Ch 13: Eye Assessment For Adv Practice And Specialty Practice Flashcards
What is the sensory organ of sight and where is it located
The eyes is a sensory organ of sight located within the skull
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) 
What is the purpose of the extraocular structures
Support and protect the eyeball
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
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) 
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
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 
What exactly is the sclera
The thin mucous membrane that lines the eye
What is the medical name for an eyelid infection/inflammation And how does it appear

Blepharitis
Will appear red swollen with drainage
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
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
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

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
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
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
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
What is in greatest concentration in the macula
Greatest cone concentration
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
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
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

What are abnormal findings for older adults in relation to vision
1 is a disease
Photophobia: light sensitivity
Cataracts: opaque white color IN PUPIL
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! 

What is a normal finding arcus senillis or Cataracts
Arcus senillus : White/blue limbus ring around Iris is a normal finding
What’s a normal finding glare
Intolerance or light intolerance
 glare intolerance is a normal finding because of an enlarged lens
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
- 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
