Ophthalmic and Otic Assessment

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Questions and Answers

Which of the following symptoms is NOT commonly associated with tinnitus?

Ringing

Buzzing

Nausea (correct)

Crackling noises

Which type of medications are commonly known to be ototoxic?

Hormonal medications

Non-steroidal anti-inflammatory drugs

Over-the-counter pain relievers

Certain chemotherapeutic agents (correct)

What factor does NOT contribute to the risk of hearing loss?

Prolonged exposure to loud noises

Age-related degeneration

History of ear infections

Hydration levels (correct)

During an ear inspection, what should the position of the top of the ear be in relation to the eyes?

Slightly above the level of the eyes Signup and view all the answers

Which of the following conditions is least likely to cause ear infections?

Exposure to cold weather Signup and view all the answers

Which symptom is consistent with presbyopia?

Expected changes with aging Signup and view all the answers

What does PERRLA stand for in eye assessment?

Pupils Equal, Round, Reactive to light and Accommodation Signup and view all the answers

Which condition is indicated by the term 'ptosis'?

Drooping of one or both eyelids Signup and view all the answers

What is the primary purpose of the Snellen Eye Chart?

To measure distance vision Signup and view all the answers

What does it indicate if a patient's vision score is recorded as 20/60?

The patient sees at 20 feet what a normal person can see at 60 feet Signup and view all the answers

What is the expected appearance of a normal sclera?

White to pale ivory Signup and view all the answers

When assessing the eyes for cardinal fields of vision, what is the examiner checking for?

Smooth movement and eye alignment Signup and view all the answers

In the procedure of using the Snellen Eye Chart, what is the first step?

The patient stands 20 feet from the chart Signup and view all the answers

What is a sign that may indicate neurological issues during pupil examination?

Pupils are unequal in size Signup and view all the answers

When assessing a patient's vision and they read at least half the letters on a line, what is that line considered?

Read Signup and view all the answers

What is the significance of the numbers recorded on the Snellen Eye Chart?

They show the distance from which the chart was viewed Signup and view all the answers

Which symptom indicates a potential problem with the cornea?

Opaque or not smooth texture Signup and view all the answers

What would be a normal finding when inspecting the conjunctiva?

Clear and shiny appearance Signup and view all the answers

What is considered a normal result when assessing near visual acuity using the Rosenbaum (Pocket Snellen) Chart?

14/14 with or without corrective lenses Signup and view all the answers

Which of the following changes is expected in the lens of the eye with aging?

Development of opacities (cataracts) Signup and view all the answers

What is a common risk associated with decreased tear production in older adults?

Eye irritation Signup and view all the answers

What does the presence of Arcus Senilis indicate in an older adult's eye?

Normal aging with lipid deposits Signup and view all the answers

What is a major risk associated with decreased peripheral vision in older adults?

Increased risk for falls and accidents Signup and view all the answers

What is ptosis in the context of eye assessment for older adults?

Drooping of the eyelids Signup and view all the answers

How does aging typically affect pupil response in older adults?

Pupils react slower to light Signup and view all the answers

Which instrument is primarily used to inspect the internal structures of the eye?

Ophthalmoscope Signup and view all the answers

What color should a healthy tympanic membrane appear?

Pearly gray Signup and view all the answers

Which test is used to differentiate between conductive and sensorineural hearing loss?

Weber Test Signup and view all the answers

What does a Rinne Test compare?

Bone conduction and air conduction Signup and view all the answers

What indicates conductive hearing loss during the Weber Test?

Sound heard louder in the impaired ear Signup and view all the answers

Which of the following is a normal change in the ear structure for aging adults?

Thickening of the tympanic membrane Signup and view all the answers

What best describes the function of air conduction in hearing?

Sound waves traveling through the air to the outer ear Signup and view all the answers

During a whispered voice test, the patient should do which of the following?

Occlude one ear with a finger Signup and view all the answers

What is the primary cause of sensorineural hearing loss?

Damage to receptor cells or cochlear (auditory) nerve Signup and view all the answers

What may lead to conductive hearing loss?

Tympanic membrane perforation Signup and view all the answers

What age-related change may increase in the ear canal?

Accumulation of cerumen Signup and view all the answers

Study Notes

Eye History

Review past medical history for diabetes, hypertension, migraine headaches, strokes, eye disease, including glaucoma, cataracts, color blindness, and eye prosthesis.
Note last visit to ophthalmologist or optometrist, including use of glasses or contact lenses.
Include current use of OTC or prescription eye medications, including any use of eye drops or ointments.
Evaluate the patient for symptoms including: changes in visual acuity, presbyopia, blurred vision, double vision, tearing, spots moving in front of the eyes, blind spots, light sensitivity, halos or rainbows around lights, flashing lights, itching, or pain.

Eye Inspection

Position and Alignment: Inspect for any bulging or crossing of the eyes. Bulging eyes, also called exophthalmos, could indicate thyroid ophthalmopathy. Crossing eyes are known as strabismus and could denote a congenital condition or nerve damage.
Eyebrows: Examine eyebrow hair for distribution and symmetry, noting any loss of hair or unusual growth patterns.
Eyelids: Observe the eyelids for position, symmetry, any drooping (ptosis), lesions, redness, edema, or ensure complete closure.

Eye Conjunctiva and Sclera

Conjunctiva: The conjunctivae should be clear and shiny, appearing as a thin transparent membrane covering the eye and inner eyelids. Abnormal findings include red, inflamed eyelids, or the presence of yellowing, signifying jaundice.
Sclera: The sclera should be white to pale ivory. Note any abnormal findings such as jaundice, excessive paleness, reddening, lesions, or nodules.

Iris and Cornea

Iris: Observe if it is round, flat, and evenly colored. An abnormal iris could be associated with inflammation or a traumatic injury.
Cornea: The cornea should be transparent, shiny, and smooth. Opaqueness, lack of shine, or uneven surface suggests the presence of a corneal abrasion or other abnormalities.

Pupil Assessment

PERRLA: Evaluate whether pupils are Equal, Round, Reactive to Light and Accommodation, and if they have a direct and consensual response.
Direct Response: Illumination of the pupil should cause constriction.
Consensual Response: The non-illuminated pupil should also constrict.
Abnormal Findings: Report any findings that include no constriction, unequal responses, or absent responses.
Unequal Pupil Response: May indicate a neurological problem requiring immediate physician attention.

Eye Cardinal Fields of Vision

Ask the patient to follow an object with their eyes, holding still and not moving their head, and move the object through the 6 cardinal fields of vision.
The eyes should move smoothly, remain parallel during movement, and return to midline between directions.

Visual Acuity

Snellen Eye Chart: Measures distance vision using an alphabet chart for most adult patients.
E Chart: Used for children, non-verbal, illiterate, or patients who do not read English.
The top number is the distance between the patient and the chart (always 20 feet). The bottom number is the distance from which a person with normal vision could read the same line.
For example, 20/40 means the patient must stand 20 feet away to see what a normal person can see from 40 feet away.
The larger the bottom number, the poorer the patient’s vision.
Repeat for each eye, with and without corrective lenses.
Near Vision Acuity
Pocket Snellen or Rosenbaum Chart: Hold at 14 inches away and assess the patient's ability to read at least half of the letters on the chart.

Ophthalmoscope

An ophthalmoscope is a lighted instrument for inspecting the internal structures of the eye, not typically used by generalist nurses but might be used by advanced practice nurses or specialty nurses.

Older Adult Eye Assessments

Expect decreased numbers and length of eyelashes, leading to a potential risk of eye injury.
Decreased tear production leading to dry, burning, or itching eyes, and increased risk of eye irritation.
Decreased eyelid elasticity causing ptosis: drooping of eyelids.
Pupil: Reduced pupil size and slower reaction to light.
Presbyopia: Diminished ability to see close objects, read small print, and experience blurred vision.
Lens: Increased discoloration, stiffening, yellowing, opacities (cataracts). Leading to altered color perception and gradual loss of vision.
Arcus Senilis: Gray or white arc around the peripheral iris caused by lipid deposits that does not require treatment.
Peripheral Vision: Loss of peripheral vision with aging.
Depth Perception: Decreased depth perception with age. These changes increase risk of falls and accidents.

Ear History

Note any ear pain or discomfort - including discharge, itching, or presence of a foreign body - and any recent changes in hearing.
Determine if any tinnitus is present, including any ringing, buzzing, humming, or crackling noises.
Assess if hearing aids are used, and review any history of ear surgery or trauma.
Identify which medications the patient is taking as some medications, such as chemotherapeutic agents and some antibiotics, are ototoxic.

Ear Risk factors

Repeated ear infections increase the risk of hearing loss.
Trauma to the ears can contribute to hearing loss.
Prolonged exposure to loud noises, including high levels of noise, ototoxic medications, and repeated ear infections, increase the risk of hearing loss.
Degeneration of inner ear structures due to age can cause hearing loss.
Illnesses, such as diabetes, hypertension, or autoimmune disorders, can also contribute to hearing loss.

Ear Allergies

Patients with seasonal or environmental allergies are at increased risk for ear infections.

Assess social history for exposure to high levels of noise at work or through hobbies or recreation activities.

Ear Inspection

Auricles: Note the color, symmetry in size, and position of both ears, and compare color to facial skin.
Assess for cyanosis of the earlobes or any redness.
The top of the ear should be slightly above the level of the eyes, low-set ears may indicate a genetic or developmental condition.

External Ear Canal

External Ear Canal: Inspect for any cerumen, discharge, odor, or visible foreign objects. Note any signs of inflammation and swelling.
Palpation: Palpate the auricle and the tragus for any tenderness.

Middle Ear Assessment

Otoscope: An otoscope is a lighted instrument used to visualize the middle ear structures and tympanic membrane. Its use requires advanced practitioner skills.
Tympanic Membrane: Should be pearly gray in color, translucent, and semi-transparent.
Abnormalities: Redness, opacity, yellow-amber, white, blue, deep red, or a dull surface.

Hearing Acuity Tests

Whispered Voice Test: This test helps determine whether conductive hearing loss is present.
Have the patient occlude one ear with a finger.
While standing 1-2 feet away, whisper a 2-syllable word or short phrase on the side of the unoccluded ear.
Ask the patient to repeat the word or phrase.
Repeat for the opposite ear.
Note if the patient can hear the whispered word or if you have to stand closer or raise your voice for the patient to hear.

Tuning Fork Tests

Bone Conduction
Sound is transmitted through bone directly to the inner ear, bypassing the outer ear.
Air Conduction: Sound travels through the air to the outer ear.

Types of Hearing Loss

Conductive Hearing Loss: Transmission of vibrations is prevented in wither the outer or middle ear, such as a mechanical blockage from excessive earwax.
Sensorineural Hearing Loss: Damage to the receptor cells or the cochlear nerve results in the inability to process sound, even if it reaches the eardrum.

Weber Test

Conductive Loss: The sound will be heard louder in the impaired ear.
Sensorineural Loss: The sound will be softer on the impaired side.

Rinne Test

Compares air conduction to bone conduction:
- Confirm the patient can hear the tuning fork.
- Place the base of the vibrating tuning fork on the mastoid process (note time in seconds)
- When the patient can no longer hear the sound, quickly place the tuning fork near the ear canal. Ask the patient to indicate when the sound is no longer heard (count seconds).
- Repeat on the opposite ear.
- Normal: The patient will hear the sound twice as long by air conduction than by bone conduction.

Older Adult Ear Assessment

External Ear: The external ear shape changes due to wrinkling, sagging, and cartilage growth.
Increased Cerumen: Increased accumulation of earwax in the ear canal.
Increased Hair Growth: Increased hair on the ear.
Dryness: Dryness of the ear canal, leading to pruritus (itching).
Middle Ear: Thickening of the tympanic membrane. Otosclerosis, calcification of the ossicles.
Inner Ear: Hearing loss, usually more severe in older adults who have been exposed to loud noise earlier in life.
Presbycusis: Age-related loss of hearing, especially for high-frequency sounds.

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Description

Test your knowledge on the essential aspects of ophthalmology patient evaluation, focusing on medical history and eye inspection techniques. This quiz covers symptoms, previous medical conditions, and signs noted during an eye examination. Perfect for students and professionals in the medical field.