Eye and Ear Assessment Flashcards
What does the cornea do?
Bend the incoming light so it can be focused on the inner retina
Iris
Produces the color of the eye- it contracts and dilates- moving with light
Pupil
Controls amount of light that is reaching the retina - size of pupil determined by the amount of light and accomodation (distance of object)
Retina
Visual receptive, inner layer of eye - changes light waves into light impulses
Visual pathways
Right vision of the eye is controlled by the left side of the brain and vice versa. World on the left side is viewed by the right side of the brain.
What is accomodation ?
Its about focusing - its the adaptation of the eye for near vision. Pupils constrict or dilate based on the distance of the object
When do the eyes form ?
During the first 8 weeks of gestation
Aging factors regarding eyes
Decreased tear production; visual acuity decreases at approx age 40; cataract, glaucoma, macular degeneration, arcus senilis
What subjective info do we need to collect about the eye ?
Visual changes Pain Trauma Redness Swelling Discharge Watering Dryness Surgery Medication Past medical history Health promotion use of glasses family history
Extra subjective data for infants and children?
Vaginal infection (mom, not baby) at time fo delivery Infant premature? Developmental milestone Safety precautions Strabismus, diplopia
What kind of objective data is needed for eyes?
Snellen Chart- for vision Rosenbaum chart- near vision Penlight Ophthalmoscope Opaque Card
What does an ophthalmoscope do?
Enlarges view of eye and allows visualization of internal structures
What does the Snellen Chart do ?
Used to screen visual acuity
Contains letters of graduated sizes at 20 feet
The numbers at the end of the chart indicate the degree of visual acuity when read from 20 feet- it is the distance from which a person with “normal” vision could read the lettering
“This patient read at 20- feet what a
“normal” person could read at
30 feet!!
What is the confrontation test?
Compares the person’s peripheral examiner against the examiners
What does EOM stand for?
Extraocular muscle
How do we test for EOM function?
Parallel alignment of eyes - the corneal light reflex tests this. Light should be aligned the same in each eye when light is shined on forehead from 12 in away.
The reflection of this light should be aligned in the same spot of each eye
What is the cover- uncover test?
Patient covers one eye and then you watch movement in uncovered eye and ask to focus on distant object. Then uncover the eye and watch to make sure no eye movement is seen.
What is the 6 Cardinal position gaze ?
6 cardinal position gaze to illicit muscle weakness. Normal response is parallel tracking of the object with both eyes (Conjugate gaze)
Note nystagmus-fine movement of eye
How do you test pupillary response?
Iris should be clearly visible and pupils equal and round
Test the pupils for direct and indirect response to light
Shine a light directly into one eye and observe whether pupil constricts in eye (direct) and opposite eye (consensual)
Perform on both eyes
How close do you get for internal inspection of the eye?
About 10 inches away- gradually come closer with the opthalmoscope until your foreheads almost touch
Pediatric considerations for eye exam
E-chart for children 3-6 years of age or illiterate clients
Picture cards for 2 years and up
Can use Snellen at age 7 to 8 depending on reading level of child
Achieves 20/20 acuity by 6-7 years of age
What does PERRLA mean?
Pupils should be equal, round, reactive to light and accomodation
Pupillary Light Reflex
This is the normal constriction of the pupil when a bright light shines on retina.
Visual Reflex Accomodation
Pupils constrict or dilate based on the distance of the object
What is strabismus ?
Crossed eyed. Eyes don’t look in exactly the same direction at the same time
What is diplopia ?
Double vision
What is the confrontation test ?
This tests peripheral vision. The examiners finger is passed from the side to the front and the patient is asked to say now when they can see the finger.
If unable to see it as examiner does it, it suggests peripheral field loss
What is presbyopia ?
Near Vision Loss - an developmental consideration for the aging adult at middle age
What is arcus senilis ?
Another developmental consideration of the aging adult - this is an old age syndrome where there is a white, grey, or blue opaque ring in the corneal margin.
What are developmental considerations for the aging adult?
Presbyopia development
central vision acuity may change, especially after age 70
peripheral vision may be diminished
eyes may appear shrunken
What color is the tympanic membrane?
The eardrum separates the external and middle ears and it should be a pearly, gray color.
The drum itself is an oval shape and is shiny and translucent.
Compare an infants eustachian tube with that of an adult.
An infants Eustachian tube is wider, more horizontal and short than that of an adults.
How do you inspect the tympanic membrane?
Using an otoscope, for an adult you lift the pinna and pull it back.
Tympanic membrane should be gray in color, flat, and the cone of light is positioned at 5 o’clock in the right ear and 7 o’clock in the left ear
What is otitis media?
An infection of the air filled space behind the eardrum
How do you assess for hearing loss ?
Perform the voice test… have patient cover opposite ear and then whisper a word into their other air, such as baseball- receiver shoud respond correctly at least 50% of time
What are the two types of hearing loss ?
Conductive and Sensorineural
What causes conductive hearing loss?
external and middle ear hearing loss results from a blockage or structural dysfunction
What causes sensorineural hearing loss?
perceptive loss from nerve damage in the inner ear
