vision/hearing/scoliosis/acanthosis: lab Flashcards
what eye/ear do you check first
right
months, a child has achieved the neuromotor ability to fixate on one visual field with both eyes
simultaneously by the age
3-4mo
strabismus
one eye deviates from the point of fixation. If the malalignment is constant, the weak eye becomes lazy
and eventually the brain suppresses the image produced by that eye. If strabismus is not detected and corrected by
age 4-6 years, a type of blindness called amblyopia may result.
corneal light
reflex test
conducted by shining a flashlight directly into the eyes of the child from a distance of about 16 inches.
The screener observes where the light falls within each pupil. If the light falls off center in one eye, the eyes are
maligned.
types of strabismus are:
- esotropia or esophoria – inward deviation of the eye.
- exotropia or exophoria – outward deviation of the eye.
- phoria – malalignment that is not obvious until fusion is disrupted.
- tropia – constant or intermittent malalignment of the eyes. More severe and more likely to result in amblyopia
than phoria.
cover test
one eye is covered and the movement of the uncovered eye is observed while the child gazes on a
near (33 cm or 13 in) or distant (50 cm or 20 in) object. If the uncovered eye does not move, it is aligned. If the
uncovered eye moves, a malalignment is present because when the stronger eye is temporarily covered, the weaker
eye attempts to fixate on the object.
uncover test
occlusion is shifted back and forth from one eye to the other eye and movement of the
uncovered eye is observed while the child is fixating at a point in front of the child. If normal alignment is present,
shifting the cover from one eye to the other eye will not cause movement of the covered eye. If malalignment is
present, the covered eye will move from its position to a straight position when uncovered. This test takes more
practice than the other cover test because the occluder must be moved back and forth quickly and accurately in order
to see the eye move. Since deviations can occur at different ranges, particularly in the case of phorias, it is important
to perform the cover test at both near and far distances.
the H:O:T:V test at a distance of 10 feet.
Visual acuity in preschoolers is assessed by using the H:O:T:V test at a distance of 10 feet. The child matches the
letters on a large card to the one the screener points to.
sweep-check screening.
screening. It is intended to screen many children in a relatively short
period of time in an attempt to identify those who may have a hearing problem. The frequencies screened are 1000, 2000, and 4000 Hz at 25 decibels (dB). Each child is tested with the right ear and then the left. The order of
frequencies for testing is 1000, 2000, and 4000 Hz.
The three charts used for vision screening for distance acuity are:
- the Snellen alphabet or letter chart which is appropriate for children 7 years and older.
- the Snellen tumbling “E” chart for 5 and 6 year-old children.
- the H:O:T:V chart for children 4 and 5 years old.
Start 4 years olds and younger at the
20/50 line
Start 5 years olds and younger at the
20/40 line
<=4yo pass
20/40
5yo+ pass
20/30
passing rules
no 2 line differences
4 items right in a line to pass
those who fail get rescreened in 2 or 3 weeks
what dB do we test ears at
25dB
failed sweep check
retest 3-4weeks
scoliosis screening
The child is stood directly in front of the nurse, feet slightly apart, toes pointed and equal. The nurse observes his
shoulders and spine. The child is asked to bend over and touch his/her fingers close to the floor while the nurse
observes the spine, and shoulders for a curvature or difference in shoulder heights. If a difference is detected, a
second person is asked to assess. The nurse places her/his hands on the pelvis of the child as they bend over again.
The information is reported to the nurse as negative for curve or unequal shoulder heights detected.
girls: 10 AND 13
boys: 13 OR 14
ACANTHOSIS NIGRICANS SCREENING
-A hyperkeratinization of the skin has been associated with insulin resistance, increase
in blood pressure and increased risk of developing Type 2 Diabetes. The hyperkeratinization serves as a marker for
development of Type 2 Diabetes.
-Students in 3rd, 5th and 7th grades are to be screened annually and referred to a physician in the case of a positive
screen which includes a blood pressure in the 90% or greater for age of the child. A child who has a positive screen
will also receive a BMI assessment.
how it is graded
-size. Grade 1 is a line Grade 2 is line that is 1-2 cm wide Grade 3 measures 2-3 cm wide Grade 4 measures greater than 3 cm wide.
the process
- Observe the back of the child’s neck.
- If discoloration is observed, have the child sit down.
- Obtain blood pressure; record on referral form.
- Wait 5 minutes to measure blood pressure again. Record on form.
- Record ht and wt. Calculate and record BMI.
- Complete referral form.
- Explain to child as age appropriate.
