weber health assessment in nursing

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Jerry Ralya

Slide 8 is not referred to in the GLN for CHapter 15, and I don't see a place there to put a reference.


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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