TERNOPIL STATE MEDICAL UNIVERSITY

INSTITUTE OF NURSING

AMERICAN NURSING SCHOOL

BACHELOR DEGREE NURSING PROGRAM

HEALTH ASSESSMENT PRACTICUM

SYLLABUS: FALL 2008

Methodical Instruction

for

Practicum #4 (7 hours)

Theme: Health assessment of the eyes.

Instructor: Dr. Inna Korda, MD, PhD.

Room No.: Nursing 16.

STUDENT OBJECTIVES:

1. Identify health history questions for assessment of the eyes.

2. Demonstrate health assessment of the eyes.

3. Differentiate between normal and abnormal assessment findings of the eye.

4. Identify health promotion needs of clients based on findings of eye assessment.

#	Practicum Outline	Assignments
2.	Eyes and Ears 1. Internal and external anatomy 2. Subjective data 3. Assessing vision and hearing 4. Assessing extraocular muscle function 5. Abnormal findings	Readings: Jarvis, Ch 14 and 15, pp. 298-404 Study Guide: Chapters 14, 15

Assessment of the Eye

I. Health History

A. Current Health Status

1. Problems

2. Corrective lenses

B. Past Health Status

1. Lens change

2. Blurred vision

3. Spots, floaters, halos

4. Infections or inflammations of the eyes

5. Eye surgery or injury

6. Styes (hordeolums)

7. High blood pressure

8. Diabetes

9. Eye medications

C. Family health status

II. Examination of the Eye

A. Vision

1. Distance vision

a. Snellen chart

SNELLEN CHART

1. Keep area well lit.

2. Client stands 20 feet from chart.

3. Test one eye at a time and then both eyes.

4. Read smallest line of print possible.

5. Record visual acuity as a fraction (20/20).

Alterations on visual acuity:

- Emmetropia
- Hyperopia
- Myopia
- Presbyopia

Near vision

Color vision

B. Extraoccular Muscle Function

1. Position and alignment

2. Six cardinal positions of gaze

- Failure of lid closure
- Failure of lid opening (ptosis)
- Nystagmus

3. Cover/uncover test

4. Corneal light reflex test

C. Peripheral Vision

1. Visual Fields

The visual field is the entire area seen by an eye when its gaze is fixed on a central point.

Visual fields are limited by the eyebrows, the cheeks, and by the nose.

To test visual fields by confrontation you need to face the subject directly at about 2 feet away with eyes at the same level. Test one eye at a time. Slowly bring a pencil in from the periphery into the field of vision. Do this in eight different directions.

D. Inspection

2. Position and alignment of the eyes

a. Abnormalities - Exophthalmos
- Lid lag

3. Eyebrows

a. Abnormalities
- Seborrheic dermatitis
- Loss of lateral 1/3 of eyebrows

4. Eyelids

§ a. Inspect for
- Edema
- Color
- Lesions
- Lashes (condition and direction)
- Adequacy of closure

§ b. Abnormalities
- Blepharitis (inflammation of the eye lids)
- Ectropion (margin of lid turned outward)
- Entropion (inward turning of lid margin)
- Periorbital edema (seen in inflammation, myxedema, nephrotic syndrome
- Herniated fat (involves lower lids)
- Ptosis (drooping of upper lid)
- Sty (hordeolum; infection around hair follicle)
- Chalazion (chronic inflammatory lesion of Meibomian gland)
- Xanthelasma (raised yellowish plaques that appear on nasal portion of eyelids
- Failure of lid closure
- Epicanthal fold

5. Lacrimal apparatus

§ a. Observe for

- Swelling
- Tearing (may occur from conjunctival inflammation, corneal irritation, inadequate drainage [ectropion], or naso-lacrimal duct obstruction
- Dryness of the eyes

§ b. Abnormalities

- Dacryocystitis (inflammation of the lacrimal sac)

6. Conjunctiva

a. Inspect lower lids
b. Inspect upper palpebral conjunctiva
c. Subconjunctival hemorrhage
d. Chemosis (edema)
e. Pinguecula
f. Pterygium
g. Conjunctivitis

7. Sclera

8. Cornea

a. Corneal reflex
b. Inspect with light

9. Iris

a. Shape

10. Pupils

a. Size

- anisocoria

b. Shape
c. Reaction to light

- Direct reaction
- Consensual reaction

E. Palpation

1. Palpate eyelids for swelling and tenderness

2. Palpate eyeball

3. Palpate lacrimal sac

F. Ophthalmoscopic examination

1. Increase light intensity by turning rheostat clockwise

2. Apertures

a. Large round beam
b. Small round beam
c. Slit-like beam
d. Green (red-free)
e. Grid

3. Lens +40 to -20

a. Positive diopters (black)
b. Negative diopters (red)

4. Ophthalmoscope exam

a. Red reflex
b. Optic fundus
c. Optic disk

- Size
- Shape
- Color
- Margins
- Cup

d. Blood vessels

	Arterioles	Veins
color	light red	dark purple
size	small	large
light reflex	bright	absent
pulsations	none	present

e. Macula
f. Periphery
g. Vitreous/lens
h. Abnormalities

- Papilledema
- Optic atrophy
- Glaucoma
- Hypertension
- Diabetic retinopathy
- Macular degeneration
- Superficial retinal hemorrhage
- Deep retinal hemorrhage
- Microaneurysms
- Neovascularization
- Cotton wool patches
- Hard exudates

Practical Activities

Demonstrate health assessment of the eyes

Required Equipment:

 Penlight

 Cotton tipped applicator

Prepared by Korda I. 27/08/08

Approved by Department of General Patient Care. Minute #________ from ____________2008

Head of the Department - Hospodarskyy I., MD, Ph.D, Doctor of Medicine