NURS612 Advanced Health Assessment Exam 1-with 100% verified solutions | Latest Update | Exams Nursing

NURS612 Advanced Health Assessment

Exam 1-with 100% verified solutions |

Latest Update

NURS612 Advanced Health Assessment: Exam 1 Study Guide

What are concepts of developing a relationship with the patient?

The first meeting with the patient sets the tone for a successful partnership as you inform

the patient that you really want to know all that is needed and that you will be open,

flexible, and eager to deal with questions and explanations. A primary objective is to

discover the details about a patient’s concern, explore expectations for the encounter, and

display genuine interest, curiosity and partnership. Identifying underlying worries,

believing them, and trying to address them optimizes your ability to be of help. Personal

interactions and physical examination play an integral role in developing meaningful and

therapeutic relationships with patients. Because cost containment is also essential, the

well performed history and physical examination can justify the appropriate and cost-

effective use of technological resources. This underscores the need for judgment and the

use of resources in a balance appropriate for the individual patient.

What are the effective communication strategies when obtaining a health history?

Seeking connection

Professional Dress and Grooming

Enhancing Patient Responses

What is a patient-centered question? Give examples.

•

Respecting and responding to patients’ wants, needs, and preferences, so that they can

make choices in their care that best fit their individual circumstances.

•

How would you like to be addressed?

•

How are you feeling today?

•

What would you like us to do today?

•

What do you think is causing your symptoms?

•

What is your understanding of your diagnosis? Its importance? Its need for management?

•

How do you feel about your illness? Frightened? Threatened? Angry? As a wage earner?

As a family member? (Be sure, however, to allow a response without putting words in the

patient’s mouth).

•

Do you believe treatment will help?

•

How are you coping with your illness? Crying? Drinking more? Tranquilizers? Talking

more? Less? Changing lifestyles?

•

Do you want to know all the details about your diagnosis and its effect on your future?

•

How important to you is “doing everything possible’?

•

How important to you is “quality of life’?

•

Have you prepared advance directives?

•

Do you have people you can talk with about your illness? Where do you get your

strength?

Partial preview of the text

Download NURS612 Advanced Health Assessment Exam 1-with 100% verified solutions | Latest Update and more Exams Nursing in PDF only on Docsity!

NURS612 Advanced Health Assessment

Exam 1-with 100% verified solutions |

Latest Update

NURS612 Advanced Health Assessment: Exam 1 Study Guide

What are concepts of developing a relationship with the patient?

The first meeting with the patient sets the tone for a successful partnership as you inform

the patient that you really want to know all that is needed and that you will be open,

flexible, and eager to deal with questions and explanations. A primary objective is to

discover the details about a patient’s concern, explore expectations for the encounter, and

display genuine interest, curiosity and partnership. Identifying underlying worries,

believing them, and trying to address them optimizes your ability to be of help. Personal

interactions and physical examination play an integral role in developing meaningful and

therapeutic relationships with patients. Because cost containment is also essential, the

well performed history and physical examination can justify the appropriate and cost-

effective use of technological resources. This underscores the need for judgment and the

use of resources in a balance appropriate for the individual patient.

What are the effective communication strategies when obtaining a health history? o Seeking connection o Professional Dress and Grooming o Enhancing Patient Responses What is a patient-centered question? Give examples.

Respecting and responding to patients’ wants, needs, and preferences, so that they can make choices in their care that best fit their individual circumstances.
How would you like to be addressed?
How are you feeling today?
What would you like us to do today?
What do you think is causing your symptoms?
What is your understanding of your diagnosis? Its importance? Its need for management?
How do you feel about your illness? Frightened? Threatened? Angry? As a wage earner? As a family member? (Be sure, however, to allow a response without putting words in the patient’s mouth).
Do you believe treatment will help?
How are you coping with your illness? Crying? Drinking more? Tranquilizers? Talking more? Less? Changing lifestyles?
Do you want to know all the details about your diagnosis and its effect on your future?
How important to you is “doing everything possible’?
How important to you is “quality of life’?
Have you prepared advance directives?
Do you have people you can talk with about your illness? Where do you get your strength?

Is there anyone else we should contact about your illness or hospitalization? Family members? Friends? Employer? Religious advisor? Attorney?

back to a topic with gentle questioning. You might say, “I think that you may be more concerned than you are saying” or I think you’re worried about what we might find out.” Financial considerations. Provide resources (social worker or financial counselor). Otherwise, an appropriate care plan acceptable to the patient cannot be devised or implemented. What is the structure and the components of a patient history? What kind of patient information is obtained in each section? Structure of the History. First, the identifiers: name, date, time, age, gender, identity, race, source of information, and referral source. Chief concern (CC). The chief concern is a brief statement about why the patient is seeking care. Direct quotes are helpful. It is important, however, to go beyond the given reason and to probe for underlying concerns that cause the patient to seek care rather than just getting up and going to work. If the patient has a sore throat, why is help sought? Is it the pain and fever, or is it the concern caused by experience with a relative who developed rheumatic heart disease? Many interviewers include the duration of the problem as part of the chief concern. History of present illness. Past medical history Family history Personal and social history Review of systems Understanding the present illness or problem requires a step-by-step evaluation of the circumstances that surround the primary reason for the patient’s visit. The full history goes beyond this to an exploration of the patient’s overall health before the chief concern, including past medical and surgical experiences. The spiritual, psychosocial, and cultural contexts of the patient’s life are essential to an understanding of these events. The patient’s family also requires attention to their health, past medical history, illnesses, deaths and the genetic, social, and environmental influences. One question should underlie all of your inquiry: why is this happening to this particular patient at this particular time? In other words, if many people are exposed to a potential problem and only some of them become ill after the exposure, what are the unique factors in this individual that led to that outcome? Careful inquiry about the personal and social experiences of the patient should include work habits and the variety of relationships in the family, school, and workplace. Finally, the ROS includes a detailed inquiry of possible concerns in each of the body’s systems, looking for complementary or seemingly unrelated symptoms that may not have surfaced during the rest of the history. Flexibility, the appreciation of subtlety, and the opportunity for the patient to ask questions and to explore feelings are explicit needs in the process. What is the difference between objective and subjective data? What components of the health history are objective and subjective? How do you approach sensitive issues when interviewing a patient?

Provide privacy
Do not waffle. Be direct and firm. Avoid asking leading questions.
Do not apologize for asking a question.
Do not preach. Avoid confrontation. You are not there to pass judgment.
Use language that is understandable to the patient, yet not patronizing.

Do not push too hard.
Afterward, document carefully, using the patient’s words (and those of others with the patient) whenever possible. It is all right to take notes, but try to do this sparingly, especially when discussing sensitive issues.
You must always be ready to explain again, why you examine sensitive areas. A successful approach will have incorporated four steps:

An introduction, the moment when you bring up the issue, alluding to the need to understand its context in the patient’s life.
Open-ended questions that first explore the patients’ feelings about the issue-whether, for example, it is alcohol, drugs, sex, cigarettes, education, or problems at home- and then the direct exploration of what is actually happening.
A period in which you thoughtfully attend to what the patient is saying and then repeat the patient’s words or offer other forms of feedback. This permits the patient to agree that your interpretation is appropriate, thus confirming what you have heard.
Finally, an opportunity for the patient to ask any questions that might be relevant. What does it mean to be culturally aware and culturally competent when caring for patients with diverse backgrounds?

Cultural awareness- the deliberate self-examination and in-depth exploration of one’s biases,
Stereotypes, prejudices, assumptions, and isms that one holds about individuals and groups who are different from them.
Cultural competency-requires that healthcare providers be sensitive to patient’s heritage, sexual orientation, socio-economic situation, ethnicity, and cultural background. What are examples of questions to explore the patient’s culture? What are the components of a cultural response to a patient?
Modes of communication- the use of speech, body language, and space.
Health beliefs and practices that may vary from your own or those of other patients you care for
Diet and nutritional practices
The nature of relationships within a family and community. EYES

How do you measure visual acuity and test cranial nerve II? Describe the various tests to

measure different types of visual acuity. How do you document your findings?

Position the patient 20 feet away from the Snellen chart. Test each eye

individually by covering one eye with an opaque card or gauze, being careful to

avoid applying pressure to the eye. If you test the patient with and without

corrective lenses, record the readings separately. Always test vision without

glasses first.

Ask the patient to identify all of the letters, beginning at any line. Determine the

smallest line in which the patient can identify all of the letters and record the

visual acuity designated by that line. When testing the second eye, you may want

to ask the patient to read the line from right to left to reduce the chance of recall

influencing the response. Visual acuity is recorded as a fraction in which the

numerator indicates the distance of the patient from the chart and the denominator

- blepharitis- crusting along the eyelashes- bacterial infection, seborrhea, psoriasis,

a manifestation of rosacea, or an allergic response.

- Lagophthalmos- if the closed lids do not completely cover the globe

When you palpate the eyes, what are you assessing for?

Palpate the eyelids for nodules. Palpation of the orbit is one of the simplest methods for

intraocular pressure assessment. Gentle palpation through closed lids can confirm that

the involved eye is much harder than the uninvolved eye. Pain on palpation is consistent

with scleritis, orbital cellulitis, and cavernous sinus thrombosis. An eye that feels very

firm and resists palpation may indicate severe glaucoma or retrobulbar tumor.

Describe how you would inspect the lower and upper conjunctiva. What is normal? What

is abnormal? How do you document these findings?

Lowe r- pulling lower eyelid down to inspect the conjunctiva

Upper - everting upper eyelid. Placing applicator above the globe. Withdrawing the lid

from the globe.

Erythema or cobblestone appearance, especially on the tarsal conjunctiva, may indicate

an allergic infectious conjunctivitis.

Bright red blood indicates sub conjunctival hemorrhage.
Pterygium is an abnormal growth of conjunctiva that extends over the cornea from the

limbus.

How do you examine the cornea for clarity and sensitivity? Cranial nerve V

Examine the cornea for clarity by shining a light tangentially on it. Because the cornea is

normally avascular, blood vessels should not be present.

Corneal sensitivity, controlled by CN V (trigeminal nerve), is tested by touching a wisp

of cotton to the cornea. The expected response is a blink, which indicates intact sensory

fibers of CN V and motor fibers of CN VII (facial nerve).

Decreased corneal sensation is often associated with diabetes, herpes simplex and herpes

zoster viral infections or is a sequela of trigeminal neuralgia or ocular surgery.

Corneal arcus (arcus senilis), which is composed of lipids deposited in the periphery of

the cornea. If present before age 40, arcus may indicate a lipid disorder.

How do you inspect and test the iris and the pupil? How do you document normal and

abnormal?

should be clear and visible
note any irregularity
round, regular, and equal in size
Test the pupils for response to light both directly and consensually. Shine the penlight

directly into one eye and note whether the pupil constricts. Note also the consensual

response of the opposite pupil constricting simultaneously with the tested pupil.

To evaluate the health of the optic nerve, look for an afferent pupillary defect by

performing the swinging flashlight test. Shine the light in one eye and then rapidly swing

to the other. There should be a slight dilation in the second eye while the light is crossing

the bridge of the nose, but it should constrict equally to the first eye as the light enters the

pupil.

Test the pupils for constriction to accommodation as well. Ask the patient to look at a

distant object and then at a test object (either a pencil or your finger) held 10 cm from the

bridge of the nose. Expect the pupils to constrict when the eyes focus on the near object.

A failure to respond to direct light but retaining constriction during accommodation is

sometimes seen in patients with diabetes or syphilis.

Inspect the lens and sclera. What is normal? Abnormal?

Lens should be transparent.
Shining a light on the lens may cause it to appear gray or yellow, but light should still

pass through.

The sclera should be examined primarily to ensure that it is white
The sclera should be visible above the iris only when the eyelids are wide open.
If liver or a hemolytic disease is present, the sclera may become pigmented and appear

either yellow or green.

Senile hyaline plaque appears as a dark, slate gray pigment just anterior to the insertion of

the medial rectus muscle. Its presence does not imply disease but should be noted.

Describe how you would inspect and palpate the lacrimal apparatus. What is normal and

abnormal?

Inspect the region of the lacrimal gland and palpate the lower orbital rim near the inner

canthus.

The puncta should be seen as slight elevations with a central depression on both the upper

and lower lid margins nasally.

If the temporal aspect of the upper lid feels full, evert the lid and inspect the gland.
The lacrimal glands are rarely enlarged but may become enlarged in some conditions

such as tumors, lymphoid infiltration, sarcoid disease, and Sjogren syndrome.

Describe you test the extra ocular movement? (CN II, IV & VI). What is normal and

abnormal?

Six cardinal fields of gaze.

Lid lag, the exposure of the sclera above the iris when the patient is asked to follow your finger

as you direct the eye in a smooth movement from ceiling to floor, may indicate thyroid disease.

Use the corneal light reflex to test the balance of the extraocular muscles.

Direct a light source at the nasal bridge from a distance of about 30cm.

Ask the patient to look at a nearby object (but not the light source). This will encourage both

eyes to converge. The light should be reflected symmetrically from both eyes.

What is the proper technique to exam the interior eye with an ophthalmoscope?

Examine the patient’s right eye with your right eye and the patient has left eye with your left eye

to prevent unintentional nose-to-nose contact.

With the patient looking at a distant fixation point, direct the light of the ophthalmoscope at the

pupil from about 12 inches way. The red reflex is caused by the light illuminating the retina.

Absence of red reflex is often the result of an improperly positioned ophthalmoscope, but it may

also indicate total opacity of the pupil by a cataract or by hemorrhage into the vitreous humor. If

you locate the red reflex and then lose it as you approach the patient, simply move back and start

again.

What structures do you visualize in the interior eye with the ophthalmoscope? What are

normal and abnormal findings? What do the abnormal findings indicate?

A blood vessel will probable the first structure seen when you are about 3 to 5 cm from the

patient. The optic disc is where the retina converges to the optic nerve and because there are no

photoreceptors in this part of the retina and it cannot respond to light.

Expect to see minimal cerumen, a uniformly pink color, and hair in the outer third of the

canal.

Cerumen may vary in color and texture but should have no odor.
Variation of a single gene determines cerumen consistency (wet, sticky, brown vs dry,

gray, flaky)

No lesions discharge, or foreign body should be present.

Describe how you would evaluate hearing by the communication with the patient, a

whispered voice, and the Weber and Rinne tests. What are normal and abnormal findings

for these tests? How do you document normal and abnormal findings?

Cranial nerve VIII is tested by evaluating hearing.
Hearing begins when the patient responds to your questions and directions
Note any behaviors such as cupping a hand behind the ear or tilting an ear toward you

when listening.

The patient should respond without excessive requests for repetition.
Speech with a monotonous tone and erratic volume may indicate hearing loss.

Whispered Voice

Mask the hearing in the untested ear by having the patient gently occlude the nontested

ear.

Stand behind and to the side of a seated patient at arm’s length from the patient’s

nontested ear.

To soften the whisper, exhale fully before whispering random combination of three to six

letters and numbers.

Ask the patient to repeat what was heard.
If the patient is unable to correctly repeat more than 50% of the sounds, he or she is likely

to have hearing impairment and should be referred for formal auditory evaluation.

Weber and Rinne Test

Hold the stem of the tuning fork without touching the tines, and stroke or tap the times

gently to make them vibrate.

The weber test help assess unilateral hearing loss. Place the base of the vibrating tuning

fork on the midline of the patient’s head. Ask the patient whether the sound is heard

equally in both ears or is better in one ear. Avoid giving the patient a cue as to the best

response. The patient should hear the sound equally in both ears. If the sound is

lateralized, have the patient identify which ear hears the sound better. To test the

reliability of the patient’s response, repeat the procedure while occluding one ear, and ask

which ear hears the sound better, it should be heard best in the occluded ear.

The Rinne test helps distinguish whether the patient hears better by air or bond

conduction. Place the base of the vibrating tuning fork against the patients

Describe how you would inspect and palpate the external nose. How do you evaluate nasal patency? What are normal and abnormal findings?

Inspect the nose for deviations in shape, size, and color. Observe the nares for discharge and for flaring or narrowing.
The skin should be smooth without swelling and conform to the color of the face.

The columella, the bridge of tissue separating the nares, should be directly midline, and its width should not exceed the diameter of a nares.
The nares are usually oval in shape and symmetrical positioned.
A depression of the nasal bridge or saddle-nose deformity can result from a fractured nasal bone or previous nasal cartilage inflammation.
Nasal flaring is associated with respiratory distress, whereas narrowing of the nares on inspiration may be indicative of chronic nasal obstruction and mouth breathing.
A transverse crease at the junction between the cartilage and bone of the nose may indicate frequent upward rubbing of the nose due to chronic nasal itching and allergies.
If nasal discharge is present, describe its character (watery, mucoid, purulent, crusty, or bloody); amount and color, and whether unilateral or bilateral.
Palpate the bridge and soft tissues of the nose. Note any displacement of bone and cartilage, tenderness, or masses. Place one finger on each side of the nasal arch and gently palpate, moving the fingers from the nasal bridge to the tip. The nasal structures should feel firm and stable to palpation without crepitus. Not tenderness or masses should be present.
Evaluate the patency of nares. Occlude one naris by placing a finger on the side of the nose, and ask the patient to breathe in and out with the mouth closed. Repeat the procedure with the other naris. Nasal breathing should be noiseless and easy through the open naris. Describe how you would inspect the nasal cavity. What are normal and abnormal findings of the nasal mucosa and nasal septum?
Use a nasal speculum and good light source to inspect the nasal cavity.
Inspect the nasal mucosa for color, discharge, masses, lesions, and swelling of the turbinates.
Inspect the nasal septum for alignment, perforation, bleeding, and crusting.
Keep the patient’s head erect to examine the vestibule and inferior nasal turbinate.
Expect the nasal mucosa to glisten and appear deep pink.
A film of clear discharge is often apparent on the nasal septum.
Purulent discharge may be associated with an upper respiratory infection, sinusitis, or a foreign body.
Increased redness of the mucosa may occur with an infection, whereas localized redness and swelling in the vestibule may indicate a furuncle.
Expect the turbinates to be firm and the same color as the surrounding area.
Turbinates that appear bluish gray or pale pink with a swollen, boggy consistency may indicate allergies.
A rounded, elongated mass projecting into the nasal cavity from boggy mucosa may be a polyp.
A nasal septum deviation may be indicated by asymmetric size of the posterior nasal cavities.
No perforations, bleeding, or crusting should be apparent.
Crusting over the anterior portion of the nasal septum may occur at the site of epistaxis. How do you test the sense of smell? CNI?
The sense of smell cranial nerve I is often tested with recognition of different odors. Describe how you inspect and palpate the sinuses. What is normal and abnormal?
Inspect the frontal and maxillary sinus areas for swelling
To palpate the frontal sinuses, use your thumbs to press up under the bony brow on each side of the nose. Then press up under the zygomatic processes, using either your thumbs or index and middle fingers to palpate the maxillary sinuses. Swelling, tenderness, and pain over the sinuses may indicate infection or obstruction.
Transillumination of the frontal and maxillary sinuses may be performed if sinus tenderness is present or infection is suspected. An opaque response may indicate that either the sinus is filled with secretions or it never developed. Asymmetry of transillumination is a significant finding. Describe the inspection and palpation of the lips. What is normal and abnormal?

Epulis, a localized gingiva enlargement or granuloma, is usually an inflammatory rather than neoplastic change.
Gingival enlargement occurs with pregnancy, puberty, vitamin C deficiency, with certain medications (phenytoin, cyclosporine, and calcium channel blockers).
Easily bleeding, swollen gums with enlarged crevices between the teeth and gum margins, or pockets containing debris at tooth margins, are associated with gingivitis or periodontal disease.
Inspect and count the teeth, noting wear, notches, caries, and missing teeth. Loose teeth can be the result of periodontal disease or trauma. The teeth generally have an ivory color but may be stained yellow from tobacco or brown from coffee of tea. Suspect caries when discolorations are seen on the crown of a tooth. Describe how you examine the oral cavity by inspection testing CNXII, inspecting the floor of the mouth, inspecting the tongue, palate, uvula, and soft palate. What is normal and abnormal?
Inspect the dorsum of the tongue, noting any swelling, variation in size or color, coating, or ulcerations.
Ask the patient to extend the tongue while you inspect for deviation, tremor, and limitation of movement. The procedure also tests the hypoglossal nerve (cranial nerve XII).
Expect the protruded tongue to be maintained at the midline.
No atrophy or fasciculations should be present. Deviation to one side indicates tongue atrophy and hypoglossal nerve impairment.
A smooth red tongue with a slick appearance (glossitis) may indicate a vitamin B12 deficiency.
The hairy tongue with yellow-brown to black elongated papillae on the dorsum sometimes follows antibiotic therapy.
Inspect the floor of the mouth and the ventral surface of the tongue for swelling and varicosities, also observing the frenulum, sublingual ridge, and Wharton ducts.
Expect the ventral surface of the tongue to be pink and smooth with large veins between the frenulum and fimbriated folds. Wharton ducts are apparent on each side of the frenulum.
A ranula (mucocele) may be seen on the floor of the mouth when the duct of a sublingual salivary gland is obstructed.
Lesions on the tongue may be due to an infectious process.
Palpate the tongue and the floor of the mouth for lumps, nodules or ulceration. Expect the tongue to have smooth, even texture without nodules, ulcerations, or areas of induration.
Any ulcer, nodule, or thickened white patch on the lateral or ventral surface of the tongue may be suggestive of malignancy.
The whitish hard palate should be dome-shaped with transverse rugae.
The pinker soft palate is contiguous with the hard palate.
The uvula, a midline continuation of the soft palate, varies in length and thickness.
The hard palate may have a bony protuberance at the midline, called torus palatinus, an expected variant present in 25% to 35% of the population, more commonly seen in women compared with men.
A nodule on the palate that is not at the midline may indicate a tumor.
Deviation of the uvula to one side may indicate vagus nerve paralysis or peritonsillar abscess. The uvula deviates to the unaffected side in both instances.
A bifid uvula is often a benign condition and may be a normal variant in some Native Americans; however, it may indicate a submucous cleft palate. A bifid uvula has recently been associated with Loeys-Dietz syndrome, a disorder in which aortic root dilation and aortic dissection may occur. Describe how you inspect the oropharynx including the tonsils and tonsillar pillars. Describe how you test CN IX and X. What is normal and abnormal?
Inspect the oropharynx using a tongue blade to depress the tongue.

Observe the tonsillar pillars, noting the size of tonsils. If present, and the integrity of the retropharyngeal wall.
The tonsils, usually the same pink color of the pharynx, are expected to fit within the tonsillar pillars.
If the tonsils are reddened, hypertrophied, and covered with exudate, an infection may be present.
The posterior wall of the pharynx should be smooth, glistening, pink mucosa with some small, irregular spots of lymphatic tissue and small blood vessels.
A red bulge adjacent to the tonsil and extending beyond the midline may indicate a peritonsillar abscess.
A yellowish mucoid film in the pharynx is typical of postnasal drip.
After preparing the patient for a gag response, touch the posterior wall of the pharynx. Elicitation of the gag reflex tests the glossopharyngeal and vagus nerves (cranial nerves IX and X). expect a bilateral response.

NURS612 Advanced Health Assessment Exam 1-with 100% verified solutions | Latest Update, Exams of Nursing

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Partial preview of the text

Download NURS612 Advanced Health Assessment Exam 1-with 100% verified solutions | Latest Update and more Exams Nursing in PDF only on Docsity!

NURS612 Advanced Health Assessment

Exam 1-with 100% verified solutions |

Latest Update

NURS612 Advanced Health Assessment: Exam 1 Study Guide

What are concepts of developing a relationship with the patient?

The first meeting with the patient sets the tone for a successful partnership as you inform

the patient that you really want to know all that is needed and that you will be open,

flexible, and eager to deal with questions and explanations. A primary objective is to

discover the details about a patient’s concern, explore expectations for the encounter, and

display genuine interest, curiosity and partnership. Identifying underlying worries,

believing them, and trying to address them optimizes your ability to be of help. Personal

interactions and physical examination play an integral role in developing meaningful and

therapeutic relationships with patients. Because cost containment is also essential, the

well performed history and physical examination can justify the appropriate and cost-

effective use of technological resources. This underscores the need for judgment and the

use of resources in a balance appropriate for the individual patient.

How do you measure visual acuity and test cranial nerve II? Describe the various tests to

measure different types of visual acuity. How do you document your findings?

individually by covering one eye with an opaque card or gauze, being careful to

avoid applying pressure to the eye. If you test the patient with and without

corrective lenses, record the readings separately. Always test vision without

glasses first.

smallest line in which the patient can identify all of the letters and record the

visual acuity designated by that line. When testing the second eye, you may want

to ask the patient to read the line from right to left to reduce the chance of recall

influencing the response. Visual acuity is recorded as a fraction in which the

numerator indicates the distance of the patient from the chart and the denominator

a manifestation of rosacea, or an allergic response.

When you palpate the eyes, what are you assessing for?

Palpate the eyelids for nodules. Palpation of the orbit is one of the simplest methods for

intraocular pressure assessment. Gentle palpation through closed lids can confirm that

the involved eye is much harder than the uninvolved eye. Pain on palpation is consistent

with scleritis, orbital cellulitis, and cavernous sinus thrombosis. An eye that feels very

firm and resists palpation may indicate severe glaucoma or retrobulbar tumor.

Describe how you would inspect the lower and upper conjunctiva. What is normal? What

is abnormal? How do you document these findings?

Lowe r- pulling lower eyelid down to inspect the conjunctiva

Upper - everting upper eyelid. Placing applicator above the globe. Withdrawing the lid

from the globe.

an allergic infectious conjunctivitis.

limbus.

How do you examine the cornea for clarity and sensitivity? Cranial nerve V

normally avascular, blood vessels should not be present.

of cotton to the cornea. The expected response is a blink, which indicates intact sensory

fibers of CN V and motor fibers of CN VII (facial nerve).

zoster viral infections or is a sequela of trigeminal neuralgia or ocular surgery.

the cornea. If present before age 40, arcus may indicate a lipid disorder.

How do you inspect and test the iris and the pupil? How do you document normal and

abnormal?

directly into one eye and note whether the pupil constricts. Note also the consensual

response of the opposite pupil constricting simultaneously with the tested pupil.

performing the swinging flashlight test. Shine the light in one eye and then rapidly swing

to the other. There should be a slight dilation in the second eye while the light is crossing

the bridge of the nose, but it should constrict equally to the first eye as the light enters the

pupil.

distant object and then at a test object (either a pencil or your finger) held 10 cm from the

bridge of the nose. Expect the pupils to constrict when the eyes focus on the near object.

A failure to respond to direct light but retaining constriction during accommodation is

sometimes seen in patients with diabetes or syphilis.

Inspect the lens and sclera. What is normal? Abnormal?

pass through.

either yellow or green.

the medial rectus muscle. Its presence does not imply disease but should be noted.

Describe how you would inspect and palpate the lacrimal apparatus. What is normal and

abnormal?

canthus.

and lower lid margins nasally.

such as tumors, lymphoid infiltration, sarcoid disease, and Sjogren syndrome.

Describe you test the extra ocular movement? (CN II, IV & VI). What is normal and

abnormal?

Six cardinal fields of gaze.

Lid lag, the exposure of the sclera above the iris when the patient is asked to follow your finger

as you direct the eye in a smooth movement from ceiling to floor, may indicate thyroid disease.

Use the corneal light reflex to test the balance of the extraocular muscles.

Direct a light source at the nasal bridge from a distance of about 30cm.

Ask the patient to look at a nearby object (but not the light source). This will encourage both