Now that we have reviewed the anatomy of the eyes and ears and their common disorders, let’s discuss common eye and ear assessments performed by nurses. Show
Subjective AssessmentNurses collect subjective information from the patient and/or family caregivers using detailed questions and pay close attention to what the patient is reporting to guide the physical exam. Focused interview questions include inquiring about current symptoms, as well as any history of eye and ear conditions. See Table 8.3a for suggested interview questions related to the eyes and ears. Table 8.3a Suggested Interview Questions for Subjective Assessment of the Eyes and Ears Interview Questions EyeHave you had any difficulty seeing or experienced blurred vision? Do you wear glasses or contact lenses? When was your last vision test? Have you had any redness, swelling, watering, or discharge from the eyes? Have you ever been diagnosed with an eye condition such as cataracts, glaucoma, or macular degeneration? Are you currently using any medication, eye drops, or supplements for your eyes? EarHave you had any trouble hearing? If so, do you wear hearing aids? Have you had any symptoms like ringing in the ears, drainage from the ears, or ear pain? Do you ever feel dizzy, off-balance, or like the room is spinning? Have you ever been diagnosed with an ear condition such as an infection, tinnitus, or vertigo? Are you currently using any medications, ear drops, or supplements for your ears? Life Span ConsiderationsPediatricWhen collecting subjective data from children, information is also obtained from parents and/or legal guardians. Children aged 2-24 months commonly experience ear infections. Vision impairments may become apparent in school-aged children when they have difficulty seeing the board from their seats. Additional subjective data may be obtained by asking these questions:
Older AdultsThe aging adult experiences a general slowing in nerve conduction. Vision, hearing, fine coordination, and balance may also become impaired. Older adults may experience presbyopia (decreased near vision), presbycusis (hearing loss), cataracts, macular degeneration, or glaucoma. They may also experience feelings of dizziness or feeling off-balance, which can result in falls. Read more about these conditions in the “Eye and Ear Basic Concepts” section earlier in this chapter. Tip: Educate all patients to have yearly eye examinations.Objective AssessmentA routine assessment of the eyes and ears by registered nurses in inpatient and outpatient settings typically includes external inspection of eyes and ears for signs of a medical condition, as well as screening for vision and hearing problems. A vision screening test, whispered voice hearing test, and assessment of pupillary response are often included in the physical exam based on the setting. Additional assessments may be performed if the patient’s status warrants assessment of the cranial nerves. InspectionEyesBegin the assessment by inspecting the eyes. The sclera should be white and the conjunctiva should be pink. There should not be any drainage from the eyes. The patient should demonstrate behavioral cues indicating effective vision during the assessment. EarsInspect the ears. There should not be any drainage from the ears or evidence of cerumen impaction. The patient should demonstrate behavioral cues indicating effective hearing. Vision TestsSee more information about procedures for assessing vision in the “Eye and Ear Basic Concepts” section earlier in this chapter. Assess far vision using the Snellen eye chart. In outpatient settings, near vision may be assessed using a prepared card or a newspaper. Color vision may be assessed using a book containing Ishihara plates. Hearing TestNurses perform a basic hearing assessment during conversation with the patient. For example, the following patient cues during normal conversation can indicate hearing loss:
Whisper TestThe whispered voice test is an effective screening test used to detect hearing impairment if performed accurately. Complete the following steps to accurately perform this test:
Pupillary Response, Extraocular Movement, and Cranial NervesWhen a patient is suspected of experiencing a neurological disease or injury, their pupils are assessed to ensure they are bilaterally equal, round, and responsive to light and accommodation (PERRLA). Extraocular movement and other cranial nerves may also be assessed that affect vision, hearing, and balance. For more information about how to assess PERRLA, extraocular eye movement, and other cranial nerves, go to the “Assessing Cranial Nerves” section in the “Neurological Assessment” chapter. See Table 8.3b for a comparison of expected versus unexpected findings when assessing the eyes and ears. Table 8.3b Expected Versus Unexpected Findings on Eyes or Ears Assessment Assessment Expected FindingsUnexpected New Findings (Document and notify provider)InspectionEyes Sclera are white. Lens is clear. Conjunctiva are pink. Eyelids do not have redness, swelling, lumps, or discharge. No drainage is present from the eyes. Patient displays behavioral cues of effective vision. Eyes appear appropriately placed in orbits. Ears No drainage or cerumen is present in the ear canals. Conversation includes behavioral cues of effective hearing. During the whispered voice test, the patient reports fewer than three out of a possible six numbers or letters correctly for both ears. What should be included in the assessment of the eyes?Inspect the eyes for symmetry of eyelids, size, contour, alignment of the eyeballs and signs of traumatic injury. Look for eyelid droop (ptosis), dysconjugate gaze, exophthalmos (protruding gaze) and sunken eyes. Ask the patient to close his eyes and note whether the eyelids completely cover the eyes.
What components are involved in the physical examination of the eye?The key to any examination is to be systematic and always perform each element.. Visual acuity. In the clinic, visual acuity is typically measured at distance. ... . Pupils. ... . Extraocular motility and alignment. ... . Intraocular pressure. ... . Confrontation visual fields. ... . External examination. ... . Slit-lamp examination. ... . Fundoscopic examination.. What components are involved in the physical examination of the eye quizlet?A comprehensive physical examination of the eye involves assessment of visual acuity, the external eye, eye muscle function, external ocular structures (including pupil reflexes), and internal ocular structures.
How does the nurse assess movements of the eyes?Make the lights normal and have patient look at a distant object to dilate pupils, and then have patient stare at pen light and slowly move it closer to the patient's nose. Watch the pupil response: The pupils should constrict and equally move to cross.
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