D. In addition to the
C. A light beam shining onto one causes
45
SECTION I: LEARNING OBJECTIVES
Learning Objectives The student will:
1.
Identify the components of the eye and the function of each.
2.
Perform an accurate health history of the eye.
3.
Describe the physical examination techniques performed to evaluate the eye.
4.
Demonstrate how to use the ophthalmoscope.
5.
Determine the measures for prevention or early detection of eye disease, infections, or vision loss.
6.
Perform and document a complete eye assess- ment utilizing information from the health history and physical examination.
SECTION II: STUDY GUIDE
Activity A FILL IN THE BLANK 1.
Complete the following statements:
A.
A fi lm of pro-
tects the and
from drying, inhibits , and gives a
to the cornea.
B.
A is the entire
area seen by an eye when it looks at a .
C.
A light beam shining onto one
Copyright © 2012. Wolters Kluwer Health | Lippincott Williams & Wilkins. Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking.
Activity B MATCHING
4.
Match the papillary abnormality with its description.
Answer Description Pupillary Abnormality
Unequal pupils A. Tonic pupil
Does not cause anisocoria as long as the sympathetic and parasympathetic innervation to both irises is normal
B. Horner syndrome
Reaction to light is severely reduced and slowed, or even absent
C. Oculomotor nerve (CN III) paralysis Pupils that accommodate but do not
react to light
D. Anisocoria
The dilated pupil is fi xed to light and near effort. Ptosis of the upper eyelid and lateral deviation of the eye are almost always present
E. Equal pupils and one blind eye
The affected pupil, though small, reacts briskly to light and near effort.
Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead
F. Small, irregular pupils (Argyll Robertson pupils)
5.
Match the lump or swelling in and around the eye with its description.
Answer Lump or Swelling Description
Pinguecula A. A localized ocular redness from infl ammation of the episcleral vessels Hordeolum B. A swelling between the lower eyelid
and nose
Xanthelasma C. A subacute, nontender, and usually painless nodule involving a meibo- mian gland
Episcleritis D. A painful, tender red infection in a gland at the margin of the eyelid Chalazion E. Yellowish triangular nodule in the
bulbar conjunctiva on either side of the iris
Dacryocystitis F. Slightly raised, yellowish, well- circumscribed plaques that appear along the nasal portions of one or both eyelids
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CHAPTER 11 THE EYES 47
Copyright © 2012. Wolters Kluwer Health | Lippincott Williams & Wilkins. Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking.
Activity C SHORT ANSWER
6.
Explain the differences between a nuclear and a peripheral cataract.
7.
Compare and contrast conjunctivitis, sub- conjunctival hemorrhage, corneal injury or infection, acute iritis, and glaucoma.
8.
Explain the visual pathway.
9.
Discuss the process for testing vision.
Activity D NCLEX STYLE QUESTIONS 10.
What is a characteristic symptom of Graves
hyperthyroidism?
a.
Pterygium
b.Exophthalmos
c.Pinguecula
d.Episcleritis
11.
What is the purpose of the health history in relation to the eyes?
a.
To identify a family history of ocular disease
b.To identify if problems are unilateral or
bilateral
c.
To test the acuity of central vision
d.To identify changes
12.
A patient in the clinic where you work is con- sidered legally blind. You know that this means the vision in his better eye, corrected by glasses, is what?
a.
20/100 or less
b.20/200 or less
c.20/300 or less
d.20/400 or less
13.
The nurse is assessing visual fi elds on a patient newly admitted for eye surgery. The patient’s left eye repeatedly does not see your fi ngers until they have crossed the line of gaze. The nurse would document that the patient has what?
a.
A left temporal hemianopsia
b.A homonymous hemianopsia
c.A bitemporal hemianopsia
d.A quadrantic defect
14.
What are you testing when you ask the patient to follow your fi nger or pencil as you move it in toward the bridge of the nose?
a.
Accommodation
b.EOM
c.
Convergence
d.Visual fi elds
15.
What systemic diseases may cause nodular episcleritis? (Mark all that apply.)
a.
Systemic lupus erythematosus
b.Multiple sclerosis
c.
Fibromyalgia
d.
Muscular dystrophy
e.Rheumatoid arthritis
16.
When examining the eye with an ophthal- moscope, where would you look to visualize the optic disc?
a.
Medially toward the nose
b.Laterally toward the ear
c.Upward toward the forehead
d.Downward toward the chin
17.
You note anterior bulging of the physiologic cup when performing a funduscopic exami- nation of your patient’s eyes. What would you document?
a.
Positive axoplasmic sign
b.Arteriovenous crossings
c.Papilledema
d.
Hyperopia
18.
What are the glands that are located on the tarsal plates and open on the lid margins?
a.
Levator glands
b.Chalazion glands
c.Pterygium glands
d.Meibomian glands
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Copyright © 2012. Wolters Kluwer Health | Lippincott Williams & Wilkins. Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking.
19.
What is vital in maintaining vision and a healthy outlook for clients?
a.
Nursing education
b.Yearly eye exams
c.Emotional support
d.Nursing care
SECTION III: CASE STUDY
Activity E
Bud Thygeson, a 57-year-old cabinet maker, pres- ents at the clinic with a chief complaint of left eye pain. He states, “I got something in my eye at work.”
a.
Describe how you would examine
Mr. Thygeson’s upper palpebral conjunctiva for the presence of a foreign body.
b.
What would you include in a teaching plan for Mr. Thygeson?
SECTION IV: DOCUMENTATION
FORM FOR USE IN PRACTICE
EYE EXAMINATION
Patient Name Date/Time
Overview.
Identifying Data Source and Reliability
Common or Concerning Symptoms Eye History
Do you have any past history of eye problems or eye disease?
Do you have a history of:
Premature birth?
Trauma or injury to the eye?
Eye surgery? Related to injury, congenital causes, or cosmetic reasons?
Eye infections?
Strabismus?
Cataracts?
Glaucoma?
Diabetes?
Retinal detachment?
Macular degeneration?
Blindness?
When was your last eye examination? Test for color blindness?
Do you wear glasses or contact lenses?
When did you begin to wear them?
Are they corrective or cosmetic?
How do you care for your contacts?
Do you share contacts?
How long are the contacts in your eye? Day hours? Night hours?
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CHAPTER 11 THE EYES 49
Copyright © 2012. Wolters Kluwer Health | Lippincott Williams & Wilkins. Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking.
Family History
Do you have a family history of congenital eye diseases, cataracts, glaucoma, macular degeneration, or diabetes?
Lifestyle Habits Do you smoke?
Do you use contacts?
Do you use goggles or protective eyewear? When?
Are you on any medications/drugs that dry out the eye?
Physical Examination Vision tests Distal Near Peripheral Inspection of the eye Eyebrows Lids
Conjunctiva Sclera Cornea Lens Iris Pupils
Inspection and palpation of the lacrimal apparatus Extraocular movements
Assessment of cardinal fi elds Convergence
Corneal light test Cover–uncover test Inspection of the fundi Optic disc and cup Retina
Retinal vessels
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50
CHAPTER 12
SECTION I: LEARNING OBJECTIVES
Learning Objectives The student will:
1.
Identify the structures of the ear, nose, mouth, and throat and the purpose of each.
2.
Perform an accurate health history of the ear, nose, mouth, and throat.
3.
Describe the physical examination techniques performed to evaluate the ear, nose, mouth, and throat.
4.
Demonstrate how to use the otoscope.
5.
Determine the measures for prevention or early detection of ear, sinus, and throat infec- tions; hearing loss; change in balance; and maintenance of oral health.
6.
Perform and document a complete ear, nose, mouth, and throat assessment utilizing infor- mation from the health history and the physi- cal examination.
SECTION II: STUDY GUIDE
Activity A FILL IN THE BLANK 1.
Complete the following statements:
A.