Module 9 Part 2 Flashcards
AKA 6 cardinal fields of gaze
Extraocular Movements (EOM)
cranial nerves related to EOM
Cranial Nerves III (Oculomotor), IV (Trochlear), and VI (Abducens)
how do you check EOM
Stand or sit 3 to 6 feet in front of the person
Ask the person to follow your finger with their eyes without moving their head
Check gaze in the six cardinal directions using a six-sided cross or “H” pattern
how do you check convergence
by moving your finger toward the bridge of the person’s nose
how do you check for nystagmus
Hold gaze in the 4 corners momentarily
what cranial nerve is related to pupillary reactions
cranial nerve II
how do you check for pupillary reaction
Dim the room lights as necessary
Ask the person to look into the distance
Shine a bright light obliquely into each pupil in turn
Observe for constriction
how do you record the pupils
size in mm and any asymmetry or irregularity
how to check far-to-near reaction accommodation
Have the person look across the room
Then have her/him look at your finger about 10” in front of their nose
Watch for pupillary constriction
how to check near-to-far accommodation
Have the person look at your finger about 10” in front of their nose
Then have her/him look across the room
Watch for pupillary dilation
what is a common abbreviation for normal findings in pupils
PERRLA (Pupils Equally Round and Reactive to Light and Accommodation)
the fundus of the eye includes
retina, macula, fovea, optic disc and retinal vessels
the fundus of the eye is only visible with what
use of the ophthalmoscope
how do you use the ophthalmoscope
Darken the room as much as possible
Adjust the ophthalmoscope so that the light is no brighter than necessary
Adjust the aperture to a plain white circle
Set the diopter dial to zero unless you have determined a better setting for your eyes
how should you examine the person’s left eye
Use your left hand and left eye
vice versa for right eye
when using the ophthalmoscope…
Place your free hand on the person’s shoulder for better control.
Ask the person to stare at a point on the wall or corner of the room.
what should you see when you shine the light of the ophthalmoscope (shine about 2 ft away)
should see the retina as a “red reflex.“
A “glow” coming from the pupil
May not always be “red”
what cranial nerve is affiliated with auditory acuity
Cranial Nerve VIII (Acoustic)
how do you perform the whisper test
Ask the person to occlude the ear canal of one ear by pushing in and out on the tragus
Stand 1-2 feet behind the person
Whisper unrelated monosyllabic and bisyllabic words 1 at a time
Ask her/him to tell you what was heard
Should be able to identify the words
how do you perform the weber test
Strike tuning fork and place on top of the head
Ask
“Can you hear the sounds better in the right, better in the left, or the same in both ears?”
Sound should be heard equally well in both ears
how do you perform the rinne test
Strike tuning fork and place on mastoid (bone conduction)
Ask her/him to tell you when the sound is no longer heard (time it in seconds)
When sound no longer heard – move tuning fork in front of the ear (air conduction)
Do not strike the tuning fork again)
Ask her/him to tell you when the sound is no longer heard (time it in seconds)
AC should be more than 2x > BC
When the person has heard it 1 second longer in front of the ear than behind, you can stop timing
how do you inspect the external ears
Inspect the auricles (should be aligned) and move them around gently
Ask the person if this is painful
Palpate the mastoid process for tenderness or deformity
otoscopic exam
Hold the otoscope with your thumb and fingers so that the ulnar aspect of your hand makes contact with the person
Straighten the canal
Insert the otoscope to a point just beyond the protective hairs in the ear canal
Use the largest speculum that will fit comfortably (usually 4 mm for adults)
Inspect the ear canal noting redness, drainage, or foreign body
how do you straighten canal in adults vs children
Adults: Pull the ear upwards and backwards
Children: Pull the ear downwards and backwards