History and Symptoms Flashcards
1
Q
Why do we need to bother with history and symptoms
A
- Know nothing about person in room
- Need to identify and problems
- Ascertain baseline - decide what is normal for them and if they come back later, we can see what was normal for them and if anything has changed
- Need to ensure appropriate tests included
- Establishes a good rapport
- Must not miss out on any tests - If you do history and symptoms in same order it makes sure you don’t miss out on any tests
- Need to appear as if you know what you are doing
- Litigation – record cards clear and complete
2
Q
What is important when taking history and symptoms
A
- Keen an open mind
- Complete thorough history and identify any symptoms px experiencing
- Don’t just focus on 1st thing they tell you
3
Q
Open questions
A
- Open questions has a lot of responses that can be given by px
- Lot of information about what sort of person your px is
4
Q
Closed questions
A
- Yes/no
- Limited choice
5
Q
What is funnel questioning
A
Start with open question
6
Q
What is included in history and symptoms
A
- Reason for Attendance
- Current ocular and optical status – do they wear glasses and if so how are those glasses
- Symptoms
- Previous Ocular History
- Ocular History (Family)
- General Medical History (Family) - are there diseases such as diabetes which can affect the eyes
- General Health
- Medication
- Allergies
- Lifestyle and Occupation - – job and what they do for a living
7
Q
What are the 3 categories of symptoms
A
- What the px sees - .g if look in distance and its blurry
- What the px sees in the mirror e.g he looked in the mirror and eye was red
- What the px feels e.g eyes dry
8
Q
What are examples of typical visual complaints
A
- Visual = not seeing so well
- Pain, ache
- Redness, congestion, inflammation
- Crustiness, flakes on lids
- Lumps, mass, swelling
- Eyelid problems
- Squint, nystagmus
- Visual defects
9
Q
What are the symptoms in order of frequency
A
- Blurred vision at near = presbyopia = = most common reason someone come in to practise
- Non specific ocular discomfort/fatigue
- Burning/tearing of eyes
- Blurred vision at distance
- No complaint: request for routine check up/ new frame
- No complaint: Broken/lost glasses
- Headache (no ocular association)
- Headache (with ocular association)
- Conjunctivitis, blepharitis (crusting and flaking)
- Lid twitching; itchy eyes - Photophobia
- Ocular pain
- Loss of vision (uniocular, binocular, and scotomas)
- Exophthalmos (uniocular or binocular) = thyroid eye disease
- Diplopia (Double vision)
- Anisocoria = different sized pupils
- Photopsia (flashes of light) and halos
- Strabismus
- Jumping of words and other difficulties when reading =Meares Irlen Syndrome
- Chromatopsia (Disturbance of colour vision)
- Vertigo
- Foreign body in eye
10
Q
What is a symptom and examples
A
- What the px reports and tells you
- e.g tunnel vision, difficulty going out at night, normal vision, night blindness, difficult reading, difficulty recognising faces
11
Q
What is sign
A
- What the optom sees when look back of eye e.g AMD
* Get out opthalmoscope and look at back of eye
12
Q
What are general rules when taking history and symptoms
A
- Treat as would like to be treated
- People older than you call Mrs X
- Dress appropriately
- Sharper suit = better
eye test - Harder to sue if like you
- Setting the stage:
•Make sure equipment is out, area is clean and tidy
•Direct px where you want them to sit
13
Q
What are general observations when taking history and symptoms
A
- Spectacle wearer • Head posture • Lids – ptosis, asymmetry, lesions • Strabismus • Facial asymmetry (iris and/or pupil) • General well-being •Squint •Right eye turning in
14
Q
What are examples of reasons for visit
A
- Crucial information
- Perhaps more than one reason
- Reminder/normal interval
- Visual problems
- Dispensing problems
- Headaches
- Preventative e.g. for child
15
Q
Why is looking at last eye test important
A
- Changes that may have occured
- Myopia, astigmatism, hyperopia
- Cataract
- IOP
- Presbyopia etc
- Rx out of date
- Able to determine if change is normal
16
Q
What are introductory questions when taking history and symptoms
A
- Start with open question:
• Hello. Why have you come to see me today? Are you having any problems?
• When was your last eye test?
17
Q
What are vision related questions when taking history and symptoms
A
Any problems with:
• DV qualify with or without Rx
• Relate this to normal distance tasks e.g. driving, TV, cinema etc
• Subjective appraisal
• Poor vision in one eye may not have been noticed especially in ‘non-dominant’ eye
Any problems with:
• IV
• Check what Px does at this distance e.g. computer and music
• Dispensing considerations •Bifocals
• Varifocals
• Single vision for DV and NV
Any problems with: • NV • Distance that they work at • What near tasks are involved? • Relates to hobbies and occupation • Myopes • Hyperopes
18
Q
History and symptoms - probing questions
A
Any problems with: • Flashes of light • Floaters Why ask about flahses of light or floaters • Retinal detachment • Associated with high myopia
Any problems with: - Double vision - Headaches Why ask about headaches or double vision: - Binocular vision problems - Tumour - Vascualr problems
19
Q
Floaters
A
- May need to describe to Px • Best seen against a bright background • Small numbers normal • Looking for a change in shape, size or frequency
20
Q
What routine can be used for follow up questions:
A
FLOADS
F = Frequency = how often
L = Location - which eye, where about
O = Onset = when did it start
A = Association = is it associated with anything
D = Duration = how long does it last for
S = Severity = how servere is it
21
Q
When do you use FLOADS and ask follow up questions
A
If px says yes to probing questions i.e any problems
22
Q
Give example of FLOADS for blurry vision
A
- FREQUENCY = how often do you get blurry vision?
= Constant without gls - LOCATION = Which eye? What distance? Whole of visual field?
= Both eyes, distance, whole of visual field - ONSET = When did this start? Six months ago
- ASSOCIATION = Is it associated with anything?
=Not wearing my glasses - DURATION = How long does this blurriness last for?
= Til I put specs on
SEVERITY = How severe is this blurry vision?
=Blind as a bat
23
Q
Follow up questions for diplopia
A
- Vertical or horizontal?
- Monocular or binocular?
- Sudden onset?
- In any position of gaze or only when look up to right
- Constant or intermittent (phoria decompensating)?
24
Q
Previous ocular history
A
Any history of: • Squint (strabismus) • Lazy eye (amblyopia) • HES = hospital eye service • Ever worn gls/CLs • Last A/C = aftercare
Why ask? • Know to expect long standing prob such as reduced vision • Know about previous operations or tendencies for things such as conjunctivitis
25
Family ocular history
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Any history of:
• Glaucoma
• Diabetes
• Hypertension
• AMD
• Any other eye disease
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Why ask?
•Certain diseases more likely with family hx
•10 – 50% of POAG ( Primary Open Angle Glaucoma ) patients report a family history
•Sibling with POAG, then 4X more likely
•Parent with POAG, 2x as likely
26
General Health
* Poor general health may be associated with ocular manifestations
* Ankylosing spondylitis = form of arthritis associated with uveitis
Why ask?
• Known eye problems associated with certain illnesses e.g. HLA B27 = tissue type for ankylosing spondylitis
27
Medication
- All medications have side effects
• Often Pxs do not know what meds are called so record what used for
Why ask?
• Some of these affect the eye
• Need to know to look for them
28
Allergies
• Allergies associated with certain eye conditions
Why ask?
• Allergies associated with certain eye conditions
• E.g hayfever, asthma, eczema associated with keratoconous
29
Driver
```
- Type of vehicle
• Do they wear glasses to
drive?
• Should they wear glasses to drive?
• A letter 79mm high at a distance of 20m AND VA must be at least 6/12 (0.5) binocularly
(1st May 2012)
```
30
Occupation
Why ask?
Need to know if meet
occupational standards or require safety specs
31
What are requirements for police officer:
- Unaided Vision 6/36 Binocularly
• Corrected VA
6/12 in either eye and 6/6 Binocularly
• Near VA (corrected) N6 at 40cm Binocularly
• Refractive Surgery
Yes if the visual standards are met.
• Colour Vision
Yes but will need to “be aware of the deficiency and make appropriate adjustments”.
• Other
History of Detached Retina or Glaucoma is not acceptable.
32
VDT = visual display terminal
* Hours/day
* Days/week
* Viewing distance
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Why ask?
Need to know what advice to offer
- Blink rate reduced
• Eyes tend to get dry
• Reduced eyelid coverage
• Employer requires eye check
```
33
Asthenopia
- Sore eyes
• Tired eyes
• Eyes pull
• Visual discomfort
34
Hobbies
* Sport - CL's?
* Painting - intermediate?
* Music
* Computing
Why ask?
Need to know what advice to offer - glasses
35
What do you finish with in history and symptoms
• Is there anything else I need to know about your eyes?
Why ask?
• To cover you in case of litigation
• If you forget to ask something
36
Litigation
* A good history and symptoms and general record keeping can save you from being banned from practicing.
* A poor history and symptoms can result in finding another career.1
37
What should the order of history and symptoms be like
- Make sure you have a logical order for your Hx and symptoms
• Not recorded means not done
• Do NOT write “No family hx” or “No BP”
• Recognise that this is a template from which to build
• Recognise that other areas will require a different approach and set of questions
• Contact lenses
• BV
• Visual impairment
