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Health Assessment > CH. 16 Assessing the Eyes > Flashcards

CH. 16 Assessing the Eyes Flashcards

Chapter 16

1
Q

eyelids

A

skin/two muscle types. protect eye from foreign bodies.

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2
Q

eyelashes

A

stiff hair projections, filter dust/dirt from air that enters eye

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3
Q

conjunctiva

A

thin transparent continuous membrane. palpebral, bulbar - protect eye/allow inspection of the underlying tissue

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4
Q

Palpebral conjunctiva

A

lines inside of eyelids

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5
Q

Bulbar conjunctiva

A

covers most of anterior eye

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6
Q

Lacrimal apparatus

A

glands/ducts that lubricate eye. lacrimal gland produces tears - from glands to puncta, lacrimal canal, lacrimal sac, nasolacrimal duct, nose (ex: if crying, tears drain into nose)

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7
Q

Extraocular muscles

A

six muscles move in six directions. four rectus, two oblique. attached to outer surface of each eyeball, associated w/ CN 3,4,6

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8
Q

External structures of eye

A

eyelids, eyelashes, conjunctiva, lacrimal apparatus, extra ocular muscles

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9
Q

Internal structure/layers of the eyes

A

external = sclera/cornea. middle = iris/ciliary body, choroid. inner = retina extends to ciliary body anteriorly, receives visual stimuli

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10
Q

Choroid layer

A

vascular layer of eye, provides oxygen/nourishment to inner aspect of eye. prevents light from reflecting internally, anteriorly continuous w/ ciliary body/iris

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11
Q

Sclera

A

dense protective white covering, physically supports internal eye structures

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12
Q

Cornea

A

permits entrance of light, nerve endings, responsive to pain/touch. corneal reflex in response to cotton wisp touching eye

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13
Q

iris

A

circular disc of muscle used to control amount of light coming into eye, color, center is pupil

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14
Q

Ciliary body

A

muscles that control thickness of lens, focuses on images seen

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15
Q

lens

A

biconvex, transparent, avascular encapsulated structure immediately posterior to iris. refracts light into retina in order to see/focus on near/far objects

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16
Q

retina

A

receives visual stimuli/sends to brain. numerous layers of nerve cells - rods, cones. optic disc, retinal vessels

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17
Q

rods

A

highly light sensitive, black/white vision, function in dim light

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18
Q

Cones

A

function in bright light, sensitive to color

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19
Q

optic disc

A

where optic nerve enters eye, can be seen w/ ophthalmoscope, normally round/oval

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20
Q

retinal vessels

A

seen w/ ophthalmoscope, venules/arterioles. macula w/ many cones

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21
Q

visual field

A

where light rays strike cornea and are transformed into nerve impulses interpreted by brain

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22
Q

Pupillary light reflex

A

causes pupils to immediately constrict when exposed to bright light

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23
Q

accommodation

A

functional reflex allowing eyes to focus on near objects

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24
Q

Present health concern (vision)

A

visual difficulties/recent change, spots/floaters, halos/rings around lights, trouble seeing at night, double vision (diplopia)

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25
Q

Present health concern (eyes)

A

pain/itching, pain w/ bright lights (photophobia), redness/swelling, excessive watering (which eye) - epiphora, eye discharge

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26
Q

epiphora

A

excessive tearing, caused by exposure to irritants or obstruction of lacrimal ducts

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27
Q

Personal health history

A

problem w/ eyes or vision, eye surgeries, past eye treatments, medications, last eye exam, macular degeneration (amsler test), glasses/corrective lens, tested for glaucoma? family history w/ eye problems

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28
Q

Amsler Test

A

evaluates visual field defects. eye level, cover one eye, fix on center black dot, see if any lines are distorted, mark defect on chart, test eyes separately (same distance every time). tell provider about distortion, graying, blurring, or blank spots

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29
Q

Lifestyle and health practices

A

exposed to chemicals at work/home, sunglasses, vision loss, vision aids, diet, smoke - greater risk of cataracts

30
Q

Equipment for eye exam

A

snellen chart, near card screener, penlight, opaque cards, ophthalmoscope, disposable gloves

31
Q

Preparing the client

A

explain procedure, seated comfortably, warn of slight discomfort w/ some tests

32
Q

General routine screening

A

distant/near acuity, gross peripheral vision, eyelids/eyelashes, position/alignment of eyeball, bulbar conjunctiva/sclera, lacrimal apparatus, iris/pupil, pupillary reaction to light

33
Q

Focused specialty assessment

A

corneal light reflex test, cover test, cardinal fields of gaze test, inspect palpebral conjunctiva, palpate lacrimal apparatus, inspect cornea/lens, accommodation, inspect optic disc, retinal vessels, fovea/macula, anterior chamber

34
Q

Vision tests (distant visual acuity)

A

snellen chart, handheld snellen chart, confrontational, corneal light reflex, cover test, cardinal fields of gaze test

35
Q

Snellen chart

A

normal 20/20 - what normal people read at 20 feet. can use glasses or contacts (not reading glasses)

36
Q

What is 20/40 vision?

A

myopia. see at 20 feet what most people see at 40 feet

37
Q

Handheld snellen chart

A

hold 14 inches away, test each eye individually, normal 14/14

38
Q

What is impaired near vision?

A

presbyopia

39
Q

Confrontational test tests

A

visual fields for gross peripheral vision

40
Q

Confrontational test procedure

A

two feet away from client at eye level, each eye separate one eye closed, extend left arm at midline for right eye test, slowly move finger upward from below until client sees (how many fingers?)

41
Q

Corneal light reflex test tests

A

extra ocular muscle function - parallel alignment of eyes

42
Q

Corneal light reflex test procedure

A

hold penlight 12 inches from client’s face, shine light toward bridge of nose while client stares straight ahead, note light reflected on corneas - should be in exact same spot on each eye

43
Q

Cover test detects

A

deviation in alignment or strength and slight deviations in eye movement/interrupting fusion reflex that normally keeps eyes parallel

44
Q

Cover test procedure

A

ask client to stare straight ahead, cover one eye w/ opaque card, observe uncovered eye for movement, then remove and observe that eye’s movement. repeat w/ opposite eye. no movement in uncovered = normal, whichever eye moves is not normal

45
Q

Cardinal fields of gaze tests

A

eye muscle strength/cranial nerve function

46
Q

Cardinal fields of gaze test procedure

A

hold object 12 inches from client face and have them focus on it, move through six cardinal positions of gaze in clockwise direction/observe eye movements. should be smooth/symmetric. only move eyes, go far enough that eyes move all the way

47
Q

Nystagmus

A

oscillating/shaking movement of eyeball

48
Q

Is oscillation in extreme lateral gaze normal?

A

yes

49
Q

External eye structures assessment

A

inspect eyelids/eyelashes, ability to close eyelids - corneal damage if fail. observe for redness, swelling, discharge, lesions, position/alignment of eyeball, bulbar conjunctiva/sclera, jaundice. inspect palpebral conjunctiva, lacrimal apparatus

50
Q

Jaundice in Sclera

A

yellow

51
Q

Inspect palpebral conjunctiva

A

uncomfortable, use gloves, no signs of lesions, redness, swelling, foreign bodies, trauma. pull down lower eyelid, evert upper eyelid - push down w/ qtip while holding eyelashes = hold just below eyebrow to maintain

52
Q

Assess lacrimal apparatus

A

inspect area over lacrimal gland - no swelling/redness, turned slightly toward eye. palpate using gloves, nasolacrimal duct to assess blockage

53
Q

Inspect cornea and lens

A

shine light from side to side for oblique view, look through pupil to inspect lens, cornea transparent

54
Q

Inspect iris and pupil

A

shape/color of iris, size/shape of pupil against gauge

55
Q

Arcus senilis

A

white arc around limbus in older adults. normal, no effect on vision

56
Q

Testing pupils

A

pupillary reaction to light, accommodation

57
Q

Pupillary reaction to light

A

dark area, shine light into pupil/note reaction - should have constriction

58
Q

Accommodation test

A

move focus from distant point to near point, normal response = constriction/convergence of eyes

59
Q

Red reflex is an ________ eye structure test

A

internal

60
Q

red reflex test

A

set diopter of ophthalmoscope to 0, stand 10-15 inches from client’s right side at 15 degree angle, place free hand on client’s head, shine light beam toward client’s pupil, normal result = easily visible through ophthalmoscope, red areas round/regular borders

61
Q

What are most abnormalities in the red reflex test?

A

cataracts

62
Q

Optic disc test (internal eye structures)

A

keep light beam focused on pupil/move closer to client from 15 degree angle, get within 3-5cm and rotate diopter so retinal structures are in sharp focus. note shape/color/size/physiologic cup. glaucoma different

63
Q

What does glaucoma look like in the optic disc test?

A

interferes w/ blood supply to optic structures. enlarged/pale base physiologic cup, obscured or displaced retinal vessels

64
Q

If the optic disc is white

A

caused by death of optic nerve fibers

65
Q

Inspect retinal vessels

A

same procedure as optic disc, note number/sets of arterioles/venules, note color/diameter of arterioles. AV ratio/crossings should be 2:3 or 4:5

66
Q

Inspect retinal background

A

same procedure as seeing optic disc, from disc to macula, note any lesions

67
Q

Inspect fovea and macula

A

same procedure as viewing retinal vessels, shine light beam/ask to look directly into, observe fovea/macula - macula darker area, fovea star like light reflex

68
Q

fovea

A

sharpest area of vision

69
Q

Inspect the anterior chamber

A

same position as optic disc, rotate lens wheel to 10, 12 or higher. inspect anterior chamber, should be transparent

70
Q

Eye trauma

A

foreign body that remains after gentle flushing, perforated globe, blood in eye

71
Q

What to look for with blunt force trauma to the eye

A

lid swollen shut, blood in anterior chamber, white hazy cornea, irregularly shaped/fixed/dilated or contracted pupil

72
Q

visual perception

A

where light rays strike cornea and are transformed into nerve impulses interpreted by brain

Health Assessment (32 decks)

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