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Nursing School > NUR 220 - Lecture 3 > Flashcards

NUR 220 - Lecture 3 Flashcards

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1
Q

what test do we use to test Cranial Nerve II Optic?

A

snellen chart

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2
Q

what test do we use to test peripheral vision?

A

confrontation test

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3
Q

what does HEENT stand for?

A

Head Ears Eyes Nose Throat

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4
Q

hair observations

A
  • fine vs. thick
  • shiny vs. dull
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5
Q

scalp observations

A
  • look at it
  • feel for lesions
  • redness
  • flakes
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6
Q

skin observations

A
  • even skin tone
  • smooth
  • facial hair
  • no edema
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7
Q

what is included in gathering head history

A
  • headaches
  • injuries
  • surgeries
  • pain
  • sun exposure
  • birth history
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8
Q

where is patient looking during confrontation test?

A

your nose

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9
Q

skull observations

A
  • symmetry
  • bumps
  • size
  • normocephalic
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10
Q

face observations

A
  • eyes + eyebrows
  • palpebral fissures
  • symmetry
  • calm expression
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11
Q

why is it important to gather recent visual changes at the beginning of the eye exam?

A

you can act quickly

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12
Q

what family history can affect vision?

A
  • cataracts
  • glaucoma
  • diabetes
  • HTN
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13
Q

what STI’s can affect vision?

A
  • chlamydia
  • gonorreah
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14
Q

what part of the eye does the Snellen chart test?

A

CN II Optic

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15
Q

what does the confrontation test assess?

A

peripheral vision

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16
Q

how many blinks per minute?

A

15-20

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17
Q

how to look at conjunctiva

A

pull lid up and pull down

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18
Q

healthy conjunctiva appearance

A

pink/pale pink

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19
Q

healthy sclera

A

white + clear

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20
Q

healthy cornea

A

no film over eye

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21
Q

healthy iris

A

color is round and consistent

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22
Q

how is the lens tested?

A

visual acuity tests such as snellen chart

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23
Q

mneumonic for pupil

A

PERRLA

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24
Q

what does PERRLA stand for?

A

P - Pupil is
E - equal
R - round
R - reactive to
L- light
A - accommodation

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25
Q

when testing accommodations distance = ____ and close = _____,

A

distance = dilate
close = constrict

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26
Q

what does 20/50 vision mean?

A

you have to stand at 20 feet to read what a normal person usually reads at 50 feet

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27
Q

how do we test parallell tracking?

A

six cardinal fields of gaze test

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28
Q

how is the six cardinal fields of gaze test conducted?

A

draw a star or an H and have client follow

29
Q

what is the corneal light relfex test?

A

shine light at bridge of nose - reflection of light should be the same spot in both eyes

30
Q

3 types of pupillary response

A
  1. direct reflex
  2. consensual relex
  3. accommodation
31
Q

direct reflex

A

pupil constricts

32
Q

consensual reflex

A

when shining light in one pupil, the other one simulatenously constricts

33
Q

what does the opthalmoscope look at?

A

retina

34
Q

what damage can be seen in the opthalmoscope?

A

damaged to the retina caused by diabetes or hypertension

35
Q

presbycusis

A

hearing loss

36
Q

tinnitus

A

ringing in ear

37
Q

ear pain word

A

otoalgia

38
Q

vertigo

A

trouble balancing

39
Q

pinna of ear should be in line with what?

A

outer eye

40
Q

serumen

A

earwax

41
Q

what does an otoscope look at?

A

ear canal

42
Q

how do you do a whisper test?

A

stand behind patient, have them cover one ear, say three words and have them repeat it back

43
Q

how do you do a finger rubbing test?

A

stand infront of patient and have them close their eyes, rub you fingers on one side of their head and have them tell you what direction the rubbing is coming from

44
Q

which is first, webber or rinne test?

A

webber

45
Q

how do you do the webber test

A

smack tuning fork and place it on patients forehead. they should hear it equally in both ears

46
Q

what does it mean is a patient hears the webber test better in one ear?

A

the ear that they hear it better in has conductive hearing loss

47
Q

how do you do the rine test?

A

smack fork and place on patients mastoid bone and count how long they hear it. when they no longer hear it place next to ear and count again.

48
Q

_____ should be twice as long as ______.

A

air conduction should be twice as long as bone conduction

49
Q

if bone conduction is longer than air conduction then that means …

A

conductive hearing loss

50
Q

how do you straighten an adults ear for an otoscope?

A

up and back

51
Q

how do you straighten a childs ear for an otoscope?

A

down and back

52
Q

ethmoid sinus location

A

bridge of nose between eyes

53
Q

sphenoid sinus location

A

behind ethmoid sinus

54
Q

patency

A

nose obstruction

55
Q

what are the two sinuses you can palpate?

A

frontal and maxillary

56
Q

cheilitis

A

chapped lips

57
Q

cyanosis

A

blue/purple coloring; in darker tone ppl mouth may appear blue/grey

58
Q

jaundice

A

yellow coloring

59
Q

what is jaundice caused by

A

liver not processing bilirubin

60
Q

where do you check for jaundice in darker people?

A

sclera, palms, soles of feet

61
Q

erythema

A

inflammation from bug bite

62
Q

how to test for erythema in darker people?

A

feel for temperature

63
Q

pallor

A

paleness

64
Q

ecchymosis

A

bruising

65
Q

what is unique about ecchymosis?

A

color changes as bruises heal

66
Q

petechiae

A

pinpoint, flat, red spots

67
Q

what causes petechiae

A

small blood vessels rupturing

68
Q

what are come causes of petechiae (3)

A
  • drug reaction
  • liver issue
  • or nothing
69
Q

edema

A

fluid build up

Nursing School (16 decks)

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