weber health assessment in nursing

Chapter 15: Eyes

WeberHealth Assessment in Nursing

External Structure of the Eye•Eyelids•Lateral and medial canthus•Eyelashes, conjunctiva•Lacrimal apparatus•Extraocular muscles

Structure of Eye

Internal Structure of the Eye

•Sclera, cornea, iris, ciliary body, •Pupil, lens, choroid, retina, optic disc•Physiological cup, retinal vessels•Anterior chamber, posterior chamber

Question

Tell whether the following statement is True or False.The lens flattens to focus on close objects and bulges to focus on far objects.

Answer

False.The lens bulges to focus on close objects and flattens to focus on far objects. This is possible due to the refractive ability of the lens.

Vision•Visual fields•Visual pathways•Visual reflexes

– Pupillary light reflex– Accommodation

Collecting Subjective Data

•History of present health concern•Past health history•Family history•Lifestyle and health practices

Cataract

•Opacity or clouding of the eye’s lens•Leading cause of blindness worldwide

Risk Factors•Increasing age •Exposure to ultraviolet B light•Diabetes mellitus•Cigarette smoking•Alcohol use•Diet low in antioxidant vitamins

Risk Factors (cont.)• High blood pressure• Eye injuries/surgery• Steroid use• Female gender• Persistent diarrhea• Gout • Abdominal obesity• Beta blocker use

Risk Reduction

•Wear sunglasses•Quit smoking•Limit alcohol intake•Avoid eye injuries•Regular eye examination

Question

Tell whether the following statement is True or False.Exposure to ultraviolet radiation increases the risk for development of cataracts.

Answer

True.Exposure to ultraviolet radiation increases the risk for development of cataracts.

Collecting Objective Data•Preparing the client•Equipment

– Snellen or E chart– Hand-held Snellen card or near vision

screener– Penlight– Opaque cards– Ophthalmoscope

Distant Visual Acuity

•Snellen chart•Normal acuity is 20/20 with or without

corrective lenses

Near Visual Acuity

•Handheld vision chart•Normal acuity is 14/14 with or without

corrective lenses

Question

Tell whether the following statement is True or False.When testing near visual acuity the client should be asked to remove his or her glasses.

Answer

False.When testing near visual acuity the client should keep his or her glasses on.

Confrontation Test

Testing Extraocular Muscle Function•Corneal light reflex test: use penlight to

observe parallel alignment of light refection on corneas

•Cover test: use opaque card to cover an eye to observe for eye movement

•Positions test: observe for eye movement

Testing Extraocular Muscle Function

Extraocular Muscle Dysfunction•Corneal light reflex test abnormalities

– Pseudostrabismus, strabismus•Test abnormalities

– Phobia•Positions test abnormalities

– Paralytic strabismus, 6th, 4th, 3rd nerve paralysis

External Eye Structures•Inspect the eyelids and eyelashes•Observe the position and alignment of

the eyeball in the eye socket•Inspect the bulbar conjunctiva and

sclera•Inspect the palpebral conjunctiva•Inspect the lacrimal apparatus

External Eye Structures (Cont’d)

•Palpate the lacrimal apparatus•Inspect the cornea and lens•Inspect the iris and pupil•Test pupillary reaction to light•Test accommodation of pupils

Abnormalities of External Eye

•Ptosis, exophthalmos•Entropion, chalazion•Blepharitis, ectropion•Conjunctivitis•Hordeolum, diffuse episcleritis

Pupillary Reaction to Light

• Darkened room• Have client focus on a distant object• Shine light obliquely into the pupil and

observe the pupil’s reaction to light• Normally, pupils constrict

Accommodation

•Shifting gaze from far to near•Normally, pupils constrict

Ophthalmoscope

Internal Eye Structures

•Inspect the optic disc•Inspect the retinal vessels•Inspect retinal background•Inspect fovea and macula•Inspect anterior chamber

Visual Field Defects

•Unilateral blindness•Bitemporal hemianopia •Lesion in optic nerve•Lesion of optic chiasm•Left superior quadrant anopia •Right visual field loss

Abnormalities of Cornea and Lens

•Corneal abnormalities– Corneal scar, pterygium

•Lens abnormalities– Nucleus cataract, peripheral

cataract

Abnormalities of Iris and Pupil

•Irregularly shaped iris•Miosis•Anisocoria•Mydriasis

Abnormalities of Retinal Vessels and Background•Constricted arteriole•Copper wire arteriole•Silver wire arteriole•Arteriovenous nicking•Arteriovenous tapering•Arteriovenous banking

Abnormalities of Retinal Vessels and Background (Cont’d)•Cotton wool patches•Hard exudate•Superficial retinal hemorrhages•Deep retinal hemorrhages•Microaneurysms

Abnormalities of Optic Disc

•Papilledema•Glacoma•Optic atrophy

Question

Tell whether the following statement is True or False. In 3rd nerve paralysis, the eyes cannot look down when turned inward.

Answer

False.In 3rd nerve paralysis, the eye looks straight ahead. If the eyes cannot look down when turned inward it indicates 4th nerve paralysis.

weber health assessment in nursing

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