History and symptoms and record keeping Flashcards
Why would you carry out history & symptoms on a patient (list 8 main points)
- know nothing about the person in your room
- need to identify any problems
- ascertain baseline
- need to ensure appropriate tests included
- establishes a good rapport
- must not miss out any tests
- need to appear as if you know what you are doing
- litigation
Give an example on an open question
How are you today?
why would you ask open questions
you can learn a lot about a px with the variable answers they can give
give an example of a closed question and possible answers
is your name rose bush? yes/no limited choices
what are the three steps to funnel questioning
- start with an open question
- narrow question down
- response
list the 10 topics needed to be completed in history and symptoms
- reason for attendance
- current ocular and optical status
- symptoms
- previous ocular history
- family ocular history
- general family medical history
- general health
- medication
- allergies
- lifestyle and occupation
list the 3 categories of symptoms
- what the px sees
- what the px sees in the mirror
- what the px feels
list the 8 different types of typical patient complaints
- visual
- pain, ache
- redness, congestion, inflammation
- crustiness, flakes on lids
- lumps, mass, swelling
- eyelid problems
- squint, nystagmus
- visual defects
list the 22 most frequent symptoms in order of frequency, stated by Borish 1970
- blurred vision at near (presbyopia)
- non-specific ocular discomfort/fatique
- 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, belpharitis (crusting and flaking)
- lid twitching: itchy eyes
- photophobia
- ocular pain
- loss of vision - uniocular, binocular and scotomas
- exophthalmos/swollen eye - uniocular or binocular
- diplopia/double vision
- anisocoria - different size pupils
- photopsia/flashes of light & haloes
- strabismus
- jumping of words and other difficulties when reading - placing colour light can improve or worsen the movement
- chromotopsia - disturbance of colour vision
- vertigo
- foreign body in eye
what is a symptom
what the patient reports
what is a sign
what the optom sees e.g. fund photo, what px can’t see
list 5 general rules which should be considered as an optom
- treat as you would like to be treated
- people older than you call Mrs X
- dress appropriately
- sharper suit = better eye test
- harder to sue if you like
what 6 general observations on a px should you carry out as an optom
- spectacle wearer
- head posture
- lids - ptosis, asymmetry, lesions
- strabismus
- facial asymmetry - iris and/or pupil
- general well-being
what 4 things can you work out from a general observation such as a px’s ‘right eye turning in’
- right eye has a strabismus
- would expect poorer vision in that eye
- RE = amblyopic
- no tests that involve binocularity needed
from general observations from a px that has these clues, what can you work out:
- wheelchair
- left leg larger than right
- left arm in spasm
- right arm appears to be working
- left leg does not appear to be working
- px restricted to wheelchair
- left hand non functioning
- left leg larger than right leg so…prosthesis?
- left paralysis
- stroke
- vision = left sided hemianopia
(can only see one side) - concentration..poor?
- communication difficulties - left side paralysis so speech should be fine?
- need to order tests
what can you tell by a px with these general observations:
- normal head posture
- eyes straight
- looks healthy
- not expecting to find anything wrong
- full set of tests needed
give 6 examples of outcomes you can get from asking a px their reason for visit
- crucial information
- perhaps more than one reason
- reminder/normal interval
- visual problems
- dispensing problems
- headaches
- preventative e.g. for child, if other child has e.g. a squint etc
give 7 benefits/pieces of information that can be obtained from knowing when a px had their last eye examination
- changes that may have occurred
- myopia, astigmatism, hyperopia
- cataract
- IOP
- presbyopia etc
- rx out of date
- able to determine if change is normal
what points should be considered when asking a px if they have any problems with DV
- 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
what points should be considered when asking a px if they have 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
what points should be considered when asking a px if they have any problems with NV
- distance that they work at
- what near tasks are involved
- relates to hobbies and occupation
myopes
hyperopes
give 2 examples of probing questions in history and symptoms, and state why you would ask these in particular
any problems with…
- flashes of light
- floaters
ask because…
- retinal detachment
- associated with myopia
what things need to be thought about when dealing with flashes
- may need to describe to px
- best seen against a bright background
- small numbers normal
- looking for changes in shape, size or frequency
list the meaning of FLOADS
- frequency
- location
- onset
- association
- duration
- severity
give 4 examples of probing questions in history and symptoms, and state why you would ask these in particular
any problems with…
- flashes of light
- floaters
- double vision
- headaches
for flashes of light & floaters ask because…
- retinal detachment
- associated with myopia
for double vision and headaches ask because…
- BV probs
- tumour
- vascular probs
which further questions should you ask, when a px reports that they get diplopia
- vertical or horizontal
- monocular or binocular
- sudden onset
- in any position of gaze
- constant or intermittent (phoria decompensating?)
what 5 points need to be covered when asking about previous ocular history and state why you would ask
- squint
- lazy eye
- HES
- ever worn glasses/CLs
- last A/C
asked because…
- know to expect long standing prob such as reduced vision
- know about previous operations or tendencies for things such as conjunctivitis
what 5 points need to be covered when asking about family ocular history and state why you would ask
- glaucoma
- diabetes
- hypertension
- AMD
= closed questions - any other eye diseases = open question
asked because…
- certain diseases more likely with family history
- 10-15% of POAG patients report a family history
- sibling with POAG, then 4x more likely
- parent with POAG, then 2x more likely
why ask about general health
poor general health may be associated with ocular manifestations e.g. ankylosing spondylitis
what points need to be considered when asking about medication and state why you would ask if they’re on medication
- all medicines have side effects
- often pxs do not know what meds are called so record what used for
asked because…
- some of these affect the eye
- need to know to look for them
why do we need to ask if a px has any allergies
allergies are associated with certain eye conditions e.g. hay fever, asthma, eczema associated with KC
what points need to be considered for a px who is a 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 atlas 6/12 (0.5) binocularly
why do you need to ask a px of their occupation
need to know if meet occupational standards or require safety specs
what is the unaided vision standards for the police
6/36 binocularly
what is the corrected visual acuity standards for the police
6/12 in either eye and 6/6 binocularly
what is the corrected near visual acuity standards for the police
N6 at 40cm binocularly
what is the refractive surgery standards for the police
yes if the visual standards are met
what is the colour vision standards for the police
yes can have colour vision anomalies, but will need to be aware of the deficiency and make appropriate adjustments
what other standards for the police should be known
history of detached retina or glaucoma is not acceptable
what 3 things should be asked about VDU
- hours/day
- days/week
- viewing distance
why should you ask things about VDU
need to know what advice to offer
why is it important for a px who uses the VDU to get their eyes checked
- blink rate reduced
- eyes tend to get dry
- reduced eyelid coverage
- employer requires eye check
what symptoms are described with asthenopia
- sore eyes
- tired eyes
- eyes pull
- visual discomfort
why would you ask a px of their hobbies
need to know what advice to offer
what question should you always finish with once completed history and symptoms and why
is there anything else i need to know about your eyes?
because. ..
- to cover you in case of litigation
- if you forget to ask something
