one, smaller

For a Snellen Eye Chart, we record the number of the ?

last line pt. can read

What does the top number represent of Snellen Eye Chart measurement?

distance between pt. and chart, should always be 20

What does the bottom number of the SNellen Eye Chart measurement represent?

distance from which a person w/ normal vision could read same line

For Snellen Eye Chart, the larger the bottom number means

the poorer the vision

For testing near vision, we use what kind of chart(s)?

Pocket Snellen or Rosenbaum chart

When testing near vision, we should hold it how many inches away from pt.? (top number)

14

Normal measurement for near vision is

14/14

Define opthalmoscope

instrument used to inspect internal structures of eye

2 expected age-related changes of the EYELASHES in older adults

1. decreased #

2. shorter / thinner

A normal expected change in an older adult pt. is decreased tear production, which can cause what 3 effects?

1. dry eyes

2. burning eyes

3. itching eyes

An expected age-related change of older adults is decreased eye elasticity , which can cause?

ptosis

2 expected age-related changes of the PUPILS in older adults

1. reduced size / diameter

2. react slower to light

2 expected age-related changes of VISUAL ACTIVITY in older adults

1. presbyopia

2. blurred vision

An expected age-related change of older adults is the decreased ability to accommodate extreme changes in light, like ____ & ______

glare, darkness

An expected age-related change of older adults is a loss of ______ _____ of eyebrows

lateral third

5 expected age-related changes of the LENS in older adults

1. increased discoloration, stiffens

2. yellow

3. cataracts

4. altered color perception

5. gradual vision loss

1 expected age-related changes of the ARCUS SENILIS in older adults

1. gray / white arc (ring) around peripheral iris

Why can some older adults develop a gray / white arc (ring) around their peripheral iris?

lipid deposits

What are expected age related changes in older adults regarding their peripheral vision and depth perception?

both decreased

Define tinnitus

ringing, buzzing, humming, crackling noises

Nursing health hx on the EAR

1. ear pain or ______

2. recent changes in _______

3. use of _______ ______

4. hx of ear ________ or _______

5. medications

1. discomfort

2. hearing

3. hearing aids

4. surgery, trauma

Some meds can be ototoxic like (2)

1. chemotherapeutic agents

2. some antibiotics

Risk Factors for Hearing Loss

1. prolonged exposure to high levels of _______

2. exposure to _______ meds

3. repeated ear ________

4. Ear _______

5. age ( degeneration of inner _____ _______)

6. Illness

1. noise

2. ototoxic

3. infections

4. trauma

5. ear structures

Ear infections are common in pt.s w/ ?

seasonal / environmental allergies

When gathering nursing hx of the ear, we want to know about family hx of?

hearing loss & age

When gathering a social health hx about the ear, we want to know of what 3 things?

1. loud noise / music

2. exposure to loud noises at work

3. hobbies / recreation that involves loud noises

How should the color of a normal auricle appear?

same color of facial skin

Abnormal colors of earlobes

blue, red

Where should the top of ear be positioned?

slightly above level of eyes

What may low set ears be associated w/?

congenital abnormality

During inspection of external portion of ear canal, what should we look for? (5)

1. cerumen visible?

2. discharge

3. odor

4. foreign body visible?

5. inflammation and/or swelling

We should palpate what 2 parts of the ear for tenderness?

1. auricle

2. tragus

Define otoscope

light instrument inserted into external ear canal to see middle ear structures

We can inspect the tympanic membrane with what?

otoscope

What color should the tympanic membrane be?

pearly gray, semitransparent

Abnormal colors of tympanic membrane

pink to red / opaque / yellow-amber / white / blue / deep red / dull surface

1. When performing a hearing acuity test, we should have the pt. cover ____ ear with a finger.

2. We stand ___ to ___ feet away from pt. and whisper a _-______ word or short phrase on side of uncovered ear.

3. Ask pt. to repeat.

4. Then do other ear

one, 1-2, 2 syllable

What does the tuning fork test assess?

bone and air conduction

What is bone conduction?

sound is transmitted through bone directly to inner ear, bypassing outer ear

What is air conduction?

sound waves travel through air to outer ear and funneled to eardrum for perception

Define conductive hearing loss

transmission of vibrations is prevented in outer or middle ear

What could conductive hearing loss be caused by?

mechanical blockage (ex: excessive earwax)

Define sensorineural hearing loss

due to damage of receptor cells or cochlear nerver

The Tuning Fork Weber Test differentiates what?

conductive hearing loss from sensorineural

With sensorineural hearing loss, it doesn’t matter if sound waves reach the ear drum, why?

the nerves / mechanism for reception or processing is impaired

To perform a Tuning Fork Weber Test, we place the vibrating tuning fork where on the pt.?

top of head

1. What results from the Tuning Fork Weber Test imply conductive hearing loss?

2. What results from the Tuning Fork Weber Test imply sensorineural hearing loss?

1. sound heard louder in impaired ear

2. Sound heard softer on impaired side

Tuning Fork Rinne Test compares what?

Air conduction and bone conduction

To perform a Tuning Fork Rinne Test, we place the vibrating tuning fork where?

mastoid process

What is a normal result from the Tuning Fork Rinne Test ?

pt. heard sound twice as long by air conduction as by bone

4 expected older adult age-related changes of the external ear

1. change in shape

2. increased cerumen

3. increased hair growth

4. dryness of ear canal

Why may an older adults external ear change shape?

wrinkling and sagging of tissue and growth of non-articular cartilage

2 expected older adult age-related changes of the middle ear

1. thickening of tympanic membrane

2. otosclerosis

define otosclerosis

calcification of ossicles (3 bones of middle ear)

2 expected older adult age-related changes of the inner ear

1. hearing loss

2. presbycusis

define presbycusis

age related hearing loss (esp. high frequency sounds)