1. Assessment of the Eye and Vision
Chapter 48
Assessment of the Eye and Vision

2. Anatomy and Physiology Review
Anatomic features of the eye.

3. Eye
Left: Flow of aqueous humor. Right: The extraocular muscles.

4. Refraction
Emmetropia
Hyperopia
Myopia
Astigmatism

5. Pupillary Constriction
Miosis
Mydriasis
Accommodation
Miosis and mydriasis.

6. Assessment Patient history Nutrition history
Family history and genetic risk
Current health problems

7. Assessment (cont’d) Near vision Visual field
Extraocular muscle function
Color vision

8. Snellen Chart

9. Age-Related Structural Changes
Decreased eye muscle tone
Ectropion and dry eye
Arcus senilis
Corneal changes
Changes in color of sclera
Less ability to dilate pupil
More light needed for reading

10. Arcus Senilis

11. Cataract

12. Age-Related Functional Changes
Yellowing of lens
Accommodation gradually lost
Presbyopia
Far point decreases
Color perception decreases
IOP increases

13. Diagnostic Tests Imaging assessment Slit-lamp examination
Corneal staining
Tonometry

14. Diagnostic Tests (cont’d)
The Tono-Pen.

15. IOP Estimation
Use of Goldman’s applanation tonometer and a slit lamp to measure IOP.

16. Ophthalmoscopy
Proper technique for direct ophthalmoscopic visualization of the retina.

17. Other Diagnostic Tests
Fluorescein angiography
Electroretinography

18. Audience Response System Questions
Chapter 48
Audience Response System Questions 18

19. Question 1
Which circumstance places the patient at the greatest risk for developing vision disturbances?
History of working with computer
Advanced age
History of diabetes mellitus
Retired construction worker
Answer: C
Rationale: Certain systemic diseases greatly increase the risk for developing visual problems. Diabetes mellitus and hypertension can have serious adverse effects on vision. Working with a computer can cause eye strain. Working outside can result in too much exposure to ultraviolet rays if proper eye protection is not worn. Advanced age also influences vision, but environmental factors and diseases impact vision changes associated with advanced age.

20. Question 2
Which is a priority nursing intervention when providing care to an older patient who has problems with vision?
Review the medication administration record for artificial tears
Review medications before administration
Ensure adequate, nonglare lighting in the patient’s room
Provide written and verbal instruction for nursing education interventions
Answer: C
Rationale: Several changes in the eye that occur with aging alter vision, increasing the risk for tripping or falling. Good lighting is necessary for the best vision. Color discrimination can be difficult for older patients, so medication education should include names and indications of medications, but use caution when instructing on color. Verbal and written education provide reinforcement for new information. With aging, the eye dries and artificial tears or normal saline drops can help relieve eye irritation.

21. Question 3
In performing a psychosocial assessment of a patient who has recently experienced vision changes, the nurse should:
Provide the patient with a list of services for the visually impaired.
Meet with family members or significant others to determine whether the patient can still perform ADLs.
Provide opportunities for the patient and family to express their concerns about a possible change in vision status.
Ask the patient if he or she has made appropriate adjustments in lifestyle to accommodate the vision changes.
Answer: C
Rationale: A patient who has experienced changes in visual perception may be anxious or fearful about a possible loss of vision. Visual impairment services are probably not necessary at this early stage. The patient’s ability to perform ADLs should be assessed first, with information elicited directly from the patient (not family members).