Chapter 16 Assessing Eyes
1. Describe the key Key external structures: eyelid, eyelashes, conjunctiva, lacrimal apparatus,
external and internal eye extraocular muscles
structures the nurse can
assess. Key internal structures: sclera, cornea, retina, pupil, lens, iris, optic disc
2. What are the risk Age causes the lens to become rigid and thick. (development can
factors for development begin at 30, but prevalent at 75).
of cataracts and how can Maternal infections can result in infant cataracts
the nurse teach clients to Diabetes
reduce risk factors. Drinking excessive alcohol amounts
Excessive exposure to sunlight
Family history of cataracts
High blood pressure
Obesity
Previous eye injury or inflammation
Previous eye surgery
Smoking
Patient education
Regular eye examinations
Wear sunglasses that block UVB rays
Protect eyes if exposed to ionizing radiation
Avoid smoking or stop
Avoid alcohol abuse
Maintain healthy weight
Eat a well-rounded dirt
Antioxidant supplements to prevent cataracts
Seek medical care for prolonged or unusual inflammation or for an
eye injury
3. As a nurse Do you have any recent visual difficulties or changes in your
conducting a focused vision? If the client responds with sudden decline, this could mean
health history on the there is trauma or intracranial pressure increase.
eyes what questions Do you see halos or rings around lights? This could be associated
should the nurse asks? with narrow-angled glaucoma.
Which client responses Do you experience diplopia? This could indicate increased
would be concerning intracranial pressure due to injury or a tumor if the client answers
yes.
4. As the nurse For near visual acuity, the nurse would instruct the client to
collecting objective data perform the jaeger test, holding a newspaper or jaeger test 14
on the eyes what inches/arms length from the client with one eye covered. 14/14
instructions would the vision is expected.
nurse give the client in Visual fields by confrontation: position yourself approximately 2 ft
order to perform the away from the client at eye level. Have the client cover the left eye
following assessments while you cover your right eye (Fig. 16-10). Look directly at each
and what is the expected other with your uncovered eyes. Next, fully extend your left arm at
response: midline and slowly move one finger (or a pencil) upward from
near visual below until the client sees your finger (or pencil). Test the
acuity remaining three visual fields of the client’s right eye (i.e., superior,
visual fields by temporal, and nasal). Repeat the test for the opposite eye.
confrontation o The client should see the object at the same time as the
, corneal light examiner
reflex Corneal light reflex: Hold a penlight approximately 12 in from the
extraocular eye client’s face. Shine the light toward the bridge of the nose while the
movements client stares straight ahead.
o Reflection of light on the corneas should be in the exact
same spot on each eye
EOM eye movements: Instruct the client to focus on an object you
are holding (approximately 12 in from the client’s face). Move the
object through the six cardinal positions of gaze in a clockwise
direction, and observe the client’s eye movements
o Eye movement should be smooth and symmetric in all 6
directions
6. Based on assessment Health promotion: to improve visual integrity
of the eyes and vision Risk: eye injury risk based on work area or activity, risk for injury
what nursing diagnoses due to vision loss, risk for injury due to tear duct production loss,
should the nurse utilize and risk for self-care deficit due to vision loss.
Actual Diagnoses: Dry eye related to decreased tear production,
inadequate intake of nutrients and advancing age. Ineffective
Health Maintenance related to lack of knowledge of necessity for
eye examinations. Self-Care Deficit (specify) related to poor vision.
Acute Pain related to injury from eye trauma, abrasion, or exposure
to chemical irritant. Social Isolation related to inability to interact
effectively with others secondary to vision loss
Case Study
The nurse is conducting a distance vision acuity test for James Adamson, a 55-year-old male client who
has come in for an eye exam. Mr. Adamson has a history of hypertension (HTN) for 12 years and juvenile
diabetes since age 8. He wears glasses. He takes medication for the HTN and insulin for the diabetes. He
states that he takes his medication as prescribed, but his blood pressure has been higher than usual lately.
He has had “very bad” headaches for the past few weeks, and his vision has become blurred. He has been
having difficulty driving, especially at night. The nurse positions the client 20 ft away and instructs him to
remove his glasses and read the Snellen chart. The client leans forward to read the chart. The nurse notes
that the client is able to read until the fifth line in the Snellen chart and documents vision as 20/50.
(Learning Objectives: 1, 2,3,4)
1. Given the client’s age and medical history, what changes would you expect to find during the eye
exam? (what are the changes that occur with the eye/vision related to age?) Mr. Adamson may be
experiencing a decline in near visual acuity due to age, and he is experiencing visual acuity decline,
representative of his score of 20/50 on the Snellen chart. He is at risk for cataracts due to his
hypertension, diabetes, and blurred vision.
2. When conducting the health assessment, what specific subjective data and objective would be
important for the nurse to obtain? His patient history of diabetes and hypertension, his headaches, and his
blurred vision. The difficulty of driving at night should be noted, and his objective score of the Snellen
chart.
Short Answer Q&A
1. Describe the key Key external structures: eyelid, eyelashes, conjunctiva, lacrimal apparatus,
external and internal eye extraocular muscles
structures the nurse can
assess. Key internal structures: sclera, cornea, retina, pupil, lens, iris, optic disc
2. What are the risk Age causes the lens to become rigid and thick. (development can
factors for development begin at 30, but prevalent at 75).
of cataracts and how can Maternal infections can result in infant cataracts
the nurse teach clients to Diabetes
reduce risk factors. Drinking excessive alcohol amounts
Excessive exposure to sunlight
Family history of cataracts
High blood pressure
Obesity
Previous eye injury or inflammation
Previous eye surgery
Smoking
Patient education
Regular eye examinations
Wear sunglasses that block UVB rays
Protect eyes if exposed to ionizing radiation
Avoid smoking or stop
Avoid alcohol abuse
Maintain healthy weight
Eat a well-rounded dirt
Antioxidant supplements to prevent cataracts
Seek medical care for prolonged or unusual inflammation or for an
eye injury
3. As a nurse Do you have any recent visual difficulties or changes in your
conducting a focused vision? If the client responds with sudden decline, this could mean
health history on the there is trauma or intracranial pressure increase.
eyes what questions Do you see halos or rings around lights? This could be associated
should the nurse asks? with narrow-angled glaucoma.
Which client responses Do you experience diplopia? This could indicate increased
would be concerning intracranial pressure due to injury or a tumor if the client answers
yes.
4. As the nurse For near visual acuity, the nurse would instruct the client to
collecting objective data perform the jaeger test, holding a newspaper or jaeger test 14
on the eyes what inches/arms length from the client with one eye covered. 14/14
instructions would the vision is expected.
nurse give the client in Visual fields by confrontation: position yourself approximately 2 ft
order to perform the away from the client at eye level. Have the client cover the left eye
following assessments while you cover your right eye (Fig. 16-10). Look directly at each
and what is the expected other with your uncovered eyes. Next, fully extend your left arm at
response: midline and slowly move one finger (or a pencil) upward from
near visual below until the client sees your finger (or pencil). Test the
acuity remaining three visual fields of the client’s right eye (i.e., superior,
visual fields by temporal, and nasal). Repeat the test for the opposite eye.
confrontation o The client should see the object at the same time as the
, corneal light examiner
reflex Corneal light reflex: Hold a penlight approximately 12 in from the
extraocular eye client’s face. Shine the light toward the bridge of the nose while the
movements client stares straight ahead.
o Reflection of light on the corneas should be in the exact
same spot on each eye
EOM eye movements: Instruct the client to focus on an object you
are holding (approximately 12 in from the client’s face). Move the
object through the six cardinal positions of gaze in a clockwise
direction, and observe the client’s eye movements
o Eye movement should be smooth and symmetric in all 6
directions
6. Based on assessment Health promotion: to improve visual integrity
of the eyes and vision Risk: eye injury risk based on work area or activity, risk for injury
what nursing diagnoses due to vision loss, risk for injury due to tear duct production loss,
should the nurse utilize and risk for self-care deficit due to vision loss.
Actual Diagnoses: Dry eye related to decreased tear production,
inadequate intake of nutrients and advancing age. Ineffective
Health Maintenance related to lack of knowledge of necessity for
eye examinations. Self-Care Deficit (specify) related to poor vision.
Acute Pain related to injury from eye trauma, abrasion, or exposure
to chemical irritant. Social Isolation related to inability to interact
effectively with others secondary to vision loss
Case Study
The nurse is conducting a distance vision acuity test for James Adamson, a 55-year-old male client who
has come in for an eye exam. Mr. Adamson has a history of hypertension (HTN) for 12 years and juvenile
diabetes since age 8. He wears glasses. He takes medication for the HTN and insulin for the diabetes. He
states that he takes his medication as prescribed, but his blood pressure has been higher than usual lately.
He has had “very bad” headaches for the past few weeks, and his vision has become blurred. He has been
having difficulty driving, especially at night. The nurse positions the client 20 ft away and instructs him to
remove his glasses and read the Snellen chart. The client leans forward to read the chart. The nurse notes
that the client is able to read until the fifth line in the Snellen chart and documents vision as 20/50.
(Learning Objectives: 1, 2,3,4)
1. Given the client’s age and medical history, what changes would you expect to find during the eye
exam? (what are the changes that occur with the eye/vision related to age?) Mr. Adamson may be
experiencing a decline in near visual acuity due to age, and he is experiencing visual acuity decline,
representative of his score of 20/50 on the Snellen chart. He is at risk for cataracts due to his
hypertension, diabetes, and blurred vision.
2. When conducting the health assessment, what specific subjective data and objective would be
important for the nurse to obtain? His patient history of diabetes and hypertension, his headaches, and his
blurred vision. The difficulty of driving at night should be noted, and his objective score of the Snellen
chart.
Short Answer Q&A
