Name: IBUOS, APRIL S.

A-1 BSN
HEALTH ASSESSMENT
MODULE 8
1.Lymphedema is a chronic, debilitating condition in which excess fluid called lymph collects in tissues
and causes swelling (edema) in them.
Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms
and both legs swell. Lymphedema is most commonly caused by the removal of or damage to your lymph
nodes as a part of cancer treatment.

2.Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much
calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart
and brain work. Hypercalcemia is usually a result of overactive parathyroid glands.

3.Hypocalcemia is defined as a total serum calcium concentration < 8.8 mg/dL (< 2.20 mmol/L) in the
presence of normal plasma protein concentrations or as a serum ionized calcium concentration < 4.7
mg/dL (< 1.17 mmol/L).Hypocalcemia: Lower-than-normal level of calcium in the blood, which makes the
nervous system highly irritable, as evidenced by tetany (spasms of the hands and feet, muscle cramps,
abdominal cramps, and overly active reflexes).

Module 9
1.ECTROPION- is a condition in which your eyelid turns outward. This leaves the inner eyelid surface
exposed and prone to irritation. Ectropion is more common in older adults, and it generally affects only
the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out.
Guidelines on how to assess:
 Get the health history of the client/patient. Its very important to understand if the client/patient
had prior surgery, for example, lower eyelid blepharoplasty, trauma or cancer excision and repair
of the lower eyelid and/or check area.
 Ask about any symptoms relayed to dry eye, eye rubbing or instability of the eyelids
 Assess the position of the lower punctum which may rotate way the medical laxity and no longer
make contact with ocular surfaces and tear lake.
 Examine the bony architecture of the lower orbital rim and midface position.
 Inspect the face and facial muscle strength to assess for paralysis
 A full ophthalmic examination is necessary to properly assess the bilateral eyelids as well as the
ocular surface and cornea to evaluation for any complications related to the ectropion.

Bibliography
L,Skorin."Ectropion:Symptoms and Causes",Mayo Clinic,13 December
2018,https://www.mayoclinic.org/diseases-conditions/ectropion/symptoms-causes/syc-20351164

2.ENTROPION- a condition in which the eyelid is rolled inward against the eyeball, typically caused by
muscle spasm or by inflammation or scarring of the conjunctiva (as in diseases such as trachoma), and
resulting in irritation of the eye by the lashes (trichiasis)
Guidelines on how to assess:
 Assess history of eye
 Assess all medications, vitamins and supplements that the client takes including the doses.
 Assess symptoms that the client been having and for how long
 Assess other eye conditions, injuries or surgeries he/she had
 Note for any blepharo o facial spam, signs of skin irritation or infection and ocular surface
disturbance including cicatricial changes.
 Pay attention the lid margin structures to evaluate for certain condition/signs/symptoms.
Bibliography
Shukla,Gauravl."What is Entropion?",Britannica,18 June
2008,https://www.britannica.com/science/ptosis/additional-info

3.CHALAZION- is a small swelling or lump on your eyelid because of a blocked gland. They’re called
chalazia if you have more than one. A chalazion is one of the most common types of eyelid lumps.

Chalazia are most likely to happen on your upper eyelid. You can get them on both eyes at once. Chalazia
often go away and come back.

Guidelines on how to assess:

 Ask about the client symptoms, past eye problems and health history in general.
 Palpate nodule on the eyelid, sometimes as large as 7-8 mm in diameter
 Assess the condition of the meibomian glands-(which often show diffuse inspissations of
yellowish content from the eyelid margin orifices).
 Describes swelling, round, erythematous surrounding the swelling
 Assess for visual acuity

Bibliography
Seltman,Whitney."Chalazion:Symptoms,Causes and Treatments",WebMD,23 April
2020,https://www.webmd.com/eye-health/chalazion-what-is

4.HORDEOLUM- is a localized infection or inflammation of the eyelid margin involving hair follicles of the
eyelashes (ie, external hordeolum) or meibomian glands (ie, internal hordeolum). A hordeolum usually is
painful, erythematous, and localized. It may produce edema of the entire lid.

Guidelines on how to assess:

 Ask about the client symptoms, past eye problem and health history in general
 Assess the area around the orbit, the eye and the conjunctival surface
 Examine the eye for clinical features of an external (swelling at the eyelid margin) or internal
(swelling on the internal eyelid) style.
 Evaluate the lid margins, the base of the eyelashes and oil gland openings
 Careful inspection of the underside of the eyelid in necessary to distinguished an external from
internal hordeolum.
 Palpation of adjacent lymph nodes can help to identify spread of the disease beyond an
uncomplicated eyelid lesion.

Bibliography
Michael J Bessette, MD and FACEP."What is Hordeolum?",Medscape,08 October
2019,https://www.medscape.com/answers/798940-61460/what-is-a-hordeolum-stye#:~:text=A
%20hordeolum%20(ie%2C%20stye),edema%20of%20the%20entire%20lid.

5.Blepharitis- Inflammation of the eyelids. Blepharitis occurs in two forms, anterior and posterior.
Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two
most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff. Posterior
blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by
problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this
form of blepharitis: rosacea and seborrheic dermatitis.
Guidelines on how to assess:
 Assess the health history. Patient history to determine any symptoms the patient is experiencing
and any general health problems that may be contributing to the eye problem.
 Examine the eyes. You might eye special magnifying instrument to examine the eyelids and the
eyes.
 Observe symptoms such as chronic irritation, itching, burning and mild lacrimation. And signs
such as telangiectasia on the anterior eyelid, hard scales/collarettes encircling the lash base, and
corneal changes (infiltrates, phylctenules)
 Swabbing skin for testing
 Signs of blepharitis are assess subjectively using reference scales.
 Find characteristic slit-lamp biomicroscopic
 Examine the tear film

Bibliography
Seltman,Whitney.",Blepharitis:Symptoms,Causes and Treatment",WebMD,16 April
2020,https://www.webmd.com/eye-health/blepharitis

6.PTOSIS- In this condition, the border of the upper eyelid falls to a lower position than normal. In severe
cases, the drooping eyelid can cover all or part of the pupil and interfere with vision.

Ptosis can affect one or both eyes. It may be present at birth (congenital ptosis), or it may develop
gradually over decades. Sometimes ptosis is an isolated problem that changes a person's appearance
without affecting vision or health. In other cases, however, it can be a warning sign that a more serious
condition is affecting the muscles, nerves, and brain or eye socket. Ptosis that develops over a period of
days or hours is more likely to signify a serious medical problem.

Guidelines on how to assess:

 Provide patient privacy and ensure comfort
 Perform hand hygiene
 Inform the patient
 Review your client's previous medical record if available and this is done to identify
instances of harm to patients
 Her/his medical histories and current treatment procedures.
 Determine the scope of the assessment and prepare the necessary equipment to
conserve time and energy
 Check for use of any visual aids prior to starting the test

Bibliography
DeAngelis,Kendra."Drooping Eyelid(Ptosis)?",American Academy of Ophthalmology",19 February
2021,https://www.aao.org/eye-health/diseases/what-is-ptosis

7.CONJUCTIVITIS-often called pink eye. It happens when the conjunctiva is irritated by an infection or
allergies. Your eyes are red and swollen (inflamed), and sometimes they have a sticky discharge. You can
have conjunctivitis in one or both eyes. Some types of pink eye are very contagious (easily spread from
person to person).

Guidelines on how to assess:

 Provide patient privacy and ensure comfort
 Perform hand hygiene
 Inform the patient
  Review your client's previous medical record if available and this is done to identify
instances of harm to patients
 Her medical histories and current treatment procedures.
 Determine the scope of the assessment and prepare the necessary equipment to
conserve time and energy
 Check for use of any visual aids prior to starting the test

Bibliography
Boyd,Kierstan."Conjunctivitis:What is Pink Eye?",American Academy of Ophthalmology,17 February
2020,https://www.aao.org/eye-health/diseases/pink-eye-conjunctivitis

8.MIOSIS- means excessive constriction (shrinking) of your pupil. In miosis, the diameter of the pupil is
less than 2 millimeters (mm), or just over 1/16th of an inch.

The pupil is the circular black spot at the center of your eye that allows light to enter. Your iris (the
colored part of your eye) opens and closes to change the size of the pupil.

Guidelines on how to assess:

 First thing to do is introduce yourself to verify your client identity.
 Explain to the client what we're going to do why it's necessary and how the plan can
cooperate.
 Perform hand hygiene and observe for other appropriate infection control procedure
 Provide client's privacy and dignity
 Determine quiet history of the following like vision difficulty
 Inspect position, appearance and eye blinking
 Inspect for the client's flare
 Check the client visual activity

Bibliography
Hetch,Marjorie."What is Miosis?",Healthline,21 February
2019,https://www.healthline.com/health/miosis

9.MYDRIASIS- is the medical term for an unusual dilation or widening of the pupils. Normally, a person's
pupils dilate when the light is dim so that more light can enter the eye. Mydriasis describes a condition
where the pupils dilate without a change in the levels of light.

Guidelines on how to assess:

•Provide patient privacy and ensure comfort
•Perform hand hygiene
•Inform the patient
•Review your client's previous medical record if available and this is done to identify instances of harm to
patients
•Her medical histories and current treatment procedures.
•Determine the scope of the assessment and prepare the necessary equipment to conserve time and
energy
•Introduce self and verify client's identity
•Explain what the procedures all about are and how the client can participate.
•Check for use of any visual aids prior to starting the test
•Take three reading: right eye, left eye and both eyes
•Record the reading of each eye and both eyes
Bibliography
Dresden,Danielle."Causes and Treatment of Dilated Pupils",Medical News Todays,30 April
2018,https://www.medicalnewstoday.com/articles/321686

10.ANISOCORIA- is a condition in which the pupil of one eye differs in size from the pupil of the other eye.
Your pupils are the black circles in the center of your eyes. They are usually the same size.

Anisocoria can be caused by several things. You can be born with this condition or develop it later. You
might experience it on an ongoing basis or only temporarily. In some cases, your doctor might diagnose
an underlying medical condition or other cause of anisocoria.

Guidelines on how to assess:

Ask about the client symptoms, past eye problems, and health history in general.
The examination room should be dimly lit as an accurate assessment of aniscoria cannot be done in a
brightly lit room.
The patient should focus on a distant object to avoid miosis from a near papillary reaction which may
confuse the response to the examiner’s light.
Measure the patient’s pupil diameter to look for any evidence of aniscoria
Light reaction
Radiological with computed tomogram (CT) or magnetic resonance angiogram (MRI)
Magnetic resonance angiogram(MRA)

Bibliography
Kahn,April."Anisocoria:Symptoms,Causes and Treatment",Healthline,23 July
2019,https://www.healthline.com/health/anisocoria

11.PRESBYOPIA- is the gradual loss of your eyes ability to focus on nearby objects Its natural, often
annoying part of aging. Presbyopia usually becomes noticeable in your early to mid-40s and continues
worsen until around age of 65.

Guidelines on how to assess

 Ask about the client symptoms, past eye problems and health history in general.
 Basic eye exam which includes a refraction assessment and an eye health exam
 Evaluate the appropriate management options for the patient
 Minimize the visual disability through optometric care

Bibliography
Boyd,Keirstan."What is Presbyopia?",American Academy of Ophthalmology,13 January
2020,https://www.aao.org/eye-health/diseases/what-is-presbyopia

12.NYSTAGMUS- is a condition where the eyes move rapidly and uncontrollably. They can move:

 side to side (horizontal nystagmus)

 up and down (vertical nystagmus)
 in a circle (rotary nystagmus)
The movement can vary between slow and fast and usually happens in both eyes. The eyes may shake
more when looking in certain directions. People with nystagmus may tilt or turn their head to see more
clearly. This helps to slow down the eye movements.
Guidelines on how to assess:
 Patient preparation
 Ask the client symptoms, past eye problems and health history in general
 Inspect the eyes, eye lids, pupils, sclera and conjunctiva
 Testing the cranial nerves responsible for eye function

Bibliography
Boyd,Keirstan."What is Nystagmus?",American Academy of Ophthalmology,28 October
2020,https://www.aao.org/eye-health/diseases/what-is-nystagmus

13.ESOTROPIA- is a condition where one or both eyes turn inward. The term derives from Greek, where
‘eso-‘ means ‘inward,’ and ‘trope’ means ‘turn.’

Esotropia can take several forms, with some types developing in infancy and others occurring in
adulthood.

Guidelines on how to assess:

 Ask about the client symptoms, past eye problems and health history in general.
 All patients with esotropia would need a complete ophthalmologic examination including visual
acuity, binocular function and stereopsis, motility evaluation, strabismus measurement of
fusional amplitudes, cycloplegic refraction.

Bibliography
Leonard,Jayne."What you need to know about Esotropia."Medical News Today,8 November
2017,https://www.medicalnewstoday.com/articles/319948

14.EXOTROPIA- is a common form of strabismus characterized by an outward eye turn, away from the
nose.
Exotropia is a eye turn where one eye points outwards, this may be noticed while the child is looking at
distance objects, near objects or both.

Guidelines on how to assess:

 Patient preparation
 Asses external eye structures and pupils, visual acuity, ocular movements and peripheral vision.
 Assessment of external eye structures: position and alignment of eye, eye bro, eye lids, eye lashes,
lacrima glands, pupil and iris.
 Assessment of pupils done by using penlight which produce constriction of pupil to show
accommodation and convergence of pupil.
 Collection information such as observation, auscultation, palpation and percussion.
Bibliography
Lazarus,Russel."What is Exotropia?",Optometrists,26 March 2020,https://www.optometrists.org/a-
guide-to-eye-turns/exotropia-outward-eye-turn/

15.STRABISMUS- is a failure of the two eyes to maintain proper alignment and work together as a team.

Strabismus can be constant or intermittent. The misalignment might always affect the same eye
(unilateral strabismus), or the two eyes may take turns being misaligned (alternating strabismus).

Guidelines on how to assess:

 Patient history ( determine the symptom of the patient he/she have, family history general health
problems, medications being used and any other possible causes of symptoms).
  Visual acuity
 Refraction
 Alignment and focus test
 Examination after dilation (widening) of the pupils to determine the health internal eye structure
Bibliography
Heiting,Gary."Strabismus(Crossed eyes)",All About Vision,https://www.allaboutvision.com/masthead-
gary-heiting.htm

16.RED REFLEX- is elicited in the Brü ckner test, a pediatric screening tool often used by primary care
doctors and pediatricians to detect abnormalities of the eyes and ocular diseases. Originally described as
a “transillumination” test, Brü ckner found that the red reflex was useful in detecting strabismus and
amblyopia in young children. The red reflex from the retina is a quick and non-invasive test used to
identify opacities in the visual axis, such as a corneal abnormality or cataract, as well as abnormalities in
the posterior segment of the eye, such as retinoblastoma.

Guidelines on how to assess:

 Patient preparation like explain to the patient about the nature of the test to seek his/her
confidence and co-operation.
 Assess vision related history such type of vision loss (gradual, sudden, transient) as time onset,
duration, history of spectacle wear.
 Assess history of red eye, pain, swelling, diplopia, photophobia, trauma, surgery.
 Observe abnormality in posture, capacity to comprehension

Bibliography
M,Nguyen and K,Blair."Red Reflex",Books,6 September
2020,https://www.ncbi.nlm.nih.gov/books/NBK553139/#_NBK553139_pubdet_

17.PAPILLEDEMA- also known as papilloedema, is optic disc swelling that is secondary to elevated
intracranial pressure. In contrast to other causes of optic disc swelling, vision usually is well preserved
with acute papilledema. Papilledema almost always presents as a bilateral phenomenon and may develop
over hours to weeks.

Guidelines on how to assess:

 Patient preparation
 History and physical examination including blood pressure measurement
 Ophthalmic examination- in addition to fundus examination, assessment of visual acuity,
pupillary examination, ocular motility and alignment and visual fields.
 MRI with or without contrast in the best investigation of choice

Bibliography
Gossman,Mitchel and MD."What is Papilledema?",Medscape,4 September
2019,https://www.medscape.com/answers/1217204-102249/what-is-papilledema

18.How should you assess the pupils and iris?

Pupils should be examined in light and then in the dark. A comparison of the size, symmetry and shape of
the pupils in both eyes is crucial. Get the patient to fix their eyes on a distant point to begin with, then to
observe the pupils through a side illumination.

Bibliography
Goh,Lih Yen."The assessment of pupils and pupillary reactions",Eyenews,1 October
2015,https://www.eyenews.uk.com/education/trainees/post/the-assessment-of-pupils-and-pupillary-
reactions#:~:text=Pupils%20should%20be%20examined%20in,the%20size%20of%20the%20pupils .

19.How should you assess the lacrimal apparatus?

The lacrimal apparatus is checked by observing for excess dryness or tearing. Gently pressing the lacrimal
sac at the medial corner of the lower lid and nose will normally not express any discharge.

Bibliography
FC,Bell."The External Eye
Examination",Books,1990,https://www.ncbi.nlm.nih.gov/books/NBK218/#_NBK218_pubdet_

20.How should you check for the visual acuity,peripheral vision,accommodation?

•The visual acuity is used to determine the smallest letters you can read on a standardized chart (Snellen
chart) or a card held 20 feet (6 meters) away. Special charts are used when testing at distances shorter
than 20 feet (6 meters). Some Snellen charts are actually video monitors showing letters or images.
•You can check your peripheral vision with the help of someone else using similar techniques to those
used by an eye doctor. Cover one eye at a time while focusing on something directly in front of you. Have a
helper hold up fingers in your peripheral vision to see if you can tell them how many they are holding up.
•Checking for the accommodation reflex follows nicely on from eye movements. Ask the patient to keep
focusing on the tip of your index finger and slowly move it towards them, aiming for the tip of their nose.
You need to be watching their pupils to make sure you see them constrict as your finger gets closer.

Bibliography
Pike,Rockville."The Visual Acuity,Peripheral Vision and Accommodation",Medlineplus,2 April
2021,https://medlineplus.gov/ency/article/003396.htm#:~:text=The%20visual%20acuity%20test
%20is,monitors%20showing%20letters%20or%20images.

21.What are the abnormal findings in the retinal vessels,retinal background and macula?

•Abnormal retinal vessels seen during comprehensive eye exam.The retinal finding may demonstrate
retinal neovascularization, retinal collateral vessel, retinal arteriovenous malformations, intraretinal
microvascular abnormalities (IRMA) or retinal vessel tortuosity.
•Abnormalities in the retina background included hemorrhages in 18 (10.6%) eyes, hard exudates and
cotton wool spots in 13 (7.8%) and 4 (2.4%) eyes respectively.
•The macula is the central region of the retina situated at the posterior pole of the eye, between the
superior and inferior temporal arteries, 3 mm lateral (temporal) to the optic disc. It is the part of the
retina which produces central vision, for seeing those things which we try to focus on closely, for
detecting detail, for reading and close work - for most people the key normal, functional vision.

Bibliography
Effron,David."Retinal Abnormalities",Access Medicine,23 September
2013,https://reference.medscape.com/features/slideshow/retina

22.How does the inner canthal distance appear and the palpebral slant appear in patients with Down's
Syndrome?

Bibliography
23.How does the palpebral slant appear in patients with hydrocephalus?

Bibliography

24.What are the eye problems encountered in older adults?Briefly describe this condition

There are four major age-related eye diseases (AREDs) that affect seniors: glaucoma, cataracts, macular
degeneration and diabetic retinopathy.

•Glaucoma occurs when the pressure within the eye is elevated, which can damage the optic nerve and
result in vision loss and blindness. There usually are no initial symptoms, so as many as one million
people may have glaucoma without realizing it. This condition is one of the main causes of blindness in
the United States.

•A cataract is a clouding of the eye’s usually transparent lens. The lens is composed of water and protein,
but if the protein clumps together, it can start to obscure transmission of light through the lens. If the
cataract worsens and begins to severely affect vision, surgery may be necessary to remove the cloudy lens
and replace it with a new one.

Bibliography

Module 10

Explain briefly the pediatric variations,geriatric variations and cultural variations of ear assessment.

Discuss in a simple manner how to teach children,adolescents and geriatric patients on how to care for
their ears.