Eyes Nursing 330 Shirley Comer
External Eye structures
Inner Eye Anatomy
Visual Acuity <ul><li>Snellen eye chart </li></ul><ul><ul><li>Position pt 20 ft away </li></ul></ul><ul><ul><li>Leave glas...
Snellen chart
Other charts <ul><li>Can test with other charts for </li></ul><ul><ul><li>Colorblindness </li></ul></ul><ul><ul><ul><li>Gr...
Color Blindness pix
Visual Fields <ul><li>Visual Fields are tested by  confrontation </li></ul><ul><ul><li>Position yourself in front of pt ab...
Extra ocular Movements <ul><li>Ask pt to look at you and follow object only /c eyes </li></ul><ul><li>Hold object about 12...
6 Cardinal Positions of Gaze Pix
Inspect external structures <ul><li>General functional ability </li></ul><ul><li>Eyebrows-symmetrical </li></ul><ul><li>Ey...
Eye Structures cont <ul><li>Cornea and lens-  </li></ul><ul><ul><li>shine a light from the side and look for smoothness an...
Iris and Pupil <ul><li>Iris is round colored portion of eye  </li></ul><ul><ul><li>shape should be symmetrical  </li></ul>...
Pupillary light reflex <ul><li>Darken room </li></ul><ul><li>Ask pt to gaze into the distance to dilate pupils </li></ul><...
Fundus <ul><li>Darken room  </li></ul><ul><li>Remove pt and your glasses </li></ul><ul><li>Locate fundus using ophthalmosc...
Red Reflex
Retina
Age Specific Considerations <ul><li>Infants  </li></ul><ul><ul><li>Absent pupillary light reflex esp after 3 weeks indicat...
Age Specific Cont <ul><li>Elderly </li></ul><ul><ul><li>Arcus Senilis normal  </li></ul></ul><ul><ul><li>Sparse eyebrows <...
Practice Exam Question <ul><li>You are conducting Joe’s pre employment eye exam.  Joe can read line 20/40 while squinting ...
Rationale <ul><li>The correct answer is c.  The Snellen chart score should be recorded at the level the pt can read it w/o...
Ears Nursing 330 Shirley Comer
Ear Anatomy
Inspect and Palpate External Ear <ul><li>Size and shape </li></ul><ul><li>Skin Condition </li></ul><ul><ul><li>Discharge o...
Test hearing Acuity <ul><li>Whisper test detects high tone loss </li></ul><ul><li>Tuning forks </li></ul><ul><ul><li>Weber...
Weber and Rinne Tuning fork placement
Otoscopic Examination <ul><li>Use largest speculum that will fit </li></ul><ul><li>Tilt head away from you toward opposite...
Otoscopic Exam cont <ul><li>External Ear Canal  </li></ul><ul><ul><li>Note redness </li></ul></ul><ul><ul><li>Swelling </l...
Tympanic Membrane <ul><li>Should be pearly grey color </li></ul><ul><li>Locate cone of light </li></ul><ul><li>Observe att...
Tympanic Membrane
Otitis Media
Otitis External and Otitis Media
Age specific considerations <ul><li>Elderly </li></ul><ul><ul><li>Often have hearing loss </li></ul></ul><ul><ul><li>High ...
Practice exam question <ul><li>Mr. Jones across the street knows you are a nursing student and want you to remove some ear...
Rationale <ul><li>The correct answer is A.  The pain and discharge indicate that an infection and not ear wax is causing h...
Upcoming SlideShare
Loading in …5
×

Eyes.Ears.330

1,159 views

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,159
On SlideShare
0
From Embeds
0
Number of Embeds
47
Actions
Shares
0
Downloads
47
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Eyes.Ears.330

  1. 1. Eyes Nursing 330 Shirley Comer
  2. 2. External Eye structures
  3. 3. Inner Eye Anatomy
  4. 4. Visual Acuity <ul><li>Snellen eye chart </li></ul><ul><ul><li>Position pt 20 ft away </li></ul></ul><ul><ul><li>Leave glasses or contacts on </li></ul></ul><ul><ul><li>No squinting or leaning allowed </li></ul></ul><ul><ul><li>Have pt read smallest line they are able </li></ul></ul><ul><ul><li>Test each eye independently (os=left eye od=right eye) </li></ul></ul><ul><ul><li>Record as a fraction (20/20) </li></ul></ul><ul><ul><ul><li>Numerator = # of feet from chart </li></ul></ul></ul><ul><ul><ul><li>Denominator = distance at which normal eye can read a line </li></ul></ul></ul><ul><ul><ul><li>Refer pt at 20/30 </li></ul></ul></ul>
  5. 5. Snellen chart
  6. 6. Other charts <ul><li>Can test with other charts for </li></ul><ul><ul><li>Colorblindness </li></ul></ul><ul><ul><ul><li>Green/red </li></ul></ul></ul><ul><ul><ul><li>Black/brown </li></ul></ul></ul><ul><ul><li>Depth perception </li></ul></ul><ul><ul><li>Presbyopia </li></ul></ul><ul><ul><ul><li>Decrease in power of accommodation r/t aging </li></ul></ul></ul><ul><ul><ul><li>Holds objects father away to see upclose </li></ul></ul></ul>
  7. 7. Color Blindness pix
  8. 8. Visual Fields <ul><li>Visual Fields are tested by confrontation </li></ul><ul><ul><li>Position yourself in front of pt about 2 ft away </li></ul></ul><ul><ul><li>Cove one eye and look straight at you </li></ul></ul><ul><ul><li>Hold object out of visual field and slowly move it inward </li></ul></ul><ul><ul><li>Pt should see object at the same time you do </li></ul></ul><ul><ul><li>Test in 6 fields ( up, down, sides, transverse) </li></ul></ul>
  9. 9. Extra ocular Movements <ul><li>Ask pt to look at you and follow object only /c eyes </li></ul><ul><li>Hold object about 12 inches from pt </li></ul><ul><li>Test Six cardinal positions of gaze </li></ul><ul><li>Observe any extra eye movements- eyes should move together </li></ul><ul><li>Nystagmus- a fine oscillating movement around iris </li></ul><ul><ul><li>Normal only in extreme lateral gaze </li></ul></ul><ul><ul><li>Indicates a neurological problem </li></ul></ul>
  10. 10. 6 Cardinal Positions of Gaze Pix
  11. 11. Inspect external structures <ul><li>General functional ability </li></ul><ul><li>Eyebrows-symmetrical </li></ul><ul><li>Eyelid and lashes- drooping, lid lag, periobital edema, discharge, lesions, bulges </li></ul><ul><li>Eyeballs- color, smoothness, exopthalmos </li></ul><ul><li>Conjunctiva and sclera-inspect blood vessels, clear, blacks may have macules, </li></ul>
  12. 12. Eye Structures cont <ul><li>Cornea and lens- </li></ul><ul><ul><li>shine a light from the side and look for smoothness and clarity </li></ul></ul><ul><ul><li>cataract=opacity of lens </li></ul></ul><ul><ul><li>arcus senilis=white line on top of lens-normal in elderly </li></ul></ul><ul><ul><li>Abrasion of cornea causes irregular ridges in reflected light- must stain eye to see </li></ul></ul>
  13. 13. Iris and Pupil <ul><li>Iris is round colored portion of eye </li></ul><ul><ul><li>shape should be symmetrical </li></ul></ul><ul><ul><li>maybe irregular with lens implants following cataract removal </li></ul></ul><ul><li>Pupils </li></ul><ul><ul><li>should be equal in size and react together </li></ul></ul><ul><ul><li>if unequal may be neuro problem </li></ul></ul><ul><ul><li>pupils will not react if pt has using glaucoma medications or has had lens implants </li></ul></ul>
  14. 14. Pupillary light reflex <ul><li>Darken room </li></ul><ul><li>Ask pt to gaze into the distance to dilate pupils </li></ul><ul><li>Shine light in from side of eye and note response </li></ul><ul><li>Record as PERRLA (pupils equal, round, react to light and accommodation) </li></ul><ul><li>Compare sizes to established charts </li></ul>
  15. 15. Fundus <ul><li>Darken room </li></ul><ul><li>Remove pt and your glasses </li></ul><ul><li>Locate fundus using ophthalmoscope </li></ul><ul><li>Observe optic disk (creamy yellow orange) </li></ul><ul><li>Observe retinal vessels </li></ul><ul><li>Observe general background-light red to brown </li></ul><ul><li>Observe macula </li></ul>
  16. 16. Red Reflex
  17. 17. Retina
  18. 18. Age Specific Considerations <ul><li>Infants </li></ul><ul><ul><li>Absent pupillary light reflex esp after 3 weeks indicates blindness </li></ul></ul><ul><ul><li>Strabismus ie crossed eyes can lead to permanent vision damage if not treated </li></ul></ul><ul><ul><li>May have an epicanthal fold- excess skin fold extending over the inner corner of eye. Disappears later. </li></ul></ul><ul><ul><li>Mongolian slant- seen with down’s syndrome </li></ul></ul>
  19. 19. Age Specific Cont <ul><li>Elderly </li></ul><ul><ul><li>Arcus Senilis normal </li></ul></ul><ul><ul><li>Sparse eyebrows </li></ul></ul><ul><ul><li>Lower lid droop r/t decreased skin elasticity </li></ul></ul><ul><ul><li>Decreased orbital fat r/t sunken eye appearance </li></ul></ul><ul><ul><li>Decreased tear production </li></ul></ul><ul><ul><li>Pinguiculae-yellow nodules on sclera normal </li></ul></ul><ul><ul><li>Xanthelasma- soft raised plaques at tear ducts </li></ul></ul><ul><ul><li>Drusen- yellow spots on retina </li></ul></ul>
  20. 20. Practice Exam Question <ul><li>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? </li></ul><ul><li>A. 20/40 </li></ul><ul><li>B. 20/90 </li></ul><ul><li>C. 20/50 </li></ul><ul><li>D. none of the above </li></ul>
  21. 21. Rationale <ul><li>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. </li></ul>
  22. 22. Ears Nursing 330 Shirley Comer
  23. 23. Ear Anatomy
  24. 24. Inspect and Palpate External Ear <ul><li>Size and shape </li></ul><ul><li>Skin Condition </li></ul><ul><ul><li>Discharge or crusting indicate infection </li></ul></ul><ul><li>Tenderness </li></ul><ul><li>External meatus </li></ul><ul><ul><li>Otitis externa (infection of ear canal) = sticky yellow discharge </li></ul></ul><ul><ul><li>Otitis media (infection of middle ear) </li></ul></ul>
  25. 25. Test hearing Acuity <ul><li>Whisper test detects high tone loss </li></ul><ul><li>Tuning forks </li></ul><ul><ul><li>Weber test- place fork on top of head </li></ul></ul><ul><ul><ul><li>Should be able to hear equally in both ears by bone conduction </li></ul></ul></ul><ul><ul><li>Rinne test- place fork on mastoid and move to ear canal /p pt reports being unable to hear it </li></ul></ul><ul><ul><ul><li>Tests bone v. air conduction </li></ul></ul></ul><ul><ul><ul><li>Should hear 2x as long by air </li></ul></ul></ul>
  26. 26. Weber and Rinne Tuning fork placement
  27. 27. Otoscopic Examination <ul><li>Use largest speculum that will fit </li></ul><ul><li>Tilt head away from you toward opposite shoulder </li></ul><ul><li>Pull up on pinna (auricle) to straighten canal on adult ( on child pull down) </li></ul><ul><li>Hold scope up side down to steady and insert into external canal </li></ul><ul><li>Don’t force but advance as much as possible </li></ul>
  28. 28. Otoscopic Exam cont <ul><li>External Ear Canal </li></ul><ul><ul><li>Note redness </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Discharge </li></ul></ul><ul><ul><li>Tenderness </li></ul></ul><ul><ul><li>Blood </li></ul></ul><ul><ul><li>Ruptured ear drum </li></ul></ul><ul><ul><li>CSF </li></ul></ul>
  29. 29. Tympanic Membrane <ul><li>Should be pearly grey color </li></ul><ul><li>Locate cone of light </li></ul><ul><li>Observe attachment of malleus </li></ul><ul><li>Note position ie bulging, or retracted </li></ul><ul><li>Ear infection will cause scaring of membrane </li></ul><ul><li>Note perforations </li></ul><ul><li>Fluid behind membrane </li></ul>
  30. 30. Tympanic Membrane
  31. 31. Otitis Media
  32. 32. Otitis External and Otitis Media
  33. 33. Age specific considerations <ul><li>Elderly </li></ul><ul><ul><li>Often have hearing loss </li></ul></ul><ul><ul><li>High tone loss cases trouble hearing consonants </li></ul></ul><ul><ul><li>Caused by noise and aging </li></ul></ul><ul><ul><li>May have hair in ears </li></ul></ul><ul><ul><li>May have ears occluded with cerum </li></ul></ul>
  34. 34. Practice exam question <ul><li>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? </li></ul><ul><li>A. Refer him to a doctor, he probably has an ear infection </li></ul><ul><li>B. Rinse his ear out with peroxide and water </li></ul><ul><li>C. Tell him to get an ear syringe kit from Walgreens </li></ul><ul><li>D. Tell him to try harder with a Q-tip. </li></ul>
  35. 35. Rationale <ul><li>The correct answer is A. The pain and discharge indicate that an infection and not ear wax is causing his problem </li></ul><ul><li>The other options may result in injury and should not be attempted. Refer all such complaints to a doctor. </li></ul>

×