Head (Skull, Scalp, Hair)
Face
Eyebrows, Eyes and Eyelashes
Eye lids and Lacrimal Apparatus
Conjunctivae
Sclerae
Cornea
Anterior Chamber and Iris
Pupils
Cranial Nerve II (optic nerve)
Cranial Nerve III, IV & VI (Oculomotor, Trochlear, Abducens)
Ears
Nose and Paranasal Sinuses
Cranial Nerve I (olfactory Nerve)
Neck
Thorax ( Cardiovascular System)
Breast
Abdomen
Extremities
This document provides information on examining the 12 cranial nerves, beginning with a overview of their origins and locations. It then examines each cranial nerve individually, describing their function, relevant examination techniques, and ways to interpret the results. For cranial nerves I-II (olfactory and optic), it discusses testing smell identification and visual acuity/fields. For cranial nerves III-VI (oculomotor, trochlear, abducens), it outlines how to examine the pupils, accommodation reflex, and eye movements. The summary provides a high-level view of examining the main cranial nerves and evaluating sensory and motor functions.
The document provides details on performing eye and ear examinations, including inspecting the external eye and ear structures, assessing visual acuity and fields, examining the internal eye with an ophthalmoscope, and testing hearing through techniques like the Weber, Rinne, and Romberg tests which evaluate hearing and balance. Examinations of both systems involve inspection, assessment of functions, and specialized tests to thoroughly evaluate eye and ear health.
Eyelid, Lacrimal System, and Orbital Examination (1).pptxJazzyLazzy
The document describes examination techniques for the eyelids, lacrimal system, and orbit. It includes:
1) Assessment of eyelid position, symmetry, closure, and measurements like interpalpebral fissure height.
2) Evaluation of proptosis using an exophthalmometer to measure distance from orbital rim to corneal apex.
3) Examination of the lacrimal system including the puncta, sac, and tear drainage using tests like dye disappearance and Jones tests.
The document provides information on techniques for examining the eye, including:
1. Visual acuity is tested using a Snellen eye chart from 20 feet.
2. Visual fields are assessed using confrontation tests like finger wiggling.
3. The optic disc, retina, blood vessels and macula are examined using an ophthalmoscope.
This document provides information on performing a comprehensive eye examination, including:
- Assessing visual acuity using a Snellen chart
- Examining the external structures of the eye
- Testing eye movements and cranial nerve function
- Performing diagnostic tests like ophthalmoscopy, slit lamp examination, and tonometry
- Evaluating color vision, the macula, retinal blood vessels, and intraocular pressure
The goal is to gather all relevant information to assist in diagnosing any ocular conditions.
This document provides guidance on performing a comprehensive eye examination, including:
- Testing visual acuity using a Snellen chart from 20 feet and reducing distance if needed.
- Examining the external eye structures like eyelids, sclera, conjunctiva, pupils and extraocular eye movements.
- Evaluating the cranial nerves that control eye movement by having the patient follow an object.
- Using diagnostic tools like an ophthalmoscope, slit lamp, color vision tests, Amsler grid, OCT and color fundus photography.
The examination aims to gather a thorough ocular history and inspect the eye to assist in diagnosing any eye conditions.
Head (Skull, Scalp, Hair)
Face
Eyebrows, Eyes and Eyelashes
Eye lids and Lacrimal Apparatus
Conjunctivae
Sclerae
Cornea
Anterior Chamber and Iris
Pupils
Cranial Nerve II (optic nerve)
Cranial Nerve III, IV & VI (Oculomotor, Trochlear, Abducens)
Ears
Nose and Paranasal Sinuses
Cranial Nerve I (olfactory Nerve)
Neck
Thorax ( Cardiovascular System)
Breast
Abdomen
Extremities
This document provides information on examining the 12 cranial nerves, beginning with a overview of their origins and locations. It then examines each cranial nerve individually, describing their function, relevant examination techniques, and ways to interpret the results. For cranial nerves I-II (olfactory and optic), it discusses testing smell identification and visual acuity/fields. For cranial nerves III-VI (oculomotor, trochlear, abducens), it outlines how to examine the pupils, accommodation reflex, and eye movements. The summary provides a high-level view of examining the main cranial nerves and evaluating sensory and motor functions.
The document provides details on performing eye and ear examinations, including inspecting the external eye and ear structures, assessing visual acuity and fields, examining the internal eye with an ophthalmoscope, and testing hearing through techniques like the Weber, Rinne, and Romberg tests which evaluate hearing and balance. Examinations of both systems involve inspection, assessment of functions, and specialized tests to thoroughly evaluate eye and ear health.
Eyelid, Lacrimal System, and Orbital Examination (1).pptxJazzyLazzy
The document describes examination techniques for the eyelids, lacrimal system, and orbit. It includes:
1) Assessment of eyelid position, symmetry, closure, and measurements like interpalpebral fissure height.
2) Evaluation of proptosis using an exophthalmometer to measure distance from orbital rim to corneal apex.
3) Examination of the lacrimal system including the puncta, sac, and tear drainage using tests like dye disappearance and Jones tests.
The document provides information on techniques for examining the eye, including:
1. Visual acuity is tested using a Snellen eye chart from 20 feet.
2. Visual fields are assessed using confrontation tests like finger wiggling.
3. The optic disc, retina, blood vessels and macula are examined using an ophthalmoscope.
This document provides information on performing a comprehensive eye examination, including:
- Assessing visual acuity using a Snellen chart
- Examining the external structures of the eye
- Testing eye movements and cranial nerve function
- Performing diagnostic tests like ophthalmoscopy, slit lamp examination, and tonometry
- Evaluating color vision, the macula, retinal blood vessels, and intraocular pressure
The goal is to gather all relevant information to assist in diagnosing any ocular conditions.
This document provides guidance on performing a comprehensive eye examination, including:
- Testing visual acuity using a Snellen chart from 20 feet and reducing distance if needed.
- Examining the external eye structures like eyelids, sclera, conjunctiva, pupils and extraocular eye movements.
- Evaluating the cranial nerves that control eye movement by having the patient follow an object.
- Using diagnostic tools like an ophthalmoscope, slit lamp, color vision tests, Amsler grid, OCT and color fundus photography.
The examination aims to gather a thorough ocular history and inspect the eye to assist in diagnosing any eye conditions.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye. The size of the pupil is regulated by two sets of muscles - the sphincter pupillae constricts the pupil in response to parasympathetic stimulation while the dilator pupillae dilates the pupil under sympathetic influence. Abnormalities in pupil size, shape, reaction to light and accommodation can provide clues to underlying ocular and neurological diseases. Common causes of an abnormal pupil include trauma, inflammation, drugs and disorders of the autonomic nervous system.
The document provides information about ophthalmic nursing and eye anatomy. It discusses the three layers of the eye wall, structures of the human eye like the iris, pupil, lens, sclera, cornea, choroid, ciliary body, retina, vitreous body and aqueous humour. It also describes visual assessment techniques including history taking, physical assessment of extraocular structures and the use of tools like the Snellen chart, tonometer and phoropter. Common refractive errors like myopia, hyperopia, presbyopia and astigmatism are also summarized.
The pupil is an opening located in the center of the iris that allows light to enter the retina. • Its function is to control the amount of light entering the eye and it does this via contraction (miosis) and dilation (mydriasis) under the influence of the autonomic nervous system
3. • The iris is a contractile structure, consisting mainly of smooth muscle, surrounding the pupil. Light enters the eye through the pupil, and the iris regulates the amount of light by controlling the size of the pupil.
4. The iris contains two groups of smooth muscles: a circular group called the sphincter pupillae. and a radial group called the dilator pupillae.
5. Parasympathetic pathway • First Order – Retina to Pretectal Nucleus in B/S (at level of Superior colliculus) Second Order – Pretectal nucleus to E/W nucleus (bilateral innervation!) Third Order – E/W nucleus to Ciliary Ganglion Fourth Order – Ciliary Ganglion to Sphincter pupillae (via short ciliary nerves) • • •
Ophthalmoscopy allows examination of the inside of the eye. It is done using an ophthalmoscope to view the retina and optic disc. It was invented in 1851 and has since improved. During the exam, the pupil is dilated and the ophthalmologist views the retina through different aperture settings and filters on the ophthalmoscope. They examine the optic disc, retina, blood vessels and look for any abnormalities. Common findings include signs of diabetes, hypertension, glaucoma, or other eye conditions. The ophthalmoscopy exam is important for evaluating eye health and detecting underlying diseases.
Lecture on Clinical Methods; Visual Field & Pupillary Reflexes For 4th Year M...DrHussainAhmadKhaqan
This document provides guidance on performing visual field and pupillary reflex examinations. It outlines 9 steps for visual field testing, including peripheral, central and blind spot testing. It also outlines 8 steps for pupillary reflex testing, including testing the direct and consensual light reflex, relative afferent pupillary defect and accommodation reflex. Tips are provided throughout, such as ensuring the patient can see the test object and giving precise instructions to patients. The document advises looking for additional physical signs that can help localize lesions.
This document outlines the procedures and assessments for a comprehensive eye examination. It includes collecting the patient's history, testing visual acuity with a Snellen chart, examining the external eye structures, assessing eye movements and cranial nerves, performing diagnostic tests like ophthalmoscopy and slit lamp examination, and using additional tools like tonometry, perimetry, and imaging tests. The goal is to gather all relevant information on the patient's ocular and medical history, examine the eyes, and determine if any further testing is needed to diagnose any underlying conditions.
Clinical examination of eyes By Pandian MPandian M
This document provides guidance on clinically examining the eyes. It outlines the key steps which include inspecting the eyelids, lashes, lacrimal apparatus, conjunctiva, cornea, sclera, anterior chamber, iris, pupils, lens, and fundus. For each structure, the examiner is instructed to observe for any abnormalities in color, shape, size, discharge, opacity, or other features and compare across both eyes. Palpation of the eyeball is also described to assess tension. The goal is to systematically examine each individual part of the eye and observe any abnormalities.
The pupil is a circular opening in the iris that controls the amount of light entering the eye. It constricts (miosis) and dilates (mydriasis) under autonomic nervous system influence. The iris contains two muscle groups - the sphincter pupillae and dilator pupillae - that regulate pupil size. Abnormal pupils may be unequal in size (anisocoria), irregularly shaped, or have abnormal reactions to light or accommodation. Various diseases and drugs can cause pupil abnormalities.
The purpose of a preliminary examination is to detect any gross anomalies and make a tentative diagnosis. It involves assessing visual acuity, ocular motility, binocular vision, color vision, visual fields, tonometry, blood pressure, and external and internal eye examination. The external exam evaluates lids, conjunctiva, sclera, cornea, iris, pupil, anterior chamber, and lens, while the internal exam assesses the posterior segment including the optic disc, retina, and macula using techniques like slit lamp biomicroscopy and fundoscopy. Special tests evaluate aspects like tear production, intraocular pressure, and the lacrimal system. Careful general observation of the patient is important before beginning specific examinations.
This document provides guidance on examining the pupil, including what aspects to examine (size, shape, position, color, symmetry, number), tips for the examination (seating position, fixation, lighting, dark irises), and how to examine pupil reflexes (direct reflex, consensual reflex, near reflex, relative afferent pupillary defect test). Key items that should be examined include size, shape, position, color, and symmetry of the pupils. The tips recommend dim lighting, having the patient fixate on a distant target, and using a secondary light for patients with dark irises. Pupillary reflexes should be tested via direct and consensual response, near reflex, and relative afferent pupillary
Strabismus, or squint, is a misalignment of the eyes where the visual axes are not parallel. There are several types of strabismus including pseudostrabismus (apparent squint), heterophoria (latent squint), and heterotropia (manifest squint). Heterotropia can be concomitant where the deviation is the same in all gazes, or incomitant where the deviation varies with gaze. Diagnosis involves tests like cover tests and Hess screen testing to determine the type and amount of deviation. Management depends on the type of strabismus.
This document discusses the investigation of concomitant and nonconcomitant strabismus. It begins with definitions of strabismus and classifications based on direction of deviation, constancy, and comitance. Non-concomitant or incomitant strabismus is defined as a deviation that changes by more than 10 prism diopters in different gaze positions. Clinical evaluation techniques are described, including cover tests, ocular motility testing, and imaging tests. The force duction test is used to differentiate between paralysis and mechanical restriction as causes of incomitant strabismus. Diplopia charts and Hess screen tests are also used in evaluation.
This document provides guidance on examining the eyes. It describes inspecting the external structures like eyelids, conjunctiva, sclera and assessing vision. Internally, it involves examining the lens, cornea, pupils and using an ophthalmoscope to view the optic disc, vessels and macula. Abnormal findings may indicate conditions like infection, trauma, hypertension or diabetes. The document emphasizes performing a thorough eye exam to evaluate vision and detect any abnormalities.
Eye Movements Examination
Examination Structure
Sit on the right of the patient, your eyes and the patient’s eyes should be at the same level
Speak whilst examining
Ask children their age
Look around the room for clues – spectacles, parents (for inherited syndromes)
1. Visual Acuity (Best Corrected)
The worse eye is usually the affected one (may be amblyopic)
2. Spectacles
It is easiest to estimate the script of spectacles by comparing the image of a line viewed through the lens and just around it. A distance line such as a doorway is perfect for this purpose.
Hand Neutralise
Minus lens → “With” movement
Plus lens → “Against” movement
Astigmatism
Ground in Prism
The image of the line through the lens has a fixed deviation away from the image of the line just around it. This cannot be compensated by moving the lens. The apex of the prism points towards the deviation.
Fresnel Prism
Method for easy check: turn spectacles side-on
BO (CNVI palsy), BD (CNIV palsy on affected eye)
3. Inspection
Have the patient fixate on a distant target- choose one line above their visual acuity
Only comment on a strabismus if it is obvious (say “there appears to be an exo or eso deviation” in case the patient has a dragged macula and there is no tropia)
1. Abnormal Head Posture (AHP)
Ask patient to “Please sit up straight” and stand back to inspect
Face turn? In direction of action of paretic muscle
Chin up / down? Up in elevator paresis, Down in depressor paresis
Correct any AHP before cover tests (check for neck pathology)
2. ± Corneal Light Reflexes (Hirschberg)
Shine a pen torch into the patient’s eyes and inspect the corneal reflexes. In patients with straight eyes, they should be symmetrical and lie over the same point on the cornea. In patients with strabismus, the corneal reflex of the fixing eye will lie centrally within the pupil, and the other will be displaced (1mm of corneal decentration = 15 Δ strabismus, Pupil margin = 30 Δ, Limbus = 90 Δ). Be aware that tropias can only be definitively diagnosed with cover testing. The Hirschberg test becomes more important when vision is poor (e.g. < 6 / 60 in either eye) and cover-testing is not possible.
3. Ptosis (CNIII palsy)
4. Pupils (Anisocoria) (CNIII palsy)
5. Globe Position
Proptosis (axial vs. non-axial)
6. Other
Nystagmus, facial asymmetry, hearing aids, scars (conjunctiva- squint surgery)
7. Ask Yourself
“Could this be TED?”- proptosis, chemosis, injection, lid retraction
4. Cover-Testing
Ensure the patient can fixate “Tell me if I block your view”
If VA <6 / 60 can’t do cover! → Perform Hirschberg (corneal light reflexes) and / or Krimsky (corneal light reflexes through prism placed over the fixing eye) tests.
The patient should wear their distance (& near) spectacles (unless they have prisms!)
This helps the patient if they can’t fixate on a target uncorrected
It is crucial in accommodative esotropia to test with and without spectacles
Cover for tropia (manifest)
Uncover for phoria (latent)
Cranial nerves I through XII were assessed using various tests. CN I (olfactory) was tested by having the patient smell different odors. CN II (optic) assessment included visual acuity, visual fields, and ophthalmoscopy. CN III, IV, and VI were evaluated using light reflexes, accommodation, and eye movements. Sensory and motor functions of CN V (trigeminal) were assessed using touch, temperature, and jaw movement tests. Facial expression was used to examine CN VII (facial) motor skills. Hearing was roughly tested for CN VIII (acoustic). Swallowing and palate movement checked CN IX and X. Shoulder shrugging assessed CN XI (
This document provides instructions for examining a patient's fundus using an ophthalmoscope. It describes how to position the patient and ophthalmoscope, how to focus on different parts of the fundus including the optic disc, blood vessels, periphery, and macula, and what features to assess for each area such as shape and clarity of the optic disc or signs of hypertensive retinopathy. The goal is to be able to properly examine the fundus and recognize common abnormalities.
Cranial nerves I through XII were assessed. Key tests included smell identification for CN I, visual acuity and fields for CN II, pupil reaction and eye movements for CN III, IV, and VI, facial sensation and strength for CN V and VII, hearing for CN VIII, swallowing and gag reflex for CN IX and X, neck and shoulder strength for CN XI, and tongue movement and strength for CN XII. Most tests evaluated both sensory and motor function through observation of physical responses.
Direct ophthalmoscopy involves examining the retina using an ophthalmoscope held close to the patient's eye, providing a magnified inverted image. Indirect ophthalmoscopy uses a condensing lens placed near the eye to form an erect magnified image, allowing a wider field of view but is more difficult to perform. The document describes the techniques, advantages, and disadvantages of direct and indirect ophthalmoscopy for examining the interior of the eye.
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye. The size of the pupil is regulated by two sets of muscles - the sphincter pupillae constricts the pupil in response to parasympathetic stimulation while the dilator pupillae dilates the pupil under sympathetic influence. Abnormalities in pupil size, shape, reaction to light and accommodation can provide clues to underlying ocular and neurological diseases. Common causes of an abnormal pupil include trauma, inflammation, drugs and disorders of the autonomic nervous system.
The document provides information about ophthalmic nursing and eye anatomy. It discusses the three layers of the eye wall, structures of the human eye like the iris, pupil, lens, sclera, cornea, choroid, ciliary body, retina, vitreous body and aqueous humour. It also describes visual assessment techniques including history taking, physical assessment of extraocular structures and the use of tools like the Snellen chart, tonometer and phoropter. Common refractive errors like myopia, hyperopia, presbyopia and astigmatism are also summarized.
The pupil is an opening located in the center of the iris that allows light to enter the retina. • Its function is to control the amount of light entering the eye and it does this via contraction (miosis) and dilation (mydriasis) under the influence of the autonomic nervous system
3. • The iris is a contractile structure, consisting mainly of smooth muscle, surrounding the pupil. Light enters the eye through the pupil, and the iris regulates the amount of light by controlling the size of the pupil.
4. The iris contains two groups of smooth muscles: a circular group called the sphincter pupillae. and a radial group called the dilator pupillae.
5. Parasympathetic pathway • First Order – Retina to Pretectal Nucleus in B/S (at level of Superior colliculus) Second Order – Pretectal nucleus to E/W nucleus (bilateral innervation!) Third Order – E/W nucleus to Ciliary Ganglion Fourth Order – Ciliary Ganglion to Sphincter pupillae (via short ciliary nerves) • • •
Ophthalmoscopy allows examination of the inside of the eye. It is done using an ophthalmoscope to view the retina and optic disc. It was invented in 1851 and has since improved. During the exam, the pupil is dilated and the ophthalmologist views the retina through different aperture settings and filters on the ophthalmoscope. They examine the optic disc, retina, blood vessels and look for any abnormalities. Common findings include signs of diabetes, hypertension, glaucoma, or other eye conditions. The ophthalmoscopy exam is important for evaluating eye health and detecting underlying diseases.
Lecture on Clinical Methods; Visual Field & Pupillary Reflexes For 4th Year M...DrHussainAhmadKhaqan
This document provides guidance on performing visual field and pupillary reflex examinations. It outlines 9 steps for visual field testing, including peripheral, central and blind spot testing. It also outlines 8 steps for pupillary reflex testing, including testing the direct and consensual light reflex, relative afferent pupillary defect and accommodation reflex. Tips are provided throughout, such as ensuring the patient can see the test object and giving precise instructions to patients. The document advises looking for additional physical signs that can help localize lesions.
This document outlines the procedures and assessments for a comprehensive eye examination. It includes collecting the patient's history, testing visual acuity with a Snellen chart, examining the external eye structures, assessing eye movements and cranial nerves, performing diagnostic tests like ophthalmoscopy and slit lamp examination, and using additional tools like tonometry, perimetry, and imaging tests. The goal is to gather all relevant information on the patient's ocular and medical history, examine the eyes, and determine if any further testing is needed to diagnose any underlying conditions.
Clinical examination of eyes By Pandian MPandian M
This document provides guidance on clinically examining the eyes. It outlines the key steps which include inspecting the eyelids, lashes, lacrimal apparatus, conjunctiva, cornea, sclera, anterior chamber, iris, pupils, lens, and fundus. For each structure, the examiner is instructed to observe for any abnormalities in color, shape, size, discharge, opacity, or other features and compare across both eyes. Palpation of the eyeball is also described to assess tension. The goal is to systematically examine each individual part of the eye and observe any abnormalities.
The pupil is a circular opening in the iris that controls the amount of light entering the eye. It constricts (miosis) and dilates (mydriasis) under autonomic nervous system influence. The iris contains two muscle groups - the sphincter pupillae and dilator pupillae - that regulate pupil size. Abnormal pupils may be unequal in size (anisocoria), irregularly shaped, or have abnormal reactions to light or accommodation. Various diseases and drugs can cause pupil abnormalities.
The purpose of a preliminary examination is to detect any gross anomalies and make a tentative diagnosis. It involves assessing visual acuity, ocular motility, binocular vision, color vision, visual fields, tonometry, blood pressure, and external and internal eye examination. The external exam evaluates lids, conjunctiva, sclera, cornea, iris, pupil, anterior chamber, and lens, while the internal exam assesses the posterior segment including the optic disc, retina, and macula using techniques like slit lamp biomicroscopy and fundoscopy. Special tests evaluate aspects like tear production, intraocular pressure, and the lacrimal system. Careful general observation of the patient is important before beginning specific examinations.
This document provides guidance on examining the pupil, including what aspects to examine (size, shape, position, color, symmetry, number), tips for the examination (seating position, fixation, lighting, dark irises), and how to examine pupil reflexes (direct reflex, consensual reflex, near reflex, relative afferent pupillary defect test). Key items that should be examined include size, shape, position, color, and symmetry of the pupils. The tips recommend dim lighting, having the patient fixate on a distant target, and using a secondary light for patients with dark irises. Pupillary reflexes should be tested via direct and consensual response, near reflex, and relative afferent pupillary
Strabismus, or squint, is a misalignment of the eyes where the visual axes are not parallel. There are several types of strabismus including pseudostrabismus (apparent squint), heterophoria (latent squint), and heterotropia (manifest squint). Heterotropia can be concomitant where the deviation is the same in all gazes, or incomitant where the deviation varies with gaze. Diagnosis involves tests like cover tests and Hess screen testing to determine the type and amount of deviation. Management depends on the type of strabismus.
This document discusses the investigation of concomitant and nonconcomitant strabismus. It begins with definitions of strabismus and classifications based on direction of deviation, constancy, and comitance. Non-concomitant or incomitant strabismus is defined as a deviation that changes by more than 10 prism diopters in different gaze positions. Clinical evaluation techniques are described, including cover tests, ocular motility testing, and imaging tests. The force duction test is used to differentiate between paralysis and mechanical restriction as causes of incomitant strabismus. Diplopia charts and Hess screen tests are also used in evaluation.
This document provides guidance on examining the eyes. It describes inspecting the external structures like eyelids, conjunctiva, sclera and assessing vision. Internally, it involves examining the lens, cornea, pupils and using an ophthalmoscope to view the optic disc, vessels and macula. Abnormal findings may indicate conditions like infection, trauma, hypertension or diabetes. The document emphasizes performing a thorough eye exam to evaluate vision and detect any abnormalities.
Eye Movements Examination
Examination Structure
Sit on the right of the patient, your eyes and the patient’s eyes should be at the same level
Speak whilst examining
Ask children their age
Look around the room for clues – spectacles, parents (for inherited syndromes)
1. Visual Acuity (Best Corrected)
The worse eye is usually the affected one (may be amblyopic)
2. Spectacles
It is easiest to estimate the script of spectacles by comparing the image of a line viewed through the lens and just around it. A distance line such as a doorway is perfect for this purpose.
Hand Neutralise
Minus lens → “With” movement
Plus lens → “Against” movement
Astigmatism
Ground in Prism
The image of the line through the lens has a fixed deviation away from the image of the line just around it. This cannot be compensated by moving the lens. The apex of the prism points towards the deviation.
Fresnel Prism
Method for easy check: turn spectacles side-on
BO (CNVI palsy), BD (CNIV palsy on affected eye)
3. Inspection
Have the patient fixate on a distant target- choose one line above their visual acuity
Only comment on a strabismus if it is obvious (say “there appears to be an exo or eso deviation” in case the patient has a dragged macula and there is no tropia)
1. Abnormal Head Posture (AHP)
Ask patient to “Please sit up straight” and stand back to inspect
Face turn? In direction of action of paretic muscle
Chin up / down? Up in elevator paresis, Down in depressor paresis
Correct any AHP before cover tests (check for neck pathology)
2. ± Corneal Light Reflexes (Hirschberg)
Shine a pen torch into the patient’s eyes and inspect the corneal reflexes. In patients with straight eyes, they should be symmetrical and lie over the same point on the cornea. In patients with strabismus, the corneal reflex of the fixing eye will lie centrally within the pupil, and the other will be displaced (1mm of corneal decentration = 15 Δ strabismus, Pupil margin = 30 Δ, Limbus = 90 Δ). Be aware that tropias can only be definitively diagnosed with cover testing. The Hirschberg test becomes more important when vision is poor (e.g. < 6 / 60 in either eye) and cover-testing is not possible.
3. Ptosis (CNIII palsy)
4. Pupils (Anisocoria) (CNIII palsy)
5. Globe Position
Proptosis (axial vs. non-axial)
6. Other
Nystagmus, facial asymmetry, hearing aids, scars (conjunctiva- squint surgery)
7. Ask Yourself
“Could this be TED?”- proptosis, chemosis, injection, lid retraction
4. Cover-Testing
Ensure the patient can fixate “Tell me if I block your view”
If VA <6 / 60 can’t do cover! → Perform Hirschberg (corneal light reflexes) and / or Krimsky (corneal light reflexes through prism placed over the fixing eye) tests.
The patient should wear their distance (& near) spectacles (unless they have prisms!)
This helps the patient if they can’t fixate on a target uncorrected
It is crucial in accommodative esotropia to test with and without spectacles
Cover for tropia (manifest)
Uncover for phoria (latent)
Cranial nerves I through XII were assessed using various tests. CN I (olfactory) was tested by having the patient smell different odors. CN II (optic) assessment included visual acuity, visual fields, and ophthalmoscopy. CN III, IV, and VI were evaluated using light reflexes, accommodation, and eye movements. Sensory and motor functions of CN V (trigeminal) were assessed using touch, temperature, and jaw movement tests. Facial expression was used to examine CN VII (facial) motor skills. Hearing was roughly tested for CN VIII (acoustic). Swallowing and palate movement checked CN IX and X. Shoulder shrugging assessed CN XI (
This document provides instructions for examining a patient's fundus using an ophthalmoscope. It describes how to position the patient and ophthalmoscope, how to focus on different parts of the fundus including the optic disc, blood vessels, periphery, and macula, and what features to assess for each area such as shape and clarity of the optic disc or signs of hypertensive retinopathy. The goal is to be able to properly examine the fundus and recognize common abnormalities.
Cranial nerves I through XII were assessed. Key tests included smell identification for CN I, visual acuity and fields for CN II, pupil reaction and eye movements for CN III, IV, and VI, facial sensation and strength for CN V and VII, hearing for CN VIII, swallowing and gag reflex for CN IX and X, neck and shoulder strength for CN XI, and tongue movement and strength for CN XII. Most tests evaluated both sensory and motor function through observation of physical responses.
Direct ophthalmoscopy involves examining the retina using an ophthalmoscope held close to the patient's eye, providing a magnified inverted image. Indirect ophthalmoscopy uses a condensing lens placed near the eye to form an erect magnified image, allowing a wider field of view but is more difficult to perform. The document describes the techniques, advantages, and disadvantages of direct and indirect ophthalmoscopy for examining the interior of the eye.
Similar to ASSESSMENT OF THE EYE (2)-Health Assessment.pptx (20)
The document discusses programs run by the Philippines Department of Health (DOH) related to family planning. It describes the DOH's Family Health Office, which operates health programs to improve family health. These include the National Safe Motherhood Program, Family Planning Program, Child Health Program, and others. It provides details on objectives, components, and services offered by the National Safe Motherhood Program and National Family Planning Program, which aim to improve maternal and child health and allow individuals to plan family size.
ORTHOPEDIC NURSING: CARE OF THE CLIENT WITH MUSCULO-SKELETAL DISORDERRommel Luis III Israel
The document discusses orthopedic nursing and provides information on musculoskeletal anatomy and physiology. It describes the three types of muscles, tendons, ligaments, bones, joints, and other musculoskeletal structures. It then covers assessment of the musculoskeletal system through history, physical examination including gait, posture, and range of motion. Common laboratory procedures used to assess the musculoskeletal system are also outlined such as bone marrow aspiration, arthroscopy, bone scan, and DXA scan. The nursing management of common musculoskeletal problems like pain, impaired mobility, and self-care deficits are summarized. Modalities used including traction and casting are described. Finally, common musculoskeletal conditions like osteoporosis are briefly discussed.
This document discusses common laboratory procedures used to evaluate alterations in the endocrine system. It describes assays that measure hormone levels in the blood, including stimulation and suppression tests. It provides examples of how thyroid hormone levels can indicate hypo- or hyperthyroidism. Tests are also described for radioactive iodine uptake, thyroid scans, basal metabolic rate, fasting blood glucose, oral glucose tolerance, and glycosylated hemoglobin A1C. The purpose, procedure, and interpretation of results are covered for each test.
This document provides information about end of life care. It discusses key aspects of end of life care including physical and psychological manifestations at the end of life, the goals of end of life care which are to provide comfort, improve quality of remaining life, and ensure a dignified death. It also discusses variables that can affect end of life care like cultural and spiritual needs as well as nursing management of end of life care.
This document discusses cirrhosis of the liver, liver cancer, and hepatitis. It provides information on the causes of cirrhosis including alcohol, viral hepatitis, and non-alcoholic fatty liver disease. Symptoms of cirrhosis include jaundice, fatigue, bruising, and abdominal swelling. The complications of cirrhosis are also examined, such as bleeding from varices and hepatic encephalopathy. Treatment focuses on preventing further liver damage, managing complications through medications and procedures, and potentially liver transplantation for severe cases.
This document discusses the components and process of nursing diagnosis. It begins by outlining the 5 components of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. It then focuses on the diagnostic phase, explaining the differences between medical and nursing diagnosis. It provides details on the types of nursing diagnoses according to client status, and how nursing diagnoses are formulated using NANDA terminology and diagnostic statement structures. Factors involved in analyzing data, determining strengths, and prioritizing diagnoses are also summarized.
The document discusses acute and chronic renal failure. It defines the key functions of the kidney system and describes important lab values used to assess renal function such as BUN and creatinine. It distinguishes between the different types and causes of acute renal failure including pre-renal, intra-renal, and post-renal. Medical management focuses on fluid balance, electrolyte control, and removing any obstructions. Chronic renal failure is typically irreversible and results from long-standing kidney damage from conditions like diabetes or hypertension.
The document discusses disorders of the liver, gallbladder, and pancreas. It provides information on the functions of the liver and describes conditions such as jaundice, cirrhosis, hepatitis, liver tumors, and their signs and symptoms. Gallbladder disorders like cholelithiasis and cholecystitis are covered. Pancreatitis, both acute and chronic, as well as pancreatic cancer, are explained in terms of pathophysiology, assessment findings, and treatment. Nursing management is also addressed for various conditions.
This document discusses evidence-based practice (EBP) in nursing. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and needs. The document outlines the history of EBP beginning in the 1980s and its focus on improving patient outcomes. It also discusses the skills needed for EBP, including critical thinking, information literacy, and communication skills. The five key steps of the EBP process are also summarized: formulating a clinical question, gathering evidence, appraising evidence, integrating evidence with expertise and patient preferences, and evaluating the practice change.
The Expanded Program on Immunization (EPI) was established in 1976 to provide routine childhood immunizations against six diseases: tuberculosis, polio, diphtheria, tetanus, pertussis, and measles. The program aims to reduce child mortality from vaccine-preventable diseases and has specific goals around immunizing children, maintaining polio-free status, eliminating measles, and controlling other diseases. The EPI follows principles of targeting eligible populations, focusing on epidemiology, and providing immunization as a basic health service. It utilizes a cold chain system to store and transport vaccines according to their temperature sensitivities.
The document discusses critical care nursing in the Philippines. It describes how critical care nursing deals with life-threatening illnesses and injuries. It outlines the responsibilities of critical care nurses to provide optimal care for critically ill patients and their families. It also discusses the development of critical care practice in the Philippines and the role of the Critical Care Nurses of the Philippines organization in promoting education and professional development in the field.
Vital statistics.pptx Vital statistics, the records of birth and death, are a...Sapna Thakur
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Linga mudra generates excessive heat within the body and is very useful for dealing with colds.
It also helps in boosting the immune system and makes the body more resistant to colds and similar infections.
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This posture also helps in weight loss.
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Difficulty in breathing can be relieved by this mudra.
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When navel center is shifted from its original place, comes back to its place by this mudra.
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8. ASSESSING
THE EYE
STRUCTURES
AND VISUAL
ACUITY
Planning
• Place the client in an
appropriate room for
assessing the eyes and
vision.
• The nurse must be able
to control natural and
overhead lighting
during some portions
of the examination.
BY: ROMMEL LUIS C. ISRAEL III
9. PREPARATION
Assemble equipment and
supplies:
• Cotton-tipped applicator
• Examination gloves
• Millimeter ruler
• Penlight
• Snellen’s or E chart
• Opaque card
BY: ROMMEL LUIS C. ISRAEL III
10. IMPLEMENTATION
1. Introduce yourself and verify the client’s identity. Explain to the
client what you are going to do, why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Inquire if the client has any history of the following:
• Family history of diabetes, hypertension, or blood dyscrasia
• Eye disease, injury, or surgery
• Last visit to an ophthalmologist
• Current use of eye medications
• Use of contact lenses or eyeglasses
• Hygienic practices for corrective lenses
• Current symptoms of eye problems
BY: ROMMEL LUIS C. ISRAEL III
11. Assessment Normal findings Deviation from normal
External eyes
5. Inspect the eyebrows for hair
distribution and alignment, and
for skin quality and movement.
•Hair evenly distributed;
skin intact
•Eyebrows symmetrically
aligned; equal movement
•Loss of hair; scaling and
flakeness of skin
•Unequal alignment and
movement of eyebrows
6. Inspect the eyelashes for
evenness of distribution and
direction of curl.
Equally distributed; curled
slightly outward
Turned inward
7. Inspect the eyelids for surface
characteristics, position in
relation to the cornea, ability to
blink, and frequency of blinking.
Inspect the lower eyelids while
the client’s eyes are closed.
•Skin intact; no discharge;
no discoloration
•Lids close symmetrically
•Approximately 15 – 20
involuntary
blinks/min;bilateral blinking
•When lids open, no visible
sclera above corneas, &
upper & lower borders of
cornea are slightly covered
•Redness , swelling,
flaking, crusting, plaques,
discharge, nodules,
lesions
•Lids close assymetrically,
incompletely, or painfully
•Rapid, monoocular,
absent or incomplete
blinking
•Ptosis, ectropion,
entropion, rim of the
sclera visible bet lid & iris
BY: ROMMEL LUIS C. ISRAEL III
12. 8. Inspect the bulbar
conjunctiva for color,
texture, and the presence
of lesions. Retract the
eyelids with your finger,
exerting pressure over
the over the upper and
lower bony orbits, & ask
the client to look up,
down, and from side to
side
Transparent; capillaries
sometimes evident;
sclera appears white
Jaundice sclera;
excessively pale
sclera; reddened
sclera; lesion or
nodules
9. Inspect the palpebral
conjunctiva by everting
the lids. Evert both lids,
& ask the client to look
up. Then gently retract
the lower lids with the
index fingers
Shiny, smooth, and
pink or red
Extremely pale;
extremely red; nodules
or other lesion
BY: ROMMEL LUIS C. ISRAEL III
13. 10. Evert the upper lids if a
problem is suspected.
Ask the client to look down while
keeping the eyelids slightly open.
Gently grasp the client’s eyelashes
with thumb and forefinger. Pull
lashes gently downwards.
Place a cotton-tipped applicator
stick about 1cm above the lid
margin, and push it gently
downward while holding the
eyelashes.
Hold the margin of the everted lid
or eyelashes against the ridge of
the upper bony orbit with the
applicator stick or your thumb.
Inspect the conjunctiva for color,
texture lesions, and foreign
bodies.
BY: ROMMEL LUIS C. ISRAEL III
14. 11. Inspect and palpate the
lacrimal gland.
No edema or
tenderness over
lacrimal gland
Swelling or tenderness
over lacrimal gland
Using the tip of your index
finger,
palpate the lacrimal gland.
Observe for edema between
the lower lid and the nose.
12. Inspect and palpate the
lacrimal sac and
nasolacrimal duct.
No edema or tearing Evidence of increase
tearing; regurgitation of
fluid on palpation of
lacrimal sac
Observe for evidence of
increased tearing.
Using the tip of your index
finger, palpate inside the
lower orbital rim near the
inner canthus.
BY: ROMMEL LUIS C. ISRAEL III
15. 13. Inspect the cornea for
clarity and texture. Ask the
client to look straight ahead.
Hold a penlight at an oblique
angle to the eye, and move the
light slowly across the corneal
surface.
•Transparent ,shiny,
and smooth; details of
the iris is visible
•In older people, a
thin, grayish white ring
around the margin,
called arcus senelis,,
maybe evident
•Opaque; surface not
smooth ( maybe a result of
trauma or abrasion
•Arcus senelis in clients
under age 40
14. Perform the corneal
sensitivity (reflex) test to
determine the function of the
fifth (trigeminal) cranial nerve.
Ask the client to keep both eyes
open and look straight ahead.
Approach from behind and
beside the client, and lightly
touch the cornea with a corner
of the gauze.
Clients blinks when
the cornea is touched,
indicating that the
trigeminal nerve is
intact
One or both eyelids fail to
respond
BY: ROMMEL LUIS C. ISRAEL III
16. 15. Inspect the
anterior chamber for
transparency and
depth. Use the same
oblique lighting used
when testing the
cornea.
•Transparent
•No shadows
of light on iris
•Depth of
about 3 mm
•Cloudy
•Crescent-shaped
shadoes on far
side of iris
•Shallow
chamber
(possible
glaucoma)
16. Inspect the pupils
for color, shape, and
symmetry of size.
Black in color;equal
in size;normally 3 to
7 mm in diameter;
round, smooth
border, iris flat and
round
Cloudiness, mydriasis,
miosis, anisocoria;
bulging of iris toward
cornea
BY: ROMMEL LUIS C. ISRAEL III
17. 17. Assess each pupil’s
direct and consensual
reaction to light.
Illuminated pupil
constrict (direct
response)
Neither pupil constricts
Partially darken a room. Nonilluminated pupils
constrict (consensual
response)
Unequal response
Absent responses
Ask the client to look
straight ahead.
Using a penlight and
approaching from the side,
shine a light on the pupil.
Observe the response. The
pupil should constrict
(direct response).
Shine the light on the pupil
again, and observe the
response of the other pupil.
It should also constrict
(consensual response).
BY: ROMMEL LUIS C. ISRAEL III
18. 18. Assess each pupil’s
reaction to
accommodation.
Pupils constrict when
looking at near object;
pupils dilate when
looking at far objects;
pupils converge when
near object is moved
toward nose
One or both pupils
fail to constrict,
dilate or converge
Hold an object about 10 cm from
the client’s nose.
Ask the client to look first at the top
of the object and then at a distant
object behind the penlight. Alternate
the gaze between the near and far
objects.
Observe the pupil response. Pupils
should constrict when looking at the
near object and dilate when looking
at the far object.
Next, move the penlight or pencil
toward the client’s nose. The pupils
should converge. To record normal
assessment of the pupils, use the
abbreviation PERRLA.
BY: ROMMEL LUIS C. ISRAEL III
19. Visual Fields
19. Assess peripheral visual
fields.
When looking straight
ahead, client can objects
in the periphery
Visual field smaller
than normal;1/2 vision
in 1 or both eyes
•Have the client sit directly
facing you at a distance of 60–90
cm.
•Ask the client to cover right eye
with the card and look directly
at your nose.
•Cover or close your eye directly
opposite the client’s covered eye,
and look directly at the client’s
nose.
•Hold an object in your
fingers, extend your arm,
and move the object into
the visual field from various
points in the periphery. The
object should be at an
equal distance from the
client and yourself. Ask the
client to tell you when the
moving object is first
spotted.
BY: ROMMEL LUIS C. ISRAEL III
20. 1. To test the temporal field of the left eye, extend and move your right
arm in from the client’s right periphery. Temporally, peripheral objects
can be seen at right angles to the central point of vision.
2. To test the upward field of the left eye, extend and move the right arm
down from the upward periphery. The upward field of vision is normally 50
degrees because the orbital edge is in the way.
3. To test the downward field of the left eye, extend and move the right arm up
from the lower periphery. The downward field of vision is normally 70 degrees
because the cheekbone is in the way.
4. To test the downward field of the left eye, extend and move the right arm up
from the lower periphery. The downward field of vision is normally 70 degrees
because the cheekbone is in the way.
5. To test the nasal field of the left eye, extend and move your left arm in from
the periphery. The nasal field of vision is normally 50 degrees away from the
central point because the nose is in the way.
Repeat the above steps for the right eye.
BY: ROMMEL LUIS C. ISRAEL III
21. Extraocular Muscle Tests
Normal – both eyes coordinated, move in unison, with parallel
alignment
Deviation – eye movement not coordinate or parallel; one or both eyes
fail to follow a penlight in a specific direction ex. strabismus
20. Assess six ocular movements to determine eye
alignment and coordination.
•Stand directly in front of client and hold the penlight at a
comfortable distance, such as 30 cm in front of the client’s
eyes.
•Ask the client to hold head in a fixed position facing you
and follow the movements of the penlight with the eyes
only.
•Move the penlight in a slow, orderly manner through the
six cardinal fields of gaze.
•Stop the movement s of the penlight periodically so that
the nystagmus can be detected.
BY: ROMMEL LUIS C. ISRAEL III
22. 21. Assess for location of
light reflex by shining a
penlight on the pupil in
corneal surface
(Hirschberg Test).
Lights falls
symmetrically
at both eyes
Lights falls off
center on one
eye (indicates
misalignment)
22. Have the client fixate
on a near or far object.
Cover one eye and
observe for movement in
the uncovered eye (cover
test).
Uncovered
eye does not
move
If misalignment is
present, when
dominant eye is
covered, the
uncovered eye will
move to focus on
object
BY: ROMMEL LUIS C. ISRAEL III
23. VISUAL
ACUITY
BY: ROMMEL LUIS C. ISRAEL III
A Rosenbaum eye chart maybe used to
test near vision. It consist of paragraphs
of text or characters in different sizes on
3 ½ x 6 ½ inch card. Be sure the client
has a literacy level
Assess near vision by providing adequate lighting and asking
the client to read from a magazine or newspaper held at a
distance of 36 cm (14 in). If the clients normally wears
corrective glasses, it should be worn during the test.
Normal - Able to read
Deviation – difficulty
reading newsprint
unless due to aging
process
26. 24. Assess distance
vision by asking the
client to wear corrective
lenses unless they are
used for reading only.
20/20 vision on snellen
chart
Denominator of 40 or
more Snellen type
chart with corrective
lenses
Ask the client to sit or
stand 6 meters (20 ft)
from Snellen’s chart,
cover the eye not being
tested, and identify the
letters or characters.
Take three readings: right
eye, left eye, and both
eyes.
25. Perform functional
vision tests if the client
is unable to see the top
line (20/200) of
Snellen’s chart.
26. Document findings
in the client record.
BY: ROMMEL LUIS C. ISRAEL III
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