Midterm Practicum

Eyes
Snellen Chart: Cranial Nerve II (Optic Nerve) Position patient 20 feet away from chart. Instruct patient to leave on glasses or contact lenses. Have patient cover one eye at a time with opaque card. Encourage patient to read next smallest line after any hesitancy. When charting indicate eye, then in fraction form numerator being distance from chart, and denominator being the number of feet indicated on last line read, then how many they got wrong on last line, and then if glasses or contacts were worn.
Ex. Left 20/30-2 glasses

Jaeger Screener: Have patient hold card 14 inches away from face. Test each eye separately with glasses on. Normal result is 14/14; numerator being how many inches held away from face, and denominator being the number indicated as point on the last line that patient was able to read. Patient should read with no hesitancy and without moving the card further or closer to face.
Confrontation Test: Cranial Nerve II (Optic Nerve) Measures peripheral vision. Position yourself eye level and about two feet away. Direct person to cover one eye and look straight at you. You cover eye directly opposite of their covered eye. Use a flicking finger or pen and advance from four directions. Have patient say now when they see your finger, you should see finger around same time. Four directions are superiorly seen at a 50 degree angle from anteroposterior axis of the eye, nasally seen at 60 degrees, temporally at 90 degrees, and inferiorly at 70 degrees.

Six Cardinal Positions of Gaze: CN III; oculomotor nerve CN IV; trochlear nerve and CN VI abducens nerve. Leading the eyes with your finger will elicit any muscle weakness with movement. Have person hold head steady and instruct them to follow your finger. Hold finger about 12 inches away, and move to six positions. Hold momentarily and bring back to the middle. Normal response is that eye movement and tracking is parallel

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Inspect external eye structures
General: note persons ability to move around room well and to follow your directions. Note facial expression a relaxed expression accompanies adequate vision. Eyebrows: Look for symmetry, normally they are present bilaterally, move symmetrically as facial expression changes and have no scaling or lesions.
Eyelids: Upper lids normally overlap the superior part of the iris, and approximate completely with lower lids when closed. Skin intact without redness swelling, discharge, or lesions.
Eye Lashes: evenly distributed along lid margins and curve outward
Conjunctiva: ask person to look up using thumbs slide the lower lids down along the bony orbital rim. They should be clear and show the color of the structures below pink over lower lids and white over the sclera. Note any color change swelling or lesions.

Inspect Sclera, Cornea and Iris
Sclera: China white
Cornea: Shine light from the side across cornea and check for smoothness and clarity
Iris: Normally appears flat with round regular shape and equal in both eyes. Normal adult size is 3mm to 5mm PERRLA: Pupils Equal Round Reactive to Light and Accommodation Evaluate size and shape of pupil. Darken room and ask person to gaze into the distance, dilating pupils. Advance light in from the side and note 1. A constriction of the same-sided pupil known as a direct light reflex. 2. Simultaneous constriction of the other pupil known as a consensual light reflex. Test for accommodation by asking the person to focus on a distant object dilating the pupils,. Then have them shift gaze to a near object such as your finger held about 7 to 8 cm or 3 inches away from person’s nose. Normal response shows papillary constriction and convergence of the axes of the eyes,

Ears
Inspect External Ear Ears are of equal size bilaterally with no swelling or thickening. Skin color consistent with the person’s facial skin color. Skin is intact with no lumps or lesions. Auditory Meatus should have no swelling redness or discharge.