Weber Health Assessment in Nursing

1. WeberHealth Assessment in Nursing Chapter 15: Eyes

2. External Structure of the Eye • Eyelids • Lateral and medial canthus • Eyelashes, conjunctiva • Lacrimal apparatus • Extraocular muscles

3. Structure of Eye

4. Internal Structure of the Eye • Sclera, cornea, iris, ciliary body, • Pupil, lens, choroid, retina, optic disc • Physiological cup, retinal vessels • Anterior chamber, posterior chamber

5. 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.

6. 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.

7. Vision • Visual fields • Visual pathways • Visual reflexes • Pupillary light reflex • Accommodation

8. Collecting Subjective Data • History of present health concern • Past health history • Family history • Lifestyle and health practices

9. Cataract • Opacity or clouding of the eye’s lens • Leading cause of blindness worldwide

10. Risk Factors • Increasing age • Exposure to ultraviolet B light • Diabetes mellitus • Cigarette smoking • Alcohol use • Diet low in antioxidant vitamins

11. Risk Factors (cont.) • High blood pressure • Eye injuries/surgery • Steroid use • Female gender • Persistent diarrhea • Gout • Abdominal obesity • Beta blocker use

12. Risk Reduction • Wear sunglasses • Quit smoking • Limit alcohol intake • Avoid eye injuries • Regular eye examination

13. Question Tell whether the following statement is True or False. Exposure to ultraviolet radiation increases the risk for development of cataracts.

14. Answer True. Exposure to ultraviolet radiation increases the risk for development of cataracts.

15. Collecting Objective Data • Preparing the client • Equipment • Snellen or E chart • Hand-held Snellen card or near vision screener • Penlight • Opaque cards • Ophthalmoscope

16. Distant Visual Acuity • Snellen chart • Normal acuity is 20/20 with or without corrective lenses

17. Near Visual Acuity • Handheld vision chart • Normal acuity is 14/14 with or without corrective lenses

18. 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.

19. Answer False. When testing near visual acuity the client should keep his or her glasses on.

20. Confrontation Test

21. 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

22. Testing Extraocular Muscle Function

23. Extraocular Muscle Dysfunction • Corneal light reflex test abnormalities • Pseudostrabismus, strabismus • Test abnormalities • Phobia • Positions test abnormalities • Paralytic strabismus, 6th, 4th, 3rd nerve paralysis

24. 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

25. 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

26. Abnormalities of External Eye • Ptosis, exophthalmos • Entropion, chalazion • Blepharitis, ectropion • Conjunctivitis • Hordeolum, diffuse episcleritis

27. 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

28. Accommodation • Shifting gaze from far to near • Normally, pupils constrict

29. Ophthalmoscope

30. Internal Eye Structures • Inspect the optic disc • Inspect the retinal vessels • Inspect retinal background • Inspect fovea and macula • Inspect anterior chamber

31. Visual Field Defects • Unilateral blindness • Bitemporal hemianopia • Lesion in optic nerve • Lesion of optic chiasm • Left superior quadrant anopia • Right visual field loss

32. Abnormalities of Cornea and Lens • Corneal abnormalities • Corneal scar, pterygium • Lens abnormalities • Nucleus cataract, peripheral cataract

33. Abnormalities of Iris and Pupil • Irregularly shaped iris • Miosis • Anisocoria • Mydriasis

34. Abnormalities of Retinal Vessels and Background • Constricted arteriole • Copper wire arteriole • Silver wire arteriole • Arteriovenous nicking • Arteriovenous tapering • Arteriovenous banking

35. Abnormalities of Retinal Vessels and Background (Cont’d) • Cotton wool patches • Hard exudate • Superficial retinal hemorrhages • Deep retinal hemorrhages • Microaneurysms

36. Abnormalities of Optic Disc • Papilledema • Glacoma • Optic atrophy

37. Question Tell whether the following statement is True or False. In 3rd nerve paralysis, the eyes cannot look down when turned inward.

38. 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.