Module 3 exam Flashcards
Consensual response
exposure to light in one eye results in constriction of the pupil in the opposite eye
Assessment of pupillary reaction light
Darkened room
Have client focus on a distant object
Shine light obliquely into one eye and observe the opposite pupil’s reaction to light and constrict
Normally, pupils constrict
cataracts risks
- Increasing age – often starts developing at 30 years of age
- Exposure to ultraviolet B light
- Diabetes mellitus
- Cigarette smoking
- Alcohol use
- Diet low in antioxidant vitamins
- High blood pressure
- Eye injuries/surgery
- Steroid use
- Female gender
- Persistent diarrhea
- Gout
- Abdominal obesity
- Beta blocker use
accomodation- what does it test?
- normal finding
- example of how you would test on client
o occurs when the client moves focus of vision from far to near, causing the pupils to constrict
o Normally, pupils constrict when they focus on a near object and dilate on a distant object
Example: hold a pencil 12” away from clients face and bring it into their nose
eye abnormality- tearing -aka? -define -unilateral epiphora is? bilateral epiphora is?
o Aka epiphora
o Caused by exposure to irritants or obstruction of the lacrimal apparatus
o Unilateral epiphora is often associated with foreign body or obstruction
o Bilateral epiphora is often associated with exposure to irritants such as makeup or facial cleansers or it may be a system response
cataracts
o clouding of the usually clear lens of the eye, causing a person to see as though looking through a frosty or foggy window
When client is experiencing eye pain, discomfort, or feels something in the eye, observe for what?
(3 things)
o Foreign body that remains after gently washing
o Perforated globe
o Blood in the eye
Blunt eye trauma, observe for what?
3 things
o Lid swollen shut
o Blood in anterior chamber
o White/hazy cornea
glaucoma
- define
- normal finding
- increased IOP compromises what?
- what occurs as a result of deficient blood supply?
- if iop is left untreated, what results?
o an acute or chronic condition in which there is an increase of IOP which leads to damage of the retina and optic nerve, with resulting visual field losso
Normal IOP is 10-21 mm Hg
o Increased IOP compromises blood flow to the optic nerve and retina
o Tissue damage occurs as a result of the deficient blood supply
o If IOP is left untreated, blindness results. Often called the “silent thief of sight” because most patients are unaware they have experienced visual changes and vision loss.
signs and symptoms for glaucoma
gradual loss of peripheral vision
blurred vision
“halos” around lights
difficulty focusing
difficulty adjusting eyes in low lighting
loss of peripheral vision
aching or discomfort around the eyes and/or headaches
nystagmus
- define
- what test do you use to test for a nystagmus?
• An oscillating (shaking) movement of the eye
• Associated with an inner ear disorder
o Multiple sclerosis
o Brain lesions
o Narcotic use
• To test for a nystagmus, you use the positions test (6 cardinal fields of gaze)
o
how do you perform positions test?
Instruct the client to focus on an object you are holding
o Move the object thru the 6 cardinal positions of faze in a clock wise directions
o Observe the clients eye movements
normal finding of pupil (4)
-what is anisocoria?
o Round with regular border o Centerd in the iris o Equal in size (3 to 5 mm) o Inequality in pupil size of less than 0.5 mm occurs in 20% of clients Called anisocoria
abnormal findings of pupil assessment
-miosis
-mydriasis
define both
o Miosis
Aka Pin point pupils
Constricted and fixed pupils
d/t narcotic drugs or brain damage
o Mydriasis
Dilated fixed pupils
Resulted from: Cns injury, Circulatory collapse, Deep anesthesia
what does the snellen chart assess for?
distant visual acuity
distant visual acuity test
-how do you perform it?
If the client wears glasses, they should be left on unless they are reading glasses
Note any client behaviors such as leaning forward, head tilting, or squinting while performing test
• The top number is 20/20, etc. is the number of feet between the patient and the eye chart
o If distant vision is assessed in a small room or area, the patient may stand 10 feet from the chart, resulting in the top number being 10 rather than 20
• The bottom number in 20/20 is the number found on the chart row of the smallest print that the patient can read.
o The bottom number represents the distance (in feet) at which the “normal” eye can read the letters on that line
normal and abnormal finding of distant visual acuity test using the snellen chart
-refer any client with what vision for further evaluation?
• Normal finding
o 20/20 with or without corrective lenses
• Abnormal finding
Myopia
Impaired far vision
Present when the second number in the rest resul is larger than the first
20/40
The higher the second number, the poorer the vision
Refer any client with 20//30 for further evaluation
when do you measure pupils?
• Measure pupils against a gauge ONLY If they appear larger or smaller than normal or if they appear to be two different sizes
estotropia
- define
- it is an abnormal finding of what test?
inward turn of the eye
cover test
how to perform covered test (2)
-normal finding
Use opaque card to cover an eye to observe opposite eye for eye movement
Tests for deviations in alignment or strength or slight deviation in eye movement
• Normal finding
o Uncovered eye should remain fixed straight ahead
o The covered eye should remain fixed straight ahead after being uncovered
exotopia (2)
-define
- Abnormal finding of the cover test
* Outward turn of the eye
strabismus (3)
- Abnormal finding of the cover test
- Constant malalignment of the eyes
- May cause amblyopia
Eyelids
o Two movable structures composed of skin and two types of muscle: striated and smooth
o Protect the eye from foreign bodies and limit the amount of light entering the eye
o Serve to distribute tears that lubricate the surface of the eye
o Upper eye lid larger, mobile contains Meibomian glands which secrete an oily substance that lubricates the eyelid
• Lateral and medial canthus
o Where the eyelids join together
o Medial canthus contains puncta, two small openings that allow drainage of tears into the lacrimal system
o When closed, the eye lids should touchwhen open, the upper lid position should be between the upper margin of the iris and upper margin of the pupil
o Lower lid should rest on the lower border of the iris
eyelashes
o Projections of stiff hair curving outward along the margins of the eyelids that filer dust and dirt from air entering the eye
conjunctiva
o Thin
o Transparent
o Continuous membrane that is divided into two portions
Palpebral
• Lines inside of the eyelids
Bulbar
• Covers most of the anterior eye, merging wit the cornea at the limbus
lacrimal apparatus
o Consists of glands and ducts that lubricate the eye
extraocular muscles
o 6 muscles attached to the outer surface of each eyeball
4 rectus muscles
• Responsible for straight movement
2 oblique muscles
• Responsible for diagonal movement
spots or floaters
o which are common in clients with myopia (nearsighted-close objects appear clearly, but far ones don’t) or in clients over age 40
o Is a normal physiologic change due to aging and requires no intervention
halos arounds rings or lights
o Associated with narrow angle glaucoma
visual perception (4)
- Occurs as light rays strike the retina, where they are transformed into nerve impulses, conducted to the brain through the optic nerve, and interpreted
- Light must pass thru transparent media before reaching the retina
- The cornea and lens are the main eye components that refract light rays on the retina
- The left side of the brain vies the right side of the world
earache is aka?
otilgia
assessment of earache
- what do you want to ask the client first?
- what can an earache occur with?
o Ask the client “do you have any ear pain?” o If they respond yes, use coldspa o Can occur with: o Ear infections o Cerumen blockage o Sinus infections o Teeth/gum problems o May experience nausea and dizziness
otitis externa
o Swimmers ear
o Wiggle outer ear without pain
normal findings for cerumen
- Should be odorless
- Yellow, orange, red, brown, gray, black
- Soft
- Moist
- Dry
- Flaky
- Or hard
abnormal findings of cerumen?
4
o Otitis externa/impacted foreign body
Yellow sticky foul smelling discharge
o Otitis media with ruptured tympanic membrane
Bloody purulent discharge
o Skull trauma
Blood or watery drainage—cerebrospinal fluid
o Conductive hearing loss
Impacted cerumen blocking view of external ear canal
older adults cerumen
o Harder o Dry o Rigid o Coarse thick wire like hair can grow Abnormal only if it obstructs hearing
define conductive hearing loss
• something blocks or impairs the passage of vibrations from getting to the inner ear
conductive hearing loss can be due to what?
o impacted cerumen o otitis media o foreign body o perforated tympanic membrane o drainage in the middle ear o otosclerosis
darwin tubercle
o Clinically insignificant project that is seen on the auricle
what kind of drainage is seen with Otitis externa/impacted foreign body?
what kind of drainage is seen with Otitis media with ruptured tympanic membrane?
what kind of drainage is seen with Skull trauma?
Yellow sticky foul smelling discharge
Bloody purulent discharge; Also indicates infection of external ear
Blood or watery drainage—cerebrospinal fluid
ear hygiene
o Use a warm moist washcloth to clean outside ears
o Nothing should be inserted into ear
o Can apply few drops of mineral oil, baby oil, glycerin, or commercial drops to help earwax make its way out of ear
when doing ear hygiene, NEVER use: (4 things)
o Cotton tipped swabs
o Pens
o Hairpins
o Ear candles
________ is a natural self-cleaning agent that shouldn’t be regularly removed unless its causing problem?
ear wax
otitis media
- define
- what causes it?
inflammation of the middle ear
infections
trauma
toxicity
neurologic/circulatory disorders
risk factors for otitis media (9)
age group childcare babies fed from bottle seasons of fall and winter poor air quality family hx ethncity enlarged adenoids
presbycusis
- define
- common after what age?
- what do you want t o ask the client?
often begins with a loss of high frequency sounds (womans voice), followed later by the loss of low frequency sounds; gradual hearing loss
50
Are all sounds muffled with this change or just some sounds?
What hearing test compares air and bone conduction?
Rinne test
How do you perform the Rinne Test?
activate tuning fork and place the handle tip on the mastoid bone just behind the auricle of the ear
ask pt Please tell me when you stop hearing the sounds and note time interval
After pt stops hearing the sound, hold the tuning fork infront of the auricle of the ear and say Tell me when the sound stops nd note the time interval
normal finding of Rinne test
air conduction approx 2x as long as bone conduction
cranial nerve VIII, acoustic, and hearing component intact
abnormal finding of rinne test
sensorineural hearing loss
sensorineural hearing loss
- define
- occurs with damage to what?
air conduction is heard longer than bone conduction sound, if anything is heard at all
inner ear(cochlea) or to nerve pathways between the inner ear and brain
most common type of hearing loss
it decreases ones ability to hear faint sounds
even s peech may be muffled
What causes sensorineural hearing loss?
ototoxic drugs genetic hearingloss aging head trauma malformation of the inner ear loud noise exposure
What does the Romberg test assess?
equilibrium
How to perform Romberg test
ask the client to stand with feet together, arms at their side, eyes open and then with eyes closed
put your arms around the client without touching him or her to prevent falls
- normal finding rombrg test
- abnormal finding romberg test
- what does the abnormal findings indicate?
client maintains position for 20 seconds without swaying or with minimal swaying
Client moves feet apart to prevent falling
Loses balance
-these two things indicate vestibuar (inner ear) problem
what is tinnnitus?
-what do you ask the client during subective assessment?
ringingin the ears
Do you experience any ringin,g, roaring, or crackling in your ears?
what is tinnitus associted with? (5)
excessive build up of earwax
High BP
Loud Noises
Foreign bodies
Certain ototoxic meds
streptomycin
gentamycin
kanamycin
neomycin
ethacrynic
furosemide indomethacin
high dose aspirinwhat percent of the population experiences tinnitus?
10%
what is the tympanic membrane?
how do you assess it?
what must you document when assessing it?
separates the external ear from the middl ear
assess by direct inspection
color
shape
consistency
landmarks
normal finding of the tympanic membrane
translucent pearly gray apearance shiny no bulging or retraction slightly concave smooth intact short process and handle of the malleus and the umbo are clearly visible
when using an otoscope to look at tymmpanic membrane, where should the cone shaped reflection be seen?
5 o clock in the right ear and 7 o clock in the left ear
abNormal finding of the tympanic membrane
6
acute otitis media serous otitis media white spots perforations prominent landmarks obscured or absent landarks blue/red tympanic membrane
normal older adults ear drum
appear cloudy
landmarks more prominent d/t aging
When do you administer Weber test?
What does it evaluate?
if the client reports diminished or lost hearing in one ear
the conduction of sound waves thru bone to help distinguiush between conductive hearing (sound waved transmitted by external and middle ear and sensorineural hearing (inner ear)
How do you perform Weber test?
activate a tuning fork and place it on top of the patients head on the patients forehead
centeringis important
ask pt Please tell me iif you hear the sounds better in one ear than the other or if you haer it equally i both ears
normal finding weber test
abnormal finding weber test
hears sound equally in both ears
conductive hearing loss
hear sound in poor ear
sensorineural hearing loss
lateralization of sound to good ear
assessment of gums
ask clieint to opentheir mouth
use gloves and retract clients cheeckto check gums for color and consistency
normal finding of gums
pink
moist
firm with tight margins tothe tooth
no lesions or masses
abnormal findings of gums
receding gums in younger clients
Gingivitis
Hyperplasia
enlarged reddened gums
Bluish black/grey white line along the gumline
seen in lead posioningNormal older adults gums
Gums recede
Ischemic
Undergo fibrotic changes
Normal findings of the mouth (8)
No missing teeth or decayed areas
Lips smooth and moist without lesions or swelling
32 teeth with wisdom, 28 without
Smooth buccal mucosa
Frenulim midline
Client distinguish between sweet and salty
Hard palate is pale or white with firm transverse rugae
Tonsils should be symmetric
Abnormal findings of the mouth (14)
Herpers simplex I Cheilosis of lips Carcinoma of lip Leukoplakia Harry Leukoplakia Thrush Canker Sore Fissures on the tongue-dehydration Black hairy tongue Carcinoma of the tongue Receding gums Kaposis sarcoma lesioins Acute tonsillitis and pharyngitis
What do you ask the client when assessing for oral cancer?
What increases the risk of oral caner?
What is responsible for 74% of oral caners?
Cancer of the cheek is limited to _____?
Smoking a pipe leads to ____ cancer?
Do you smoke or use Tobacco?
Cigarette,pipe or cigar smoking and use of smokeless tobacco increase persons risk for oral cancer
Heavy tobacco ad alcohol consumption
Chewing tobacco
Lip cancer
IF they use any of these, refer the to a smokng cessation program
Where do you palpate frontal inuses?
Where do you palpate maxillary sinuses?
Use your thumbs to press up on the brow on each side of he nose
pressing with thums on maxillary sinuses
Normal finding for palpating sinuses
no tenderness
no crepitus
Abnormal finding of sinuses
tender
d/t allergies
acute bacterial rhinosinusitis
creptus over mxillary sinuses
if there is a large amount of exudate in the maxiallary sinuses what will you feel when palpating?
crepitus
What is transillumination of sinuses?
lets you see if the sinuses are filled with fluid or pus
Normalfinding of transillumination of frontal sinuses
Normal finding of transillumination of maxillary sinuses
red glow indicates normal air filled sinus
red glow willbe seen on hard palate
abnormal finding of transillumination of frontal sinuses
abnormal finding of transilllumination of maxillary sinuses
absence of glow indicates sinus filled with fluid or pus
absence of red flow indicates sinus filled with fluid, pus, thick mucus from chronic sinusitis
When assessing the tongue, what should you always document?
size
color
moisture
texture
Normal findings of the tonge
pink
moist
moderate size with papillae
no lesions
older adults tongue
fissured
topogrphic maplike tongue
Abnormal findings of the tongue (9)
Deep longitudinal fissures Black tongue Black hairy tongue Niacin or vitamin B deficiencies Enlarged tongue Smalltongue Atrophied tongue/fasciculations Cankersores Decrease tongue strength
Saliva
-define
Saliva is composed of 3 glands, what are they?
breaksdown food and lubricates it
parotid gland
submandibular gland
sublingual gland
What is heard when palpating the maxillary sinuses and there is a large amount of exudate?
Crepitus
Dysphagia
- define
- increases the risk of ___?
- decrease risk by ___?
- seen with ?
difficutly swallowing
Increases the risk of aspiration
Decreases risk by thoroughly chewing food
Tumors of pharynx Esophagus GERD Anxiety Poorly fitting dentures Neuromuscular disorders
Gingivitis
- define
- What do tyou ask when collecting subjective data?
bleed easily, seen in early gum disease
red swollen gums
Do you experience rerddness, swelling, bleeding, r pain of the gums or mouth?
Leukoplakia
- what kind of patche are they and where are they located?
- Describe the spots
- Seen in ?
Seen when assessing buccal mucosa
White patches or spots on the mucous membrane of the tongue or cheek
The spots are smooth, irregular inshape and size, hard, occasionally fissured
Seen in chronic irritation and smoking
Nasal Septum Deviation
Over growth of tissue
Normal finding as long as breathing is not obstructed
Nose bleeds
- most commonly d/t what?
- other causes? (11)
Dry nasal membranes and nose picking
acute/chronic sinusitis
Allergies
Anticoagulants
Cocaine Use
Common colds
Deviated septum
Foreign body in nose
Nasal sprays
NSAIDS
aspririn
Non allergenic rhinitis
Nose trauma
Rhinitis
Acute bacterial infection
Purulent nasal discharge
Rhinorrhea
- what do you need to ask client during subjective data?
- signs
- Indiates?
Do you experience frequent clear or mucous draining from your nose?
Thin, watery, clear nasal drainage
Chronic allergy
Cerebrospinal fluid leak
recent head injury
Signs and symptoms of Sinusitis (10)
Drainage of a thick yellow green discharge fromthe nose or dwn back of the throat Nasal obstruction or congestion Pain tenderness, swelling around the eyes, cheeks, nose and forehead Reduced sense of smell and taste Ear pain Aching in your upper jaw and teeth Cough worse at night Sore throat Bad Breath Fatigue, irritability
Thrush
- infection of what bacteria?
- Describe the patches
C. Albicans
Whitish, curdlike patches that scrape off over rreddened mucosa oron the tongue
Patches are raised and creamy
Bleed easily
