HA exam 3 pics in correlation w/ STUDY PPT Cheilosis Carcinoma in tongue Ventral Surface Bells palsy – drooping Asymmetry anterior to earlobes (Abnormal) - Parotid swell Mask apperance – parkinsons disease Gingival recession – in older adults Thyroid – normal Thyroid abnormal Visual acuity - sharpness of vision, measured by the ability to discern letters or numbers at a given distance according to a fixed standard. - Check visual acuity by using Snellen chart Eye assessment & examination Visual acuity - position the client 20 feet from the Snellen or E-chart and ask her to read each line until she cannot decipher the letters, or their direction document the results Normal distant visual acuity is 20/20 clinical tip - if the client wears glasses, they should be left on unless they are reading glasses, reading glasses blur distant vision Presbyopia - impaired near vision is indicated when the client moves the chart away from the eyes to focus on the print presbyopia is a normal condition in clients over 45 years of age also known as pupillary light reflex Pupillary (consensual) response - Shine a light obliquely into one eye and observe the pupillary reaction in the opposite eye normal consensual pupillary response is constriction of the pupil of the opposite eye in which the light was shined on - Clinical tip – when testing consensual response place your hand or another barrier btw the clients eyes to light (example index card) between the client’s eye to avoid an inaccurate finding Pupillary (Direct) response - Darken the room, ask the client to focus on a distant object, shine a light into one eye and observe that eye’s pupillary reaction normal direct response, is constriction of that eye’s pupil abnormal response is pupils do not constrict at all to direct and consensual pupillary testing - indicating blindness (Pupillary) accommodation - accommodation occurs when the client moves his or her focus of vision from a distant point to near object causing the pupils to constrict and eyes to converge - Hold your finger or pencil 12 to 15 inches from the client ask the client to focus on your finger/pencil as you move it closer in toward the eyes (AKA tell the patient to focus on a FAR object and then a NEAR object) o The normal response is constriction of the pupils and convergence of the eyes (accommodation & convergence) o o Abnormal - pupils do not constrict eyes do not converge Visual field - Position yourself two feet away from the client have the client cover left eye you covered the right eye (aka: it appears as if the same eye is being covered since ya’ll are positioned directly across from each other) examiner extends left arm at midline and slowly moves one finger upward from below until the client sees the finger - This test for peripheral vision - client should see the examiners fingers at the same time as the examiner sees it - Visual fields include “SNIT” - “50,60,70 & 90” Superior 50 degrees nasal 60 degrees inferior 70 degrees temporal 90 degrees Hemianopia – blindness over half of the field of vision Bitemporal hemianopia - loss of vision in both temporal fields D/T lesion of optical chiasm Right visual field loss - right homonymous hemianopia – or similar loss of vision in half of each field d/t lesion in right optic track or lesion in temporal loop (optic radiation) Unilateral blindness - example blind right eye in this example d/t lesion in right eye or right optic nerve Extraocular eye movements are tested through - Corneal light reflex test, cover test and cardinal field of gaze - - corneal light reflex test: o shine light toward the bridge of the nose while the clients stare straight ahead o this test assesses parallel alignment of the eyes o reflection of the light on the cornea should be in the same exact spot in each eye cover test o Ask the client to stare straight ahead focus on an object, cover one of the clients’ eyes with an opaque card o when uncover eye should remain fixed straight ahead (normal response) - o abnormal – uncovered eye will move to establish focus when the opposite eye is covered & and when uncovered movement to re- establish focus occurs cardinal fields of gaze o Assesses eye muscle strength and cranial nerve function o instruct client to focus on an object you are holding, move the object through the six cardinal positions of gaze in a clockwise direction o normal - eye movement should be smooth symmetric through all six directions abnormal - failure of the eyes to follow movement symmetrically in all directions indicates weakness in one or more extraocular muscles or dysfunction of the cranial nerve that innervates the muscle abnormal extraocular eye movement include- Strabismus - constant malalignment Exotropia - eyes turn outward Esotropia - eyes turn inward Nystagmus – shaking of eyes PTOSIS – drooping of eye Ectropion – outward rolling of the lower lid Entropion - Inward rolling of the lower lid Conjunctivitis – red & inflamed conjunctiva Exophthalmos – protruding eyeball, eyelids retract Chalazion- infected meibomian gland Stye/hordeolum - is an acute, localized swelling of the eyelid that may be external or internal BlePHaritis – StaPH infection of eyelid EpiSCLERitis – inflammation of the sclera Subconjunctival hemorrhage – Bright red areas of the sclera (aka - they are hemorrhaging, aka they are bleeding) Scleral jaundice – yellowing of the sclera (most likely indicates some liver/hepatic dysfunction or abnormality) - prEsbyopia – nEar (aka impaired NEAR VISON) - Myopia – (aka impaired far vision) - - Opia = vision - Myosis – pinpoint pupils - Mydriasis – dilated fixed pupils (Think -myosis is a smaller word than mydriasis – so w/ myosis you get small pinpoint pupils vs. w/ mydriasis you get dilated fixed pupils) (also, when you see the suffix/ending -sis – think pupils) - Anisocoria – unequal pupil size - NORMAL AGE-RELATED CHANGES - - In this picture the pingecula is not on iris (but I wabted to include it so you know what it looks like) What you need to remember is that – Pingecula is a normal age related change – it will appear as a yellow nodule on the irsi – first in a medial location & then it will move laterally TIP: any time you see the word senilus it is a normal condition for old ppl Aecus senilus – white arch around limbus - Cataracts – clouding of the lens – (opacity) – NOT A NORMAL CONDITION – but common – especially in elderly - BLACK SPOKES – evedent w/ cortical cataracts (mostly seen in elderly) Tophy – gout
