Eyes and Ears

Cards (170)

  • Suggested interview questions for subjective assessment of the eyes and ears
    • Eye: Have you had any difficulty seeing or experienced blurred vision? Do you wear glasses or contact lenses? When was your last vision test? Have you had any redness, swelling, watering, or discharge from the eyes? Have you ever been diagnosed with an eye condition such as cataracts, glaucoma, or macular degeneration? Are you currently using any medication, eye drops, or supplements for your eyes?
    • Ear: Have you had any trouble hearing? If so, do you wear hearing aids? Have you had any symptoms like ringing in the ears, drainage from the ears, or ear pain? Do you ever feel dizzy, off-balance, or like the room is spinning? Have you ever been diagnosed with an ear condition such as an infection, tinnitus, or vertigo? Are you currently using any medications, ear drops, or supplements for your ears?
  • Pediatric considerations

    • Information is also obtained from parents and/or legal guardians, children aged 2-24 months commonly experience ear infections, vision impairments may become apparent in school-aged children
  • Subjective assessment
    Nurses collect information from the patient and/or family caregivers using detailed questions and pay close attention to what the patient is reporting to guide the physical exam
  • Older adult considerations
    • The aging adult experiences a general slowing in nerve conduction, vision, hearing, fine coordination, and balance may become impaired, they may experience presbyopia, presbycusis, cataracts, macular degeneration, or glaucoma, they may experience feelings of dizziness or feeling off-balance which can result in falls
  • Suggested interview questions for subjective assessment of the eyes and ears
    • Eye: Have you had any difficulty seeing or experienced blurred vision? Do you wear glasses or contact lenses? When was your last vision test? Have you had any redness, swelling, watering, or discharge from the eyes? Have you ever been diagnosed with an eye condition such as cataracts, glaucoma, or macular degeneration? Are you currently using any medication, eye drops, or supplements for your eyes?
    • Ear: Have you had any trouble hearing? If so, do you wear hearing aids? Have you had any symptoms like ringing in the ears, drainage from the ears, or ear pain? Do you ever feel dizzy, off-balance, or like the room is spinning? Have you ever been diagnosed with an ear condition such as an infection, tinnitus, or vertigo? Are you currently using any medications, ear drops, or supplements for your ears?
  • Pediatric
    • When collecting subjective data from children, information is also obtained from parents and/or legal guardians. Children aged 2-24 months commonly experience ear infections. Vision impairments may become apparent in school-aged children when they have difficulty seeing the board from their seats.
  • Additional subjective data for pediatrics
    • Have you or your child's teachers noticed your child experiencing any problems seeing or hearing?
    • Has your child experienced frequent ear infections or had tubes placed in their ears? If so, have you noticed any effects on their language development?
  • Older adults
    • The aging adult experiences a general slowing in nerve conduction. Vision, hearing, fine coordination, and balance may also become impaired. Older adults may experience presbyopia (decreased near vision), presbycusis (hearing loss), cataracts, macular degeneration, or glaucoma. They may also experience feelings of dizziness or feeling off-balance, which can result in falls.
  • Educate all patients to have yearly eye examinations
  • Objective assessment
    A routine assessment of the eyes and ears by registered nurses in inpatient and outpatient settings typically includes external inspection of eyes and ears for signs of a medical condition, as well as screening for vision and hearing problems
  • Objective assessments
    • Vision screening test
    • Whispered voice hearing test
    • Assessment of pupillary response
  • Additional assessments may be performed if the patient's status warrants assessment of the cranial nerves
  • Inspection - Eyes
    • The sclera should be white and the conjunctiva should be pink. There should not be any drainage from the eyes. The patient should demonstrate behavioral cues indicating effective vision during the assessment.
  • Inspection - Ears

    • There should not be any drainage from the ears or evidence of cerumen impaction. The patient should demonstrate behavioral cues indicating effective hearing.
  • Vision tests assess far vision using the Snellen eye chart and near vision may be assessed using a prepared card or a newspaper. Color vision may be assessed using a book containing Ishihara plates.
  • Inspection of eyes
    Sclera should be white, conjunctiva should be pink, no drainage, patient should demonstrate behavioral cues indicating effective vision
  • Hearing test
    Nurses perform a basic hearing assessment during conversation with the patient. Cues that may indicate hearing loss include lip-reading, leaning forward, moving head to catch sounds, misunderstanding questions, using an inappropriately loud voice, and demonstrating garbled speech or distorted vowel sounds.
  • Whisper test
    Stand at arm's length behind the seated patient, test each ear individually, have the patient occlude the non-tested ear, whisper a combination of numbers and letters, and ask the patient to repeat the sequence. The patient passes if they repeat at least three out of six correctly for each ear.
  • Subjective assessment
    Nurses collect information from the patient and/or family caregivers using detailed questions and pay close attention to what the patient is reporting to guide the physical exam
  • Inspection of ears
    No drainage or cerumen impaction, patient should demonstrate behavioral cues indicating effective hearing
  • When a patient is suspected of experiencing a neurological disease or injury, their pupils are assessed to ensure they are bilaterally equal, round, and responsive to light and accommodation (PERRLA). Extraocular movement and other cranial nerves that affect vision, hearing, and balance may also be assessed.
  • Suggested interview questions for subjective assessment of the eyes and ears
    • Eye: Have you had any difficulty seeing or experienced blurred vision? Do you wear glasses or contact lenses? When was your last vision test? Have you had any redness, swelling, watering, or discharge from the eyes? Have you ever been diagnosed with an eye condition such as cataracts, glaucoma, or macular degeneration? Are you currently using any medication, eye drops, or supplements for your eyes?
    • Ear: Have you had any trouble hearing? If so, do you wear hearing aids? Have you had any symptoms like ringing in the ears, drainage from the ears, or ear pain? Do you ever feel dizzy, off-balance, or like the room is spinning? Have you ever been diagnosed with an ear condition such as an infection, tinnitus, or vertigo? Are you currently using any medications, ear drops, or supplements for your ears?
  • Pediatric
    • When collecting subjective data from children, information is also obtained from parents and/or legal guardians. Children aged 2-24 months commonly experience ear infections. Vision impairments may become apparent in school-aged children when they have difficulty seeing the board from their seats.
  • Hearing test
    Observe patient cues during normal conversation that may indicate hearing loss, perform whispered voice test
  • Whispered voice test
    Stand at arm's length behind seated patient, test each ear individually, patient occludes non-tested ear, whisper combination of numbers and letters, patient repeats sequence, patient passes if they repeat at least 3 out of 6 correctly
  • Expected findings on eye and ear assessment
    • Eyes: Sclera is white, lens is clear, conjunctiva is pink, no redness/swelling/discharge, no drainage, patient displays behavioral cues of effective vision, eyes appear appropriately placed
    • Ears: No drainage or cerumen, conversation includes behavioral cues of effective hearing, patient passes whispered voice test, demonstrates good balance and gait
  • Additional subjective data for pediatrics
    • Have you or your child's teachers noticed your child experiencing any problems seeing or hearing?
    • Has your child experienced frequent ear infections or had tubes placed in their ears? If so, have you noticed any effects on their language development?
  • Older adults
    • The aging adult experiences a general slowing in nerve conduction. Vision, hearing, fine coordination, and balance may also become impaired. Older adults may experience presbyopia (decreased near vision), presbycusis (hearing loss), cataracts, macular degeneration, or glaucoma. They may also experience feelings of dizziness or feeling off-balance, which can result in falls.
  • Pupillary response, extraocular movement, and cranial nerves
    • Assessed when patient is suspected of neurological disease or injury, pupils should be bilaterally equal, round, and responsive to light and accommodation, extraocular movement and other cranial nerves affecting vision, hearing, and balance may also be assessed
  • Unexpected findings on eye and ear assessment (document and notify provider)
    • Eyes: Yellow sclera, cloudy lens, red conjunctiva/discharge, eyelid redness/crusting/lumps, behavioral cues of vision loss, sunken eyes
    • Ears: Purulent drainage, cerumen impaction, behavioral cues of hearing loss, fails whispered voice test, poor balance or gait
  • Critical conditions to report immediately: new and sudden problems such as vision loss, blurred vision, eye pain, red eye, ear pain, vertigo, poor balance, or gait change
  • Anatomy of the eye
    The eyes are located within the orbits in the skull. The eyelids, conjunctiva, iris, pupil, cornea, retina, and optic nerve are key structures. Tears are produced by the lacrimal gland and flow over the conjunctiva. Eye movement is controlled by the extraocular muscles innervated by cranial nerves III, IV, and VI.
  • Expected vs unexpected findings on eye and ear assessment
    • Expected: Eyes - sclera white, lens clear, conjunctiva pink, no redness/swelling/discharge, no drainage, patient displays behavioral cues of effective vision. Ears - no drainage/cerumen, patient demonstrates behavioral cues of effective hearing, passes whispered voice test, good balance and gait.
    • Unexpected: Eyes - yellow sclera, cloudy lens, red conjunctiva/discharge, redness/crusting on lids, tender lump, behavioral cues of vision loss. Ears - purulent drainage, cerumen impaction, behavioral cues of hearing loss, fails whispered voice test, poor balance/gait.
  • Common eye disorders
    • Myopia
    • Presbyopia
    • Color blindness
    • Dry eye
    • Conjunctivitis
    • Stye
    • Cataracts
    • Macular degeneration
    • Glaucoma
  • Myopia
    Impaired vision, also known as nearsightedness, that makes far-away objects look blurry. It is caused by the eyeball growing too long or problems with the shape of the cornea or lens, causing light to focus in front of the retina.
  • Additional assessments may be performed if the patient's status warrants assessment of the cranial nerves
  • Inspection - Eyes
    • The sclera should be white and the conjunctiva should be pink. There should not be any drainage from the eyes. The patient should demonstrate behavioral cues indicating effective vision during the assessment.
  • Critical conditions to report immediately: new and sudden problems such as vision loss, blurred vision, eye pain, red eye, ear pain, vertigo, poor balance, or gait change
  • Anatomy of the eye
    Eyes located in orbits, eyelids/lashes protect eye, conjunctiva covers sclera, iris controls pupil, cornea refracts light, retina contains photoreceptors, optic nerve transmits visual info to brain, extraocular muscles control eye movement
  • Presbyopia
    Impaired near vision that commonly occurs in middle-aged and older adults, making it difficult to clearly see objects up close. It is caused by the lens in the eye getting harder and less flexible, stopping it from focusing light correctly on the retina.