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    Eyes.Ears.330 Eyes.Ears.330 Presentation Transcript

    • Eyes Nursing 330 Shirley Comer
    • External Eye structures
    • Inner Eye Anatomy
    • Visual Acuity
      • Snellen eye chart
        • Position pt 20 ft away
        • Leave glasses or contacts on
        • No squinting or leaning allowed
        • Have pt read smallest line they are able
        • Test each eye independently (os=left eye od=right eye)
        • Record as a fraction (20/20)
          • Numerator = # of feet from chart
          • Denominator = distance at which normal eye can read a line
          • Refer pt at 20/30
    • Snellen chart
    • Other charts
      • Can test with other charts for
        • Colorblindness
          • Green/red
          • Black/brown
        • Depth perception
        • Presbyopia
          • Decrease in power of accommodation r/t aging
          • Holds objects father away to see upclose
    • Color Blindness pix
    • Visual Fields
      • Visual Fields are tested by confrontation
        • Position yourself in front of pt about 2 ft away
        • Cove one eye and look straight at you
        • Hold object out of visual field and slowly move it inward
        • Pt should see object at the same time you do
        • Test in 6 fields ( up, down, sides, transverse)
    • Extra ocular Movements
      • Ask pt to look at you and follow object only /c eyes
      • Hold object about 12 inches from pt
      • Test Six cardinal positions of gaze
      • Observe any extra eye movements- eyes should move together
      • Nystagmus- a fine oscillating movement around iris
        • Normal only in extreme lateral gaze
        • Indicates a neurological problem
    • 6 Cardinal Positions of Gaze Pix
    • Inspect external structures
      • General functional ability
      • Eyebrows-symmetrical
      • Eyelid and lashes- drooping, lid lag, periobital edema, discharge, lesions, bulges
      • Eyeballs- color, smoothness, exopthalmos
      • Conjunctiva and sclera-inspect blood vessels, clear, blacks may have macules,
    • Eye Structures cont
      • Cornea and lens-
        • shine a light from the side and look for smoothness and clarity
        • cataract=opacity of lens
        • arcus senilis=white line on top of lens-normal in elderly
        • Abrasion of cornea causes irregular ridges in reflected light- must stain eye to see
    • Iris and Pupil
      • Iris is round colored portion of eye
        • shape should be symmetrical
        • maybe irregular with lens implants following cataract removal
      • Pupils
        • should be equal in size and react together
        • if unequal may be neuro problem
        • pupils will not react if pt has using glaucoma medications or has had lens implants
    • Pupillary light reflex
      • Darken room
      • Ask pt to gaze into the distance to dilate pupils
      • Shine light in from side of eye and note response
      • Record as PERRLA (pupils equal, round, react to light and accommodation)
      • Compare sizes to established charts
    • Fundus
      • Darken room
      • Remove pt and your glasses
      • Locate fundus using ophthalmoscope
      • Observe optic disk (creamy yellow orange)
      • Observe retinal vessels
      • Observe general background-light red to brown
      • Observe macula
    • Red Reflex
    • Retina
    • Age Specific Considerations
      • Infants
        • Absent pupillary light reflex esp after 3 weeks indicates blindness
        • Strabismus ie crossed eyes can lead to permanent vision damage if not treated
        • May have an epicanthal fold- excess skin fold extending over the inner corner of eye. Disappears later.
        • Mongolian slant- seen with down’s syndrome
    • Age Specific Cont
      • Elderly
        • Arcus Senilis normal
        • Sparse eyebrows
        • Lower lid droop r/t decreased skin elasticity
        • Decreased orbital fat r/t sunken eye appearance
        • Decreased tear production
        • Pinguiculae-yellow nodules on sclera normal
        • Xanthelasma- soft raised plaques at tear ducts
        • Drusen- yellow spots on retina
    • Practice Exam Question
      • You are conducting Joe’s pre employment eye exam. Joe can read line 20/40 while squinting and 20/50 w/o squinting. How should you record Joe’s visual Acuity?
      • A. 20/40
      • B. 20/90
      • C. 20/50
      • D. none of the above
    • Rationale
      • The correct answer is c. The Snellen chart score should be recorded at the level the pt can read it w/o cheating ie squinting or leaning in.
    • Ears Nursing 330 Shirley Comer
    • Ear Anatomy
    • Inspect and Palpate External Ear
      • Size and shape
      • Skin Condition
        • Discharge or crusting indicate infection
      • Tenderness
      • External meatus
        • Otitis externa (infection of ear canal) = sticky yellow discharge
        • Otitis media (infection of middle ear)
    • Test hearing Acuity
      • Whisper test detects high tone loss
      • Tuning forks
        • Weber test- place fork on top of head
          • Should be able to hear equally in both ears by bone conduction
        • Rinne test- place fork on mastoid and move to ear canal /p pt reports being unable to hear it
          • Tests bone v. air conduction
          • Should hear 2x as long by air
    • Weber and Rinne Tuning fork placement
    • Otoscopic Examination
      • Use largest speculum that will fit
      • Tilt head away from you toward opposite shoulder
      • Pull up on pinna (auricle) to straighten canal on adult ( on child pull down)
      • Hold scope up side down to steady and insert into external canal
      • Don’t force but advance as much as possible
    • Otoscopic Exam cont
      • External Ear Canal
        • Note redness
        • Swelling
        • Discharge
        • Tenderness
        • Blood
        • Ruptured ear drum
        • CSF
    • Tympanic Membrane
      • Should be pearly grey color
      • Locate cone of light
      • Observe attachment of malleus
      • Note position ie bulging, or retracted
      • Ear infection will cause scaring of membrane
      • Note perforations
      • Fluid behind membrane
    • Tympanic Membrane
    • Otitis Media
    • Otitis External and Otitis Media
    • Age specific considerations
      • Elderly
        • Often have hearing loss
        • High tone loss cases trouble hearing consonants
        • Caused by noise and aging
        • May have hair in ears
        • May have ears occluded with cerum
    • Practice exam question
      • Mr. Jones across the street knows you are a nursing student and want you to remove some ear wax which has been troubling him. He tells you his ear is sore and draining a yellow liquid and he tried to get the wax out with a q-tip but was unable. He feels sure that if the wax would come out he’d feel better. You should?
      • A. Refer him to a doctor, he probably has an ear infection
      • B. Rinse his ear out with peroxide and water
      • C. Tell him to get an ear syringe kit from Walgreens
      • D. Tell him to try harder with a Q-tip.
    • Rationale
      • The correct answer is A. The pain and discharge indicate that an infection and not ear wax is causing his problem
      • The other options may result in injury and should not be attempted. Refer all such complaints to a doctor.