Christopher R. Bañez, RN, RM, US – RN, MSNc

Concept of

Perception

Assessment of

Vision &Diagnostic Procedure

s

Measures distance and near vision

Maintain 20 feet distance

Snellen’s Chart

Examines the visual fields or peripheral vision

Instructions: Facing each other (examiner and the

patient) Examiner- cover his/her right eye Patient- covers his/her left eye The test assumes that the examiner

has a normal peripheral vision

Confrontational

Test

Six cardinal positions of gaze. Client holds head still and is

asked to move eyes and to follow a small object.

Extraocular Muscle Function

Ishihara Polychromatic plate: Consists of numbers

that are composed of colored dots.

Client is asked to read using each eye.

Assesses red or green blindness

Color Vision

Normal pupil: P-upil E-qual R-ound R-eactive L-ight reacting A-ccommodation

Pupil

Sclera Normal color is dull white Yellow sclera indicates a problemCornea Normal cornea is transparent,

smooth, shiny, and bright Cloudy areas or specks indicates

an eye accident or injury

Sclera and

Cornea

Hand held device Darken the roomThe examiner: Uses right hand and right eye to

examine the right eye of the patient

Uses left hand and left eye to examine the left eye of the patient

Ophthalmoscop

y

Ophthalmoscop

y

Series of photographs after the administration of a dye.

MEM RY CANDY Assess for allergy. Administer mydriatic 1 hour before the test. Prepare IM antihistamines. Encourage fluid intake after the procedure. Expect photophobia.

Fluorescein

Angiography

A cross sectional image is formed by the use of a computer

The patient will be positioned in a confined space

Computed Tomograp

hy

The client lean on a chin rest to stabilize the head

Advise the client about the brightness of the light

Slit Lamp

Topical dye is instilled into the conjunctival sac

The eye is viewed through a blue filter

Instruct the client to blink the eye after the dye has been applied

Bright green color- indicates non-intact corneal epithelium

Corneal Staining

Measures IOPNon-Contact tonometry Use of air puff to flatten the corneaContact tonometry Use of anesthesia Instruct the patient not to rub the eye

after the procedure

Tonometry

Tonometry

Disorders of

the Eye

20/200 visual acuity.

MEM RY CANDY

Alert the patient Allow the client to touch the environment Clock placement of food Dependence of the patient avoided Dominant hand – cane is placed Environmental safety is priority

Legally Blind

Conjunctivitis

Complete or Partial Opacity of the lens

Causes: Congenital Ageing Nutritional deficiency Trauma Secondary

Cataract

Common Clinical Manifestations: Absence of red reflex Blurring of vision Color blindness Decrease visual acuity

Painless Opaque/milky white

Cataract

Cataract

MEM RY CANDYC

ATARACTS

are to prevent increased IOPpply eye patchesurn patient on back/unoperative sidedminister mydriaticsaise side railsssist with ambulationyclopegicsimingafety is priority!

Increase IOP due to OVERPRODUCTION of Aqueous Humor

or OBSTRUCTION in the flow of Aqueous Humor

Glaucoma

Risk factors: Familial tendency Age Myopia Secondary diseases

Glaucoma

Common Clinical Manifestations: Loss of peripheral vision Elevated IOP Halos around white lights Frontal Headache Tunnel vision

Glaucoma

Lifelong medication use: Beta blockers Anhydrase inhibitors Hyperosmotics Miotics

Avoid: Anticholinergics Benadryl Cogentin

Pharmacotherapy first followed by surgical approach

Prevent increase in IOP

MEM RY CANDY

Tear and separation of retinal layer due to vitreous pull.

Causes: Tractional Exudative Rhegmatogenous

Retinal Detachme

nt

Common Clinical Manifestations:

Retinal Detachme

ntFV

lashes of lightloatersalling curtaineil–like

image

MEM RY CANDY

BEDS

ed rest

ye patches on OU

iscourage jerky head movements

cleral buckling

Retinal Detachme

nt

A deterioration of the macula, the area of central vision, commonly caused by:

Ageing

Common Clinical Manifestations:

Blurring of vision

Central vision affected

Macular Degenerat

ion

Macular Degenerat

ion

Maximize remaining vision toMaintain independence

Ear Assessme

nt and Diagnostic Procedure

s

MEM RY CANDY Pen hold position Pink – normal color of the external canal Pearly gray and slightly concave – normal

Tympanic membrane Pull the pinna:

A CD HUp and back IL LT Down and

back

Otoscopic Examinati

on

Weber’s test Place the vibrating fork stem in the:

Middle of the client’s forehead. Midline of the forehead. Upper lip over the teeth .

Normal: tone is heard equally in OU. CHL: tone is heard in the affected ear. SHL: tone is heard in the unaffected

ear.

Tuning Fork Test

Rinne’s test Compares:

Air conduction: place the vibrating tuning fork 2 inches away from opening of the ear.

Bone conduction: place the vibrating tuning fork against the mastoid bone.

Normal: air conduction is better than bone conduction – positive Rinne’s test.

CHL: tone is louder behind the ear – negative Rinne’s test.

SHL: the test is of no value in determining SHL

Tuning Fork Test

Romberg’s Sign

MEM RY CANDY Stand with feet together.

Arms hanging loosely at the side.

Close eyes.

Mild swaying is normal.

Obvious swaying is a positive Romberg’s sign.

Test for Falling

Disorders of the

Ear

Infective inflammatory or allergic response involving the auricle

Swimmer’s ear Common Clinical Manifestations:

Pain

Itching

Plugged feeling in the ear

Exudate, edema

Redness

External Otitis

MEM RY CANDYA

SAKA

NALGESIC

TEROID

NTIBIOTICeep it dry, no to cotton tipped applicator

lways use earplugs when swimming

Infective, inflammatory or allergic response involving the structure of the middle ear as a result of blocked Eustachian tube.

Risk factors: Upper RTI. Common in infant and children.

Otitis Media

Common Clinical Manifestations:

Fever and loss of appetite.

Irritability, rolling of head from side to side.

Red, bulging tympanic membrane.

Earache, ear drainage.

Otitis Media

Medical and Nursing Management: Analgesic and Antibiotic. Local heat application affected ear down. Upright position when feeding. Fluid intake increased.Myringotomy – equalizes pressure and maintains aeration. Keep the ears dry. Earplugs during swimming, shampooing and

bathing. No to diving and submerging under water.

Otitis Media

Due to untreated or inadequately treated acute or chronic otitis media.

Common Clinical Manifestations:

Swelling behind the ear

Unrelieved by myringotomy

Low grade fever

A reddened, dull, thick, immobile tympanic membrane with or without perforation

Tender or enlarged post auricular lymph nodes

Mastoiditis

MEM RY CANDY

MIDO

astoidectomy with tympanoplasty

njury due to dizziness – watch out

ressing change 24 hours post opperative side up

Bony overgrowth of the tissue surrounding the ossicles.

This results to stapes fixation leading to Conductive Hearing Loss.

Causes: Unknown. Familial tendency. Common Clinical Manifestations: Schwartze’s sign. Weber’s test to the affected ear. Aringing or roaring type of tinnitus. Negative Rinne’s test.

Otosclerosis

MEM RY CANDY

FAPAS

enestration

void excessive nose blowing and the use of cotton tipped applicatorrevent middle or external ear infectionssist with ambulation

afety is priority!

Also called ENDOLYMPHATIC HYDROPSCauses: Bacterial. Allergy. Viral. Any factor that increases endolymphatic

secretion.

Miniere’s

Disease

Classic triad of symptoms: VERTIGO TINNITUS SENSORINEURAL HEARING LOSS

Severe headache

Nausea and vomiting

Nystagmus

Miniere’s

Disease

SAFETY – priority DIET – low sodium PHARMACOTHERAPY – 3 As: Antihistamine, Antivertigo,

Antiemetics plus niacin. SURGERY – vestibular nerve

resection.

Miniere’s

Disease