Module 1,2,3

Questions

Findings

Current Symptoms: Eyes

1. Recent changes in vision?

2. Spots or floaters in front of eyes?

3. Blind spots, halos, or rings around lights?

4. Trouble seeing at night?

5. Double vision?

6. Eye pain?

7. Redness or swelling in eyes with regular daily activity?

8. Excessive watering or tearing or other discharge from eyes?

Past History

9. Previous eye or vision problems (medication, surgery, laser treatment, corrective lenses)?

Family History

10. Family history of eye problems or vision loss?

Lifestyle and Health Practices

11. Exposure to chemicals, fumes, smoke, dust, flying sparks, etc.?

12. Use of safety glasses?

13. Use of sunglasses?

14. Medications (corticosteroids, lovastatin, pyridostigmine, quinidine, risperdal, and rifampin) may have ocular side effects?

15. Has vision loss affected ability to work or care for self or others?

16. Date of last eye examination?

17. Are corrective glasses or contacts worn regularly?

Ears

Current Symptoms

1. Recent changes in hearing (if yes, were all or just some sounds affected)?

2. Ear discharge (if yes, amount/odor)?

3. Ear pain (if yes, is there accompanying sore throat, sinus infection, or problem with teeth or gums)?

4. Ringing or crackling in ears?

Past History

5. Previous ear or hearing problems such as infections, trauma, or earaches (medications, surgery, hearing aids)?

Family History

6. Family history of ear problems or hearing loss?

Lifestyle and Health Practices

7. Live or work around frequent or continuous loud noise?

8. Use of ear protection from noise or while in water?

9. Has hearing loss affected ability to work or care for self or others?

Questions

Findings

Current Symptoms

1. Mouth problems (tongue or mouth sores or lesions, gum or mouth redness, swelling, bleeding, or pain)?

2. Sinus problems (pain over sinuses, postnasal drip)?

3. Nose problems (nosebleeds, stuffy nose, cannot breath through one or both nostrils, change in ability to smell or taste)?

Past History

1. Previous problems with mouth, throat, nose, or sinuses (surgeries or treatment; how much and how often)?

2. Use of nasal sprays?

3. History of tooth grinding?

4. Last dental exam? Fit of dentures?

Family History

1. Family history of oral, nasal, or sinus cancer or chronic problems?

Lifestyle and Health Practices

1. Daily practice of oral care, tooth care, or denture care?

2. Usual diet? (Type of diet is acceptable here—patient may say, “I try to eat low carb, high protein, and don’t succeed very well.” If they say they don’t really think about it and just eat what they like, use “General diet”. Don’t do 24 hour recall here—that will be done with the GI system.

3. History of smoking, use of, how much, and how often?

4. Use of alcohol (how much and how often)?

Questions

Findings

Current Symptoms: Eyes

Perform Vision Tests

The vision charts for these tests are available at no cost on the internet.

1. Distant visual acuity (with Snellen chart, normal acuity is 20/20 with or without corrective lenses).

2. Near visual acuity (with a handheld vision chart, normal acuity is 14/14 with or without corrective lenses).

3. Visual fields (use procedure discussed in textbook to test peripheral vision).

Perform Extraocular Muscle Function Tests

4. Corneal light reflex (using a penlight to observe parallel alignment of light reflection on corneas).

5. Cover test (using an opaque card to cover an eye to observe for eye movement).

6. Positions test (observing for eye movement).

External Eye Structures

7. Inspect eyelids and lashes (width and position of palpebral fissures, ability to close eyelids, direction of eyelids in comparison with eyeballs, color, swelling, lesions, or discharge).

8. Inspect positioning of eyeballs (alignment in sockets, protruding or sunken).

9. Inspect bulbar conjunctiva and sclera (clarity, color, and texture).

10.Inspect the palpebral conjunctive (eversion of upper eyelid is usually performed only with complaints of eye pain or sensation of something in eye).

11.Inspect the lacrimal apparatus over the lacrimal glands (lateral aspect of upper eyelid) and the puncta (medial aspect of lower eyelid). Observe for swelling, redness, or drainage.

12. Palpate the lacrimal apparatus, noting drainage from the puncta when palpating the nasolacrimal duct.

13. Inspect the cornea and lens by shining a light to determine transparency.

14.Inspect the iris and pupil for shape and color of the iris and size and shape of the pupil.

15.Test pupillary reaction to light (in a darkened room, have client focus on a distant object, shine a light obliquely into the pupil, and observe the pupil’s reaction to light—normally, pupils constrict).

16.Test accommodation of pupils by shifting gaze from far to near (normally, pupils constrict).

Internal Eye Structure

17.Inspect the red reflex by using an ophthalmoscope or otoscope to shine the light beam toward the client’s pupil (normally, a red reflex is easily seen and should appear round with regular borders). (This is the “red-eye” seen in some home photographs.)

Optional (all blue areas)--may do the following eye assessments if you can, though it is not always possible to do well without dilating the eyes--give it a try and see if you can identify any of the following.

(Your score will not be affected by either your success or inability in this optional section in blue--it is a skill that takes quite a lot of practice! I recommend that you at least try so that if you take advanced practice classes you will have an idea how it feels.)

2. Inspect the optic disc by using the ophthalmoscope focused on the pupil and moving very close to the eye. Rotate the diopter setting until the retinal structures are in sharp focus (observe disc for shape, color, size, and physiologic cup).

3. Inspect the retinal vessels using the above technique (observe vessels for numbers of sets, color, diameter, arteriovenous ratio, and arteriovenous crossings).

4. Inspect retinal background for color and the presence of lesions.

5. Inspect the fovea and macula for lesions.

Current Symptoms: Ears

External Ear Structures

1. Inspect the auricle, tragus, and lobule for size and shape, position, lesions/discoloration, and discharge.

2. Palpate the auricle and mastoid process for tenderness.

Otoscopic Examination

3. Inspect the external auditory canal with the otoscope for discharge, color and consistency of cerumen, color and consistency of canal walls, and nodules.

4. Inspect the tympanic membrane, using the otoscope, for color and shape, consistency, and landmarks.

5. Have the client perform the Valsalva maneuver, and observe the center of the tympanic membrane for a flutter. (Do not do this procedure on an older client, as it may interfere with equilibrium and cause dizziness.)

Hearing and Equilibrium Tests

An easy-to-perform test for higher-pitched sounds is to rub the tips of your thumb and index finger together, 2 - 3 inches from the patient's ear—D. Furr

6. Perform the whisper test by having the client place a finger on the tragus of one ear. Whisper a two-syllable word (1–2 ft) behind the client. Repeat on the other ear.

7. Perform the Weber test by using a tuning fork placed on the center of the head or forehead and asking whether the client hears the sound better in one ear or the same in both ears.

8. Perform the Rinne test by using a tuning fork and placing the base on the client’s mastoid process. When the client no longer hears the sound, note the time interval, and move it in front of the external ear. When the client no longer hears a sound, note the time interval.

9. Perform the Romberg test to evaluate equilibrium. With feet together and arms at the side, close eyes for 20 seconds. Observe for swaying. (Refer to textbook, Chapters 16 and 26.)

Questions

Findings

Current Status

Mouth

1. Note any distinctive odors.

2. Inspect and palpate lips, buccal mucosa, gums, and tongue for color variations (pallor, redness, white patches, bluish hue), moisture, tissue consistency, or lesions (induration, roughness, vesicles, crusts, plaques, nodules, ulcers, cracking, patches, bleeding, Koplik spots, cancer sores), Stensen and Wharton ducts.

3. Inspect gums for hyperplasia, blue-black line.

4. Inspect teeth for number and shape, color (white, brown, yellow, chalky white areas), occlusion.

5. Inspect and palpate tongue for color, texture, and consistency (black, hairy, white patches, smooth, reddish, shiny without papillae), moisture, and size (enlarged or very small).

Throat

1. Inspect the throat for color, consistency, torus palatinus, uvula (singular).

2. Inspect the tonsils for color and consistency; grading scale (1, 2, 3, or 4).

Nose

1. Inspect and palpate the external nose for color, shape, consistency, tenderness, and patency of airflow.

2. Inspect the internal nose for color, swelling, exudate, bleeding, ulcers, perforated septum, or polyps.

Sinuses

1. Palpate the sinuses for tenderness.

2. Percuss and transilluminate (if possible) the sinuses for air versus fluid or pus.