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314 Test 3 - Eyes
Terms in this set (76)
What is the structure and function of the eye?
Structure - orbital socket
Function - sensory organ of sight
What are the extraocular structures and functions of the eye?
-Support and protect
What is the approximate diameter of the eye?
1 inch (2.5 cm)
What are the intraocular structures and functions of the eye?
-Three layers of tissue
What is the structure of vision?
When assessing the eyes, what are some lifespan considerations for pregnant women?
-Decreased conjunctival capillaries - dry eyes
-Cornea can thicken, contact lenses uncomfortable
-Corneal curvature increases and loss of accommodation
-Visual field changes due to pituitary gland affecting the optic nerve
When assessing the eyes, what are some lifespan considerations for newborns and infants?
-Least mature at birth compared to other senses
-Rapid development over the first 6 months
-Reaches adult level by 4-5 years
-Limited ability to focus, 3 months can follow objects
-Thought that visual acuity is sharpest at the distance from the infant to the mother's face
-Reflex tearing present at birth
-Emotional tearing by 3 months
When assessing the eyes, what are some lifespan considerations for children and teens?
-Visual acuity in toddlers is 20/20 to 20/40 - normal
-Depth perception develops throughout childhood
-Vison changes such as nearsightedness are common in adolescents
-If an adolescent has changes, but does not require correction, will eventually need some glasses
When assessing the eyes, what are some NORMAL lifespan considerations for older adults?
-Changes in eye structures and vision
- Eyelids droop - normal for both eye lids to droop,
- Eyes sit deeper in the orbits - loss of elasticity
- Eyebrows thinner/outer thirds absent
- Conjuctiva thinner and may appear yellowish from decreased perfusion
- Loss of vision, but treat it as if its abnormal
- Loss of accommodation
- Decreased night vision
- Vision less acute because lens enlarges and transparency decreases
When assessing the eyes, what are some ABNORMAL lifespan considerations for older adults?
- Vision loss (always assess vision loss as if it is abnormal)
- Decreased depth perception
- Tearing decreased and have dry eyes
- Drooping of one eye
When assessing the eyes, what are some cultural considerations?
-Eye color differs due to genetics
- Diameter of eye/eyelids and eyebrows can differ due to culture
When would you do an acute assessment of the eye?
- Sports and glasses - need kind of glasses that do not shatter
- Time delay can be threatening to eye function
Trauma that involves a penetrating injury
- leave it in and control bleeding until you get to surgery
What are the types of eye injuries?
Gradual vision loss
- not as critical
- surgery may be able to be delayed
What are the 3 types of Eye Assessments?
Emergent (immediate attention)
Urgent (within a few hours)
Non urgent (appointment as soon as possible)
When do you want to perform a rapid eye assessment, and what should you assess?
Hyphema (blood in eye)
You should asses:
- Testing Extraocular movements
- Examining the optic disc
Protrusion of the eyeball anteriorly out of the socket.
When assessing the risk factors for the eye, what subjective data should you collect?
- Eye conditions
- Eye surgery
Medications - ALL med because a lot of meds can cause anemia
- Some meds may cause eye problems because of side effects
- Exposure to viruses
- Environmental exposure
- Eye health
- Corrective prescriptions
- Eye protection
- Nutritional status
What should you teach a patient with DM about the risk for eye problems?
that they are at an increased risk of eye problems, i.e. diabetic retinopathy, cataracts, and glaucoma
What should you teach a patient with eye problems about sunlight exposure?
use of sun glasses
What should you teach a patient with eye problems about the importance of hydration?
the lens has no blood supply, lens must be moist
What should you teach a patient with eye problems about having a poor diet?
poor diet is linked to eye problems
What food should you promote to patients that have poor eye health?
Deep water fish
What are some common symptoms resulting from eye problems?
Trauma or surgery
Blind spots, floaters, or halos
Change in activités of daily living (ADLs)
When focused on health history related to common symptoms, how would you document normal findings?
Denies pain, trauma, visual changes, blind spots, floaters, halos, discharge. No changes in ability to perform ADLs.
When collecting objective data, what equipment should you have on hand to conduct an eye exam?
Cotton wisps and cotton-tipped applications
Snellen chart for far-vision testing
Jaeger chart for near-visoin testing
Occlusive covers for individual eye testing
Ishihara plates (optional for testing color vision)
What is the correct preparation when conducting a eye exam for objective data?
Wash hands, hand gel should be dry before touching eye
Avoid cross contamination by wearing gloves
Examine the infect eye last
May have to dilate pupil
What is visual acuity?
How do you assess visual acuity and how far should the pt. stand from the test?
What is normal findings?
Snellen's (20ft) and Allen's Chart (15ft)
Have them wear glasses or keep contacts in
Document in 2 numbers
Normal = 20/20 bilateral
What does the top number represent for the visual acuity test?
Top number is distance in feet pt was from the test
What does the bottom number represent for the visual acuity test?
And how should you document if the pt missed some letters?
On bottom, mark the number under the smallest line of letters the pt, correctly identified
Also document the number of letters missed and is the pt wears correction.
20/30 - 2 with contacts on
What does the score of the visual acuity tests mean?
The larger the number on the bottom (20/ 60) indicates diminished distance vision
The larger the bottom number, the worse visual acuity
20/20 means - someone can read at 20 ft what the normal eye can read at 20 ft.
Should be bilateral
What is the medical term for near sightedness and how is it defined?
Close objects are seen clearly, but objects farther away appear blurred
What is the medical term for far sightedness and how is it defined?
Far objects are seen clearly, difficulty focusing on near objects
What is Astigmatism?
Vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or sometimes the curvature of the lens inside the eye
How does an irregular shaped cornea or lens cause astigmatism?
It prevents light from focusing properly on the retina, the light sensitive surface at the back of the eye. As a result, vision becomes blurred at any distance.
Who is at risk for near vision?
What testing chart should you use to assess?
How should the test be done?
What is a normal result?
-For pt. over 50 years who report difficulty reading
-Use the Jaeger chart
-Hold 14 inches and read smallest line
Normal is 14/14 bilaterally
How do you assess color blindness?
Get the patient to identify color bars on the Snellen chart or Ishihara cards
When collecting objective data, how would you assess the patients visual field?
Ask the patient to fixate on a stationary object and ask what in the environment is visible.
What are the two test that the nurse conducts to assess the visual field of the patient?
What are the steps done in order to conduct a static confrontation test?
Face pt. 2 - 3 arm's length
Must be at eye level with each other
They cover the same eye you cover (their left, your right)
Present one to four fingers midway between you and the pt. in 4 quadrants
They focus on your open eye at all times
Pt. reports number of fingers correctly
What are the steps done in order to conduct a kinetic confrontation test?
Same manner to test as the static confrontation
Instruct pt. to say "now" when they see your fingers come into view
Wiggle from a far distal point and move them toward the center of each quadrant
Normal is immediate visible, except in the interotemporal quadrant and pt. sees the fingers at about the same time as the nurse
How do you document normal findings for visual acuity?
Visual Acuity 20/20. Accurately reads newsprint. Identifies door bars on Snellen chart correctly. Pt. Sees fingers at about 50 degrees superior, 90 degrees temporal,90 degrees inferior, and 60 degrees nasal.
What 3 test are assessing the movement of the extraocular muscles?
Corneal light reflex (Hirschberg)
Cardinal field of gaze
What does Corneal light reflex test?
test for Strabismus - lack of coordination between the extraocular muscles, cross eyed
What does the Cover test assess?
test for the presence and amount of ocular deviation
What does the cardinal field of gaze test?
detects muscle defects that cause misalignment or uncoordinated eye movement
How do you document normal findings of extraocular muscles?
Alignment symmetrical/corneal light reflex. Gaze fixed and steady. Extraocular movements intact (EOMI)
What is Nystagmus?
involuntary rhythmic wobbling of the eyes
What is Estropia?
What is Exotopia?
one eye pointing upward or downward
What is the technique when assessing the external eyes?
Secure good lighting
Wash hands before touching touching patients eye.
Put on gloves
- lacrimal apparatus
- Bulbar conjunctiva
- Eversion of the eyelid
What is the normal finding of eyebrows?
show no unexplained hair loss
What is the normal finding of eye lashes?
curved outward away from the eyes and are distributed evenly along the lid margins
What is the normal findings of eyelids?
open and close completely, with spontaneous blinking every few seconds
What is the normal finding of eye shape?
is round to almond but symmetrical
What is the normal findings of the eyes?
are in parallel alignment
What is the normal findings of the lacrimal apparatus?
is not enlarged or tender
What is the normal findings of the Bulbar conjunctiva?
is transparent with small blood vessels visible
What is the normal finding of the Sclera?
clear, smooth, white, and without exudate, lesions or foreign bodies
How would you document the normal findings after assessing the external eyes?
Eyebrows full and appropriate to age. Eyelashes evenly distributed. Blinking every 2-3 seconds. Eyes round, symmetrical, and in parallel alignment. Lacrimal apparatus not enlarged or tender. Conjunctiva with small vessels visible. Sclera clear and white. Lens is transparent. Iris is brown, smooth, and without vascularity. PERRLA.
What do you assess when assessing the exterior ocular structures?
Cornea and lens
Check for constriction
What are the normal findings for the lens?
Lens is transparent
What are the normal findings for the Iris?
color is evenly distributed, smooth and without apparent vascularity
What are the normal findings for the pupils?
black, round and equal with a diameter of 2 - 6 mm
What is the normal finding for pupil constriction?
Brisk constriction to light
Consensual means the other eye also constricted
What is the normal finding for accommodation?
Pupils constrit (accommodate) and eyes cross (converge)
Necessary for far-to-near focus
When assessing the internal ocular structures, what equipment do you need and what are you assessing?
Ophthalmoscope and pen light
Mydriatic drop (dilate)
Examination of the fundus
Inspect the optic disc
What is the lens selector wheel called on the ophthalmoscope?
aperture (black part)
What is the purpose of the aperture?
Allows for adjustment of refraction to bring the internal ocular structures into sharp focus. It compensates for refractive errors of the examiner.
What is the purpose of a slit aperture?
it is for examining the anterior portion of the eye
What is the grid feature used for on the ophthalmoscope?
used to locate and describe fundal-level lesions
What is the green beam (red-free filter) used for?
retinal hemorrhaging (appears black with this filter) or melanin spots (appears gray)
During an eye exam, what does the lack of a red reflex indicate?
may need urgent follow-up
What should you do when you see a red reflex?
Move the lens selector from 0 to the + black numbers to focus on the anterior ocular structures.
Move from the + black numbers to the red numbers to focus on the posterior structures
What is the purpose of Mydriatic drops?
dilate the pupil
you should darken the room and use caution when going directly out in the sun or driving
What is a possible side effect of mydriatic drops?
these drugs may precipitate acute angle closure glaucoma = emergency
After examining the eye with the ophthalmoscope, what are the normal findings?
Red reflex is present
Optic disc is creamy yellow/orange to pink; round to oval
Cup-to-disc ratio genetically determined and normally equal in both eyes
Blood vessels observed - arteries brighter and red than veins
Macula - light sensitive; darker area, can vary with ethnicity (larger and darker in African Americans)
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