Health Assessment: Eyes and Ears

What subjective data would you need to collect for the eyes? - -visual difficulties? -loss of color with vision? halos around objects? -loss of peripheral vision? (glaucoma) -night blindness? -eye pain? -contacts, glasses or reading glasses? -redness or swelling, drainage, tearing or crusting? -allergies, medication? -self care: last eye exam? protective eyewear? Poor work environment? clean contacts? remove makeup? -surgery on the eyes? What subjective data should you collect for the ear? - -history of earaches (otalgia)? ear infections? Discharge (otorrhea)? OLDCART -sinus or dental problems? -difficulty hearing/loss (presbycusis)? slow loss or abrupt? -ringing/crackling/bussing (tinnitus) -any meds? some are ototoxic (ASA, naproxen, lasix) -vertigo or dizziness (sensation of falling)? -ear disorders/disease/surgery? tubes? skin cancers? -self care: how do you clean ears? last hearing test? hearing aids? how often do you change batteries What information should you gather when observing a patient as you interview? - -are they watching your lips rather than eyes? -misunderstands or asks to repeat a question -inappropriately loud voice -reposition themselves to hear you better -irritated when you raise your voice (painful to ears-recruitment) What are recommendations regarding earbuds? - -60-60 rule: play iPods no more than 60 min a day at levels below 60% of maximum volume -set volume no higher than 6 and take a break at least every hour -federal safety standards: safe sound exposure duration at 120 db (music concert) is less than 8 min. think ear protection Recommendations for eye health? - -the American Academy for Ophthalmology recommends screening for glaucoma starting at age 29 -annual exams if you have diabetes -annual exam for those with HTN, steroid use, or severe nearsightedness -annual exam for those over 60 yrs or 40 yrs if African american What is the snellen eye chart? - -used to assess CN II -tests distance vision -score is always 20/x, determining what a patient can see that one with normal vision can see at 20 ft. If someone is 20/200, they can see at 20 feet what someone with normal vision can see at 200 ft. -read lowest line possible, may only miss 2 items per line In the US, when are you considered legally blind? - -if your best corrected visual acuity is 20/200 or worse. To get a drivers license you best be 20/40 corrected How would you test near acuity? - -use a distance equivalence card, have client remove glasses and place card 12-14 inches from their face -chart: near vision intact, normal is 14/14 What is the confrontation test for visual fields? - -tests peripheral vision which is usually lost with glaucoma or diseases of the retina and stroke -position yourself at eye level 2 ft from client. Fixer them to cover one eye and stare at your eyes and then you cover the mirror image eye and are ready or confrontation -hold an object equidistant between you and client beyond field of vision and advance it solely from the periphery and ask them to say now when the object first comes into view -compare first recognition with yours -test superior, inferior, nasally and temporally -for temporal direction, examiner does not need to cover an eye and will be able to see the target but the client will not (move target from behind client's ear) What are the three tests for extra ocular muscle function? - 1. corneal light reflex (Hirschburg test) 2. cover uncover-tests fusion reflex 3. diagnostic positions (cardinal fields)-finger held 12 inches away -tests CN III, IV, and VI