Assessment of the Eye and Ear PDF

NURS 1090 Assessment of the Eyes and Ears Review: Anatomy of the Eye Nursing History: Eye Use of contact lenses or eyeglasses Last visit to Ophthalmologist or Optometrist Current use of prescription or over-the-counter eye medications Patient and family history of Diabetes...

NURS 1090 Assessment of the Eyes and Ears Review: Anatomy of the Eye Nursing History: Eye Use of contact lenses or eyeglasses Last visit to Ophthalmologist or Optometrist Current use of prescription or over-the-counter eye medications Patient and family history of Diabetes Hypertension Migraine headaches Strokes Eye disease, injury, or surgery Glaucoma Cataracts Color blindness Eye prosthesis: is it removable? Nursing History: Eye Current Symptoms of  Spots moving in eye problems front of your eyes  Changes in visual  Blind spots acuity  Presbyopia:  Light sensitivity expected changes with  Halos/rainbows aging around lights  Blurred vision  Flashing lights  Double vision (diplopia)  Itching or pain  Tearing Physical Assessment: Eyes Inspect Eyes Position and alignment Eyes bulging (exophthalmos) Eyes crossing (strabismus) Inspect Eyebrows Inspect for hair distribution, symmetry Physical Assessment: Eyes Inspect Eyelids Position, symmetry Note drooping (ptosis) Lesions Redness Lid edema Lid closure: do they close completely Ptosis  Physical Assessment: Eyes Inspect conjunctiva Thin, transparent, continuous membrane covering eye and inside of lids Normal is clear and shiny Inspect sclera White to pale ivory Abnormal: jaundiced, excessively pale, reddened, lesions or nodules  Physical Assessment: Eyes Inspect iris Normal is round, flat, and evenly colored Inspect cornea for color and clarity Should be transparent, shiny, and smooth Note if opaque, not smooth PERRLA Physical Assessment: Eyes/Pupils Review information from Assessment of Neurological System Pupils Equal, Round, Reactive to light and Accommodation Direct and Consensual Response Illuminated pupil constricts (direct response) Nonilluminated pupil constricts (consensual response) Report to physician if neither pupil constricts, unequal responses, absent responses Unequal responses may indicate neurological Physical Assessment: Eyes Assess Cardinal Fields of Vision (Pearson, Volume 3, p. 46) Have patient face examiner and hold an object in front of his nose at about 12 inches Ask the patient to follow an object with his eyes, not moving his head Move the object through the positions of gaze (refer to textbook) Eyes should move smoothly, remain parallel during movement, and return to midline between directions. The six cardinal fields of vision Pearson, 2019 Physical Assessment: Visual Acuity Snellen Eye Chart Measures distance vision Alphabet used for most adult patients “E” chart used for children, non-verbal, illiterate, or non- English reading patients with English as a second language  Physical Assessment: Visual Acuity Directions: 1. The patient stands 20 feet from the chart, covers one eye, and reads down progressively smaller lines until he can no longer read all the letters 2. In general, consider a line ‘read’ if the patient can correctly read at least half of the letters 3. Record the number at the end of the last line that the patient can read (it looks like a fraction) Physical Assessment: Visual Acuity, cont 4. The top number is the distance between the patient and the chart (it should always be 20). 5. The bottom number is the distance from which a person with normal vision could read the same line. 6. Example: 20/40 means that the patient has to stand 20 feet away to see what a “normal” person can see from 40 feet away. 7. The larger the bottom number, the poorer the vision. 8. Repeat with each eye, and with and without corrective lenses. Visual Acuity: Near Pocket Snellen or a Rosenbaum Chart Hold 14 inches away 14 is the top number The point at which the patient can read at least half the letters is the bottom number Normal is 14/14 with or without corrective lenses  The Ophthalmoscop e Instrument used to inspect the internal structures of the eye Not within the usual practice of generalist nurses Advanced practice nurses or nurses in a specialty area Examination of the Eye with an Opthalmoscope  Assessment of the Eye: Older Adult Expected Changes with Aging Decreased number of eyelashes Also become shorter and thinner *May lead to risk for eye injury Decreased tear production Dry, burning or itching eyes *Risk for eye irritation Decreased eyelid elasticity Ptosis: drooping of eyelids  Pupil Reduced pupil size/decreased Assessm diameter ent of React slower to light the Eye Decreased visual acuity Presbyopia: Diminished ability to Older see close objects or read small print Adult: Blurred vision Expected Decreased ability to accommodate Changes extreme changes in light (glare, darkness) with Aging Loss of lateral third of eyebrows Assessment of the Eye Older Adult: Expected Changes with Aging Lens Increased discoloration, stiffens Tends to yellow with age Develops opacities (cataracts) Leads to altered color perception Can lead to gradual loss of vision Assessment of the Eye Older Adult: Expected Changes with Aging Arcus Senilis Gray or white arc (ring) around the peripheral iris Due to lipid deposits Does not require treatment Eye Assessment Older Adult: Expected Changes with Aging Peripheral vision Decreased with aging Depth perception Decreased with aging Both may significantly increase the risk for falls, accidents and injuries Assessment of the Ear  Nursing History: Ear Ear pain or discomfort Discharge, itching, foreign body in ear? Tinnitus: ringing, buzzing, humming, crackling noises Describe any recent changes in hearing Sudden or gradual loss One or both ears Nursing History: Ear, cont. Use of hearing aids History of ear surgery or trauma Medications Some medications are ototoxic such as chemotherapeutic agents, some antibiotics  Prolonged Exposure to exposure to ototoxic high levels of medications noise Risk factors Repeated ear Trauma to the for Hearing infections ears Loss Age Degeneration of Illnesses inner ear structures occur over time Review of Anatomy: Ear  Nursing History: Ear Allergies Ear infections are common in patients with seasonal or environmental allergies Family history History of hearing loss: age? Loud noise or music Social Exposure to loud noises at work history Hobbies or recreation that involve loud noises Inspection of the Ear Auricles Inspect for color, symmetry of size, and position Color: same as facial skin color Note cyanosis of earlobes, redness Position: note the level of the top of ears in relation to eyes Top of ear should be slightly above level of eyes Low set ears may be External Ear Canal Inspect the external Right Auricle portion of the ear canal Cerumen (earwax) visible? Discharge or odor? Foreign body visible? Inflammation and/or swelling Palpate auricle and tragus for tenderness  Middle Ear Assessment Requires use of otoscope Lighted instrument inserted into external ear canal to visualize middle ear structures Used to inspect the tympanic membrane Used by advanced practitioners Middle Ear Assessment Tympanic membrane Should be pearly gray color; semitransparent Abnormal: pink to red, some opacity Hear4life.com Yellow-amber White Blue or deep red Dull surface Hearing Acuity Tests: Whispered voice Have patient occlude one ear with a finger Stand 1-2 feet away from the patient and whisper a 2-syllable word or short phrase on the side of the unoccluded ear Ask the patient to repeat the word or phrase Youtube.com Repeat with the other ear Note whether you need to stand closer or raise your voice for the patient to hear you  Assesses bone Tuning Fork conduction and air Tests conduction Bone conduction: sound is transmitted through bone directly to inner ear for perception, bypassing the outer part of the ear Air Conduction: sound waves travel through air to the outer ear and are funneled to the  Conductive hearing loss: transmission of vibrations is prevented in the outer or middle ear May be a mechanical blockage; Types of example: excessive earwax Hearing Sensorineural hearing loss: due to Loss: damage of the receptor cells or the cochlear nerve Does not matter if sound waves reach the eardrum since the nerves or mechanism for reception or processing is impaired Tuning Fork Test: Weber Test Differentiates conductive from sensorineural hearing loss Place base of vibrating tuning fork on the top of the patient’s head Ask patient whether he/she hears the sound equally in both ears or better in one than the other Results Conductive loss: The sound will be heard louder in the impaired ear Sensorineural loss: The sound will be softer on the impaired side  Tuning Fork Test: Rinne Test (Pearson, Volume 1, p. 1395) Compares air conduction and bone conduction Confirm that the patient can hear the sound made by the vibrating tuning fork Place the base of the vibrating tuning fork on the mastoid process (note time in seconds) When the patient states he/she can no longer hear the sound, quickly place the tuning fork close to the ear canal Ask the patient to indicate when the sound is no longer heard (count seconds) Repeat over other mastoid bone Normal : patient will hear the sound twice as long by air conduction as by bone conduction  Demonstrations of the Whisper, Weber, and Rinne tests can be Rinne Test viewed on the ‘Assessment of the Ear’ Video on Blackboard  Ear Assessment Older Adult: Expected Changes with Aging External Ear Change in shape of the external ear due to wrinkling and sagging of tissue and growth on non-articular cartilage Increased accumulation of cerumen in ear canal Increased hair growth Dryness of ear canal contributing to pruritis  Ear Assessment Older Adult: Expected Changes with Aging Middle ear Thickening of tympanic membrane Otosclerosis: calcification of ossicles (the three bones of the middle ear) Inner Ear Hearing loss Exposure to noise earlier in life exacerbates older adult hearing loss Presbycusis: Age-related loss of hearing, especially high-frequency sounds