Presentation on theme: "Eye and Ear Assessment by Sharon Kerr, MSN, RN Spring 2010."— Presentation transcript:
Eye and Ear Assessment by Sharon Kerr, MSN, RN Spring 2010
Normal Anatomy of the Eye
External Eye Exam Inspect for: Symmetry Discharge or lesions Eyelids: blink, position (ptosis), swelling Sclera: should be white (not red or yellow) Cornea: assess for opacity or scratch Conjunctiva: should be pink
External Eye Exam continued Pupil -- Check for response to: Light Accomodation PERRLA
External Eye Exam continued Extraocular Muscle Function Check eye movement through the six cardinal directions of gaze. Watch for parallel movement Nystagmus (involuntary rapid rhythmic movement)
Normal Anatomy of the Eye Cornea: clear layer covering the front of the eye. works with the lens to focus images on the retina.
Normal Anatomy of the Eye Retina internal layer receives and transmits focused images. normally red due to its rich blood supply.
Retina Can be seen with an ophthalmoscope Allows the examiner to see through the pupil and lens to the retina Called a f unduscopic exam
Retina Examination of fundus includes Retina Optic disc Blood vessels.
Funduscopic Exam Ophalmoscope Seated in a darkened room Examiner projects a beam of light from an ophthalmoscope through the pupil to view the back of the eyeball
Using the Ophalmoscope Turn on and adjust to round beam of white light Place scope light on dim setting Set lens disc to 0 diopters (neutral) Keep index finger on lens disc to adjust during examination
Approaching the patient Right hand and right eye to pt. Right eye Left hand and left eye to pt. Left eye Hold opthalmoscope firmly against your bony orbit Glasses off (both examiner and patient) Contacts are OK
The examination Have patient look over your shoulder and across the room at a specific point on the wall From about 15 inches and 15 degrees lateral to the patient’s line of vision, shine the light beam on the pupil
Getting a closer look Should see an orange glow (the red reflex – reflection of light off retina) Move in on the 15 degree line toward the pupil, almost touching the patient’s lashes
Finding the optic disk On NASAL side of each retina Yellowish orange to creamy pink oval or round Follow a blood vessel centrally until you see it
Inspecting the optic disk Clarity – should have sharp margins Symmetry of both eyes
Inspecting the retina Visualize arteries and veins Identify any lesions in retina Red spots, streaks, light spots
Normal Anatomy of the Ear external, middle, and inner structures. eardrum and the three tiny bones conduct sound from the eardrum to the cochlea: malleus, incus, stapes
External Ear Exam Symmetry, size, shape Position: pinna level with corner of eye Lesions Drainage
Examine Auditory Acuity Whisper two syllable word (out of view) Weber Test: lateralization of sound.. Rinne test: bone vs air conduction of sound
Normal Anatomy of the Ear The tympanic membrane, or eardrum separates the ear canal and the middle ear. ossicles : can see the short process of the malleous, handle of the malleous, and the incus There is a cone of light that is a reflection of the otoscope light
Otoscopic Examination An otoscope is an instrument used to look into the ear canal ear speculum a cone-shaped viewing piece of the otoscope) Use largest size possible
Otoscopic Examination Dim lights in room Patient in sitting position Pull ear up and back (down for kids) SLOWLY insert otoscope into ear canal while looking into viewer
Otoscopic Landmarks Tympanic membrane: should be intact, pearly gray, translucent, shiny Cone of light: right side 4/5 o’clock; left side 7/8 o’clock Malleus short process -- knob
Otoscopic Examination The speculum is angled slightly toward the person's nose to follow the canal. A light beam extends beyond the viewing tip of the speculum. The otoscope is gently moved to different angles to view the canal walls and eardrum.