Ch 13: Eye Assessment For Adv Practice And Specialty Practice Flashcards by Alyssa Quintela

What is the sensory organ of sight and where is it located

The eyes is a sensory organ of sight located within the skull

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What’s the purpose of the orbital socket and what is its diameter

The orbital socket protects the complex internal eye structure (the sides and back of eye)

Diameter is 1 inch(2.5 cm)

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What is the purpose of the extraocular structures

Support and protect the eyeball

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How do the loose in mobile eyelids support and protect the eye

(4 ways )

Main function
Protects from
Regulate
Distribute

Cover eye
Protect the foreign bodies
Regulate light
Distribute tears

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What is the Palpebral Fissure (shape)

What does the upper palpebral fissure cover
what does a lower palpebral fissure cover

The pulp Pepper Fisher is the almond shape between eyelids

Upper palpebral fissure covers upper Eye

Lower palpebral fissure covers margin at limbus (outline of eye)

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Other than being the outline of the eye where exactly is the limbus also known as the lid margins

Limbus is the border between the cornea and sclera

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What is the normal color of conjunctiva and if there is a conjunctiva infection what is it typically referred to as

Normal conjunctiva color: clear

If infected conjunctiva: “pink eye”
- baceterial or viral

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What exactly is the sclera

The thin mucous membrane that lines the eye

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What is the medical name for an eyelid infection/inflammation And how does it appear

Blepharitis

Will appear red swollen with drainage

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What is the purpose of the lacrimal punctum and where is the lacrimal apparatus position

The lacrimal punctum distributes tears

Lacrimal apparatus located on the inner corner of the eye

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When doing an assessment what cranial nerves are you testing and what is their specific function

CN2,3,4,6
2 (optic): visual acuity

3(ocular motor): cardinal feilds of gaze
Accomodation
Pupil rxn PERRLA

4(trochlear): cardial feilds of gaze

6(abducens): cardinal fields of gaze

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What cranial nerve test for PERRLA and what does PERRLA stand for

Cranial nerve 3( ocular motor) test for PERRLA

Pupils equal round reactive to light accommodation

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What are the cranial nerves you test when doing extraocular movements EOM

What are the functions of the cranial nerves you’re testing ( what do they innervate)

Differentiate the normal V abnormal movement findings

Your testing cranial nerves 3,4,6

Function: innovate and control Eye motor nerve activity

norm: SMOOTH
Abnorm: nyastagmus

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What are the three layers of tissue for the eye and give its components

outer
- sclera and cornea
middle (vascular)
- Iris, ciliary body, choroids
Retina

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Give the three chambers of the eye and describe the last and most important chamber

Anterior chamber
- holds aqueous humor
Posterior chamber
- between Iris and lens
Vitreous chamber
- largest chamber filled with vitreous humor (Gel) that holds The retina in place and maintains eye shape

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What does the retina receive and transmit to the brain

what are the three most important components its made of (use for sight)

The retina receives and transmits visual stimuli to brain

Made of:

Photo receptors
rods : Low light vison , black and white
cones: bright light, color image, fine sharp detail

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What is in greatest concentration in the macula

Greatest cone concentration

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What is the optic discs purpose and what cranial nerve sit here

Optic disc is the opening for the optic nerve this is where cranel nerve 2 (OCULAR) sits

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Give the pathway of vision

5 step process

light enters cornea
Light bent onto Central Fovea
light reflected inverted reversed, FOCUSED to retina
Image communicated through the visual pathway
Is image returns to normal form in brain

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What are the parts of the neural pathway and what is the bigger structure or system it is part of

Optic nerve, optic Chiasm, optic tract
(Into cerbral cortex)

The neural pathway is part of the CNS

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What are abnormal findings for older adults in relation to vision

1 is a disease

Photophobia: light sensitivity

Cataracts: opaque white color IN PUPIL

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What are a few common considerations for older adults

Where the eyes sits, eyebrows
Conjunctiva
Iris piggemtation
Tear formation
Visual accuity 
Night and depth perception and how 
Lense (glare and peripheral vision) 
Up close vision

Eyes sits deeper(sinks in) , brows thin
Conjunctiva becomes yellowish/thins
ARCUS SENILLUS: blue/ white limbus circle around iris
decreased tear formation
decreased visual acuity
decrease night vision and death perception due to smaller pupils leading to loss of accommodation

Lens enlarges causing decreased glare tolerance and decreased peripheral vision

Presbyopia common after 40 need bifocals!

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What is a normal finding arcus senillis or Cataracts

Arcus senillus : White/blue limbus ring around Iris is a normal finding

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What’s a normal finding glare

Intolerance or light intolerance

glare intolerance is a normal finding because of an enlarged lens

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What is common to see in pregnant women in relation to their eyes Moisture of eye Accomodation Pigmentation of skin

Pregnant women have dry eyes Loss of accommodation because of increased corneal curvature Chloasma melasma

In an infant of three months what is something that they can do with their eyes

Infants contract objects and react to light

When doing a comprehensive physical exam of the eyes what three components are you testing

Visual security PERRLA EOM

We’re doing an urgent assessment what are you treating What is an urgent assessment followed up by

You were treating the emergency Urgent assessment followed up by comprehensive assessment

What characteristic of vision loss makes for an urgent assessment

Sudden vision loss requires urgent assessment

If you get an eye trauma what is the number one thing that will threaten Eye function

A time delay of seeking care will threaten I function

What are the types of traumas you can get in the eye and give an example (Five)

Mechanical -Blunt force/penetrating Thermal - burn - USE NS Radiation -Uv Chemical -USE NS Electrical

What is a florescein exam for in relation to eye issues

A flourescein exam uses drops and UV light to assess for any abrasions or lacerations

What is the medical term for blood in eye If a patient has blood in eye what position is vital for them to maintain

Hyphema = blood in eye It is vital to maintain high Fowlers position

What kind of glaucoma is a medical emergency, describe it Give a few signs and symptoms

Acute glaucoma which is blockage of fluid can lead to permanent vision loss Signs and symptoms: Blurry vision Rainbows around lights

If someone has a penetrating trauma what do you not want to do If someone has a penetrating trauma or suspected fracture to orbital bone what does it mean

If there is a penetrating trauma you do not wanna take out object, stabilize it instead A penetrating trauma or suspected orbital bone fracture =emergency

When collecting subjective data what is important information to get Eyes history Glasses or occupation Nutrition Fam history

Eyes: - any existing conditions - Eye surgeries Glasses or occupation - corrective lenses? - Eye protection if occupation needs it Any good diet Any family history of -myopia: nearsighted -hyperopia: far sighted

What are foods that help with vision

Deep water fish Fruits Vegetables -carrots and spinach Hydration

What viruses if exposed young can cause neonatal blindness

Rubella and Congenital syphilis

If a patient is diabetic what do you wanna ensure in relation to their eye health and DM and why What are some risks

Ensure DM is being treated and monitored because of the risk of developing eye conditions Diabetic retinopathy, cataracts, glaucoma

Can toxins chemicals or stress increase vision problems

| Yes

if a patient presents with Eye pain what is it classified as If a patient presents with sudden vision changes what is it classified as How do you know to suspect retinal detachment

1Emergency 2. Emergeny 3. If patient is seeing Blind spot, halos, floaters suspect retinal detachment

What things can impact activities of daily living in relation to the eye How many times you see of things and what is common among preg women

Diplopia And dry eye can change activities of daily living

What do you want to assess for if a newborn lacks tears

If a newborn lacks tears assess for a blocked lacrimal apparatus

What are cultural considerations to keep in mind when it comes to they eyes and their external appearance

Eye color Eye shape Eyebrow shape

Do we use abbreviations for each I and if not why do we not

We no longer use abbreviations for eyes we physically write out “right eye” because of errors

When is it important to wear gloves when assessing the eyes

When a patient has -blepharitis -conjunctivitis

When you’re assessing using the snellen test how far does a patient stand away from the chart What is perfect vision What does 20/60 mean (Numerator/denominator/both) How do you note if a patient is having difficulty reading What glasses must you remove for the exam How do you document if a patient missed two letters in one line What vision is considered legally blind

- When doing a Snellen test patient stand 20 feet away from chart - 20/20 = perfect -20 N= 20 ft /60 D= what patient can read • together 20/60 means patient can read at 60 feet what normal I can read at 20 - difficulty reading if leaning or squinting - Reading glasses must be removed for snellen -if two letters missed 20/60-2 -Legally blind= 20/200

When a patient is using an Allen test how far away do they stand from the chart and who is the Allen test for what does the allen test consist of

Patient stands 15 feet away from chart, Patient is a child Allen test Consists of pictures

When using the culture E test What is a good patient to use it on and how do they express their answer

Culture E tests are good to use on those who do not speak your language and the express answer by pointing in direction of E

What do the jaegar and Rosenbaum charts test for and how close If you don’t have either test what can you use

Test for near vision 14 inches If neither chess available you can use newspaper

What is an ishaharas card test for What is a patient looking for on the Ishihara‘s card

Test color blindness Patient is looking to identify embedded figure

Describe the static confrontation test

Static confrontation is presenting a number of fingers to each vision field assessing for differnces

Describe the kinetic confrontation assessment and what assesses

Kinetic confrontation= peripheral vision Patient will tell you when they notice fingers wiggling into peripheral vision

What is vital to ensure regarding the nurse when doing field of vision exams a.k.a. confrontation exams

It’s important to ensure the nurse has normal field of vision to do exam

What are normal and abnormal findings for the corneal light reflex and how do tou document normal

Normal: twinkle in Each eye is bilaterally symmetrical Document :” cornea reflects light equally) Abnormal: strabismus (crossed eyes) not aligned

When doing the Cardinal Fields of gaze what are normal and abnormal findings

Norm: smooth movement Abnorm: nystagmus jerky movements or strabismus

We’re doing a comprehensive physical eye exam give the components of exams in relation to the cranial nerves

Visual accuity: CN2 PERRLA: CN3 EOM: CN 3,4,6

We’re doing the confrontation tests and patient covers left I what I do you cover and where do you tell them to look

If patient covers left a You cover right eye tell them to look at you not your fingers and say the number they see

What nerve are you testing for when doing accommodation and convergence and how do you perform assessment

Accommodation and convergence assesses CN 3 Accomodation: have patient look at for object for 30 seconds then your pen light -distance =dilate -close= constrict Convergence: move pen close to patient and watch a Wyze come together

In sclera what is a condition you can notice for a patient with heavy UV exposure

Ptyregium

What can hypertension cause in relation to the conjunctiva

Hypertension can cause sub conjunctival bleeding

What are a few things you note when assessing sclera cornea and lens

Color, any swelling, exudate, foreign bodies any lesions

When assessing the lacrimal apparatus what do you want to assess for

Assess the punctum and for any tenderness

What is an ophthalmoscope used for

To assess the internal structures of the eye

What is normal findings V abnormal findings for the red reflex test

Normal: a red reflection on pupil Abnormal: white (retinal blastoma) . No red (Retinal detachment)

What are mydriatic drops

Dilation drops

What are miotic drops

Constriction drops

What are the leading cause of blindness in the US

Cataracts and macular degeneration

When assessing an older adults eyes with dementia what are a few strategies you can use

Go slow Go step-by-step Give clear precise directions

What ethnic backgrounds are glaucoma more prevalent in

Hispanics in African-Americans

What are few nursing outcomes(goals) in relation to the eyes

Patient will remain safe in home | Patient will state measures to reduce risk of visual loss

Give a few nursing interventions that can be used in relation to the eye

Keep furniture at a pathway Keep chords against wolves Remove carpet Ensure access to eyeglasses or magnifiers

Give to nursing diagnosis one actual and potential for the eyes

Actual: disturbed sensory perception/reception Potential: risk for injury related to impaired vision