HEALTH ASSESSMENT: EYES AND EARS

 ASSESSMENT OF THE EYES

 STRUCTURE & FUNCTIONS – EYES
3. CONJUCTIVA
 The eye transmits visual stimuli to the
 is a thin, transparent, continuous
brain for interpretation (organ of
membrane that is divided into two
vision)
portions
 The eyeball is located in the eye orbit,
1. palpebral conjunctiva lines the
a round, bony hollow formed by
inside of the eyelids
several different bones of the skull. In
2. bulbar conjunctiva covers most of
the orbit, a cushion of fat surrounds
the anterior eye, merging with the
the eye.
cornea at the limbus.
 The bony orbit and fat cushion protect
 The point at which the palpebral and
the eyeball.To perform a thorough
bulbar conjunctivae meet creates a
assessment of the eye, you need a
folded recess that allows movement
good understanding of the external
of the eyeball. This transparent
and internal structures of the eye, the
membrane allows for inspection of
visual fields and pathways, and the
underlying tissue and protects the eye
visual reflexes.
from foreign bodies.
 EXTERNAL STRUCTURE OF THE EYES
4. LACRIMAL APPARATUS
1. EYELIDS (UPPER & LOWER)
 consists of glands and ducts that
 are two movable structures
lubricate the eye
composed of skin and two types of
 The lacrimal gland, located in the
muscle: striated and smooth.
upper outer corner of the orbital
 Their purpose is to protect the eye
cavity just above the eye, produces
from foreign bodies and limit the
tears. As the lid blinks, tears wash
amount of light entering the eye
across the eye then drain into the
 The eyelids join at two points:
puncta, which are visible on the upper
1. lateral (outer) canthus and
and lower lids at the inner canthus.
2. medial (inner) canthus.
 Tears empty into the lacrimal canals
 The medial canthus contains the
and are then channeled into the
puncta, two small openings that allow
nasolacrimal sac through the
drainage of tears into the lacrimal
nasolacrimal duct. They drain into the
system, and the caruncle, a small,
nasal meatus.
fleshy mass that contains sebaceous
5. EXTRAOCULAR MUSCLES
glands. The white space between
 are the six muscles attached to the
open eyelids is called the palpebral
outer surface of each eyeball. These
fissure.
muscles control six different directions
2. EYELASHES
of eye movement.
 These are projections of stiff hair
 Four rectus muscles are responsible for
curving outward along the margins of
straight movement, and two oblique
the eyelids that filter dust and dirt from
muscles are responsible for diagonal
air entering the eye.
movement. Each muscle coordinates
with a muscle in the opposite eye. This
allows for parallel movement of the
eyes and thus the binocular vision
characteristic of humans. Innervation
for these muscles is supplied by three
cranial nerves: the oculomotor (III),
trochlear (IV), and abducens (VI).
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HEALTH ASSESSMENT: EYES AND EARS
 INTERNAL STRUCTURE OF THE EYES
1. EYEBALL
 contains several chambers that
maintain structure, protect against
injury, and transmit light rays.
 The anterior chamber is located
between the cornea and iris;
 The posterior chamber is the area
between the iris and the lens.
 These chambers are filled with
aqueous humor, a clear liquid
substance produced by the ciliary
body.
 Is composed of three separate coats or
layers :
 The EXTERNAL layer consists of the
sclera and cornea.
 SCLERA
 is a dense, protective, white
covering that physically supports
the internal structures of the eye. It
is continuous anteriorly with the
transparent cornea
 (the “window of the eye”)
 CORNEA
 permits the entrance of light, which
passes through the lens to the retina. It
is well supplied with nerve endings,
making it responsive to pain and touch.
 The MIDDLE layer contains both an
anterior portion, which includes :
 IRIS
 is a circular disc of muscle containing
pigments that determine eye color. The
central aperture of the iris is called the
pupil. Muscles in the iris adjust to control
the pupil’s size, which controls the
amount of light entering the eye. The
muscle fibers of the iris also decrease
the size of the pupil to accommodate
for near vision and dilate the pupil
when far vision is needed.
 LENS
 is a biconvex, transparent, avascular,
encapsulated structure located
immediately posterior to the iris.
Suspensory ligaments attached to the
ciliary body support the position of the
lens. The lens functions to refract (bend)
light
 CILIARY BODY
 The ciliary body consists of muscle tissue
that controls the thickness of the lens,
which must be adapted to focus on
objects near and far away.
 Aqueous Humor
 filters out of the eye from
the posterior to the anterior
chamber then into the
canal of Schlemm through
a filtering site called the
trabecular meshwork.
Another chamber,
 Vitreous Chamber
 is located in the area
behind the lens to the
retina. It is the largest of the
chambers and is filled with
a vitreous humor that is
clear and gelatinous.
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HEALTH ASSESSMENT: EYES AND EARS

 LENS
 Optic disc
 is a biconvex, transparent, avascular,
 is a cream-colored, circular
encapsulated structure located
area located on the retina
immediately posterior to the iris.
toward the medial or nasal
Suspensory ligaments attached to the
side of the eye. It is where
ciliary body support the position of the
the optic nerve enters the
lens.
eyeball.
 The lens functions to refract (bend) light
rays onto the retina. Adjustments must
be made in refraction depending on
the distance of the object being
viewed.
 Refractive ability of the lens can be
changed by a change in shape of the
lens (which is controlled by the ciliary
body). The lens bulges to focus on close
objects and flattens to focus on far
objects.
 POSTERIOR LAYER
 CHOROID LAYER
 contains the vascularity
necessary to pro-vide
nourishment to the inner aspect  VISION – VISUAL FIELD & PATHWAYS
of the eye and prevents light  Visual field refers to what a person sees
from reflecting internally. with one eye. The visual field of each
Anteriorly, it is continuous with eye can be divided into four quadrants:
the ciliary body and the iris. upper temporal, lower temporal, upper
 RETINA nasal, and lower nasal. The temporal
 The innermost layer, the quadrants of each visual field extend
extends only to the ciliary body farther than the nasal quadrants. Thus,
anteriorly. each eye sees a slightly different view
 It receives visual stimuli and but their visual fields overlap quite a bit.
sends it to the brain. As a result of this, humans have
 The retina consists of numerous binocular vision (“two- eyed” vision) in
layers of nerve cells, including which the visual cortex fuses the two
the cells commonly called slightly different images and provides
 Rods depth perception, or three-
 are highly sensitive to light, dimensional vision.
regulate black-and-white  Visual perception occurs as light rays
vision, and function in dim strike the retina, where they are
light. transformed into nerve impulses,
 Cones conducted to the brain through the
 function in bright light and optic nerve, and interpreted. In the
are sensitive to color. eye, light must pass through transparent
 These specialized nerve cells are often media (cornea, aqueous humor, lens,
referred to as “photoreceptors” and vitreous body) before reaching the
because they are responsive to light. retina.

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HEALTH ASSESSMENT: EYES AND EARS
 NURSING DIAGNOSES
 The cornea and lens are the main eye
components that refract (bend) light rays
on the retina. The image projected on the
retina is upside down and reversed right to
left from the actual image.
 At the point where the optic nerves from
each eyeball cross—the Optic chiasma—
the nerve fibers from the nasal quadrant of
each retina (from both temporal visual
fields) cross over to the opposite side. At this
point, the right optic tract contains only
nerve fibers from the right side of the retina
and the left optic tract contains only nerve
fibers from the left side of the retina.
Therefore, the left side of the brain views
the right side of the world.
 Visual Reflexes the pupillary light reflex
causes pupils immediately to constrict
when exposed to bright light. This can be
seen as a direct reflex, in which
constriction occurs in the eye exposed to
the light, or as an indirect or consensual
reflex, in which exposure to light in one
eye results in constriction of the pupil in
the opposite eye. These protective
reflexes, mediated by the oculomotor
nerve, prevent damage to the delicate
photoreceptors by excessive light.
 Accommodation is a functional reflex
allowing the eyes to focus on near
objects. This is accomplished through
movement of the ciliary muscles, causing
an increase in the curvature of the lens.
This change in shape of the lens is not
visible. However, convergence of the
eyes and constriction of the pupils occur
simultaneously and can be seen
 Health Promotion Diagnoses
1. Readiness for enhanced visual
integrity
 Risk Diagnoses
1. Risk for Eye Injury related to
hazardous work area or partici-
pation in high-level contact sports
2. Risk for Injury related to impaired
vision secondary to the aging
process
3. Risk for Eye Injury related to
decreased tear production sec-
ondary to the aging process
4. Risk for Self-Care Deficit (specify)
related to vision loss
 Actual Diagnoses
1. Ineffective Health Maintenance
related to lack of knowledge of
necessity for eye examinations
2. Self-Care Deficit (specify) related to
poor vision
3. Acute Pain related to injury from
eye trauma, abrasion, or exposure
to chemical irritant
4. Social Isolation related to inability to
interact effectively with others
secondary to vision loss
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HEALTH ASSESSMENT: EYES AND EARS
 ASSESSMENT OF THE EARS
 STRUCTURE & FUNCTION
 The ear is the sense organ of hearing and
equilibrium. It consists of three distinct
parts:
1. EXTERNAL
2. MIDDLE
3. INNER
 The tympanic membrane separates the
external ear from the middle ear
 Both the external ear and the tympanic
membrane can be assessed by direct
inspection and by using an otoscope.
 The middle and inner ear cannot be
directly inspected.
 External Ear
 It is composed of the auricle, or pinna,
and the external auditory canal.
 The external auditory canal is S-shaped
in the adult.
 The outer part of the canal curves up
and back; the inner part of the canal
curves down and forward.
 Modified sweat glands in the external
ear canal secrete cerumen, a wax-like
substance that keeps the tympanic
membrane soft.
 Cerumen has bacteriostatic properties,
and its sticky consistency serves as a
defense against foreign bodies.
 Tympanic membrane, or eardrum, has a
translucent, pearly gray appearance
and serves as a partition stretched across
the inner end of the auditory canal,
separating it from the middle ear.
 The membrane itself is concave and
located at the end of the auditory canal
in a tilted position such that the top of
the membrane is closer to the auditory
meatus than the bottom. The distinct
landmarks of the tympanic membrane
include:
 Handle and short process of the
malleus—the nearest auditory
ossicle that can be seen through
the translucent membrane
 Umbo—the base of the malleus,
also serving as a center point
landmark
 Cone of light—the reflection of the
otoscope light seen as a cone
due to the concave nature of the
membrane
 Pars flaccida—the top portion of
the membrane that appears to
be less taut than the bottom
portion
 Pars tensa—the bottom of the
membrane that appears to be
taut
 Middle Ear
 The middle ear, or tympanic cavity, is
a small, air-filled chamber in the
temporal bone.
 It is separated from the external ear
by the eardrum and from the inner
ear by a bony partition containing
two openings, the round and oval
windows.
 The middle ear contains three
auditory ossicles: the malleus, the
incus, and the stapes. These tiny
bones are responsible for transmitting
sound waves from the eardrum to
the inner ear through the oval
window.
 Air pressure is equalized on both
sides of the tympanic membrane by
means of the eustachian tube, which
connects the middle ear to the
nasopharynx
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HEALTH ASSESSMENT: EYES AND EARS
 Inner Ear
 The inner ear, or labyrinth, is fluid
filled and made up of the bony
labyrinth and an inner membranous
labyrinth.
 The bony labyrinth has three parts:
the cochlea, the vestibule, and the
semi- circular canals
 The inner cochlear duct contains the
spiral organ of Corti, which is the
sensory organ for hearing.
 Sensory receptors, located in the
vestibule and in the membranous
semicircular canals, sense position
and head movements to help
maintain both static and dynamic
equilibrium.
 Nerve fibers from these areas form
the vestibular nerve, which connects
with the cochlear nerve to form the
eighth cranial nerve (acoustic or
vestibulocochlear nerve).
 HEARING
 Sound vibrations traveling through air
are collected by and funneled through
the external ear, causing the eardrum
to vibrate.
 Sound waves are then transmitted
through auditory ossicles as the
vibration of the eardrum causes the
malleus, the incus, and then the stapes
to vibrate.
 As the stapes vibrates at the oval
window, the sound waves are passed
to the fluid in the inner ear. The
movement of this fluid stimulates the
hair cells of the spiral organ of Corti and
initiates the nerve impulses that travel
to the brain by way of the acoustic
nerve.
 The transmission of sound waves
through the external and middle ear is
referred to as “conductive hearing,”
and the transmission of sound waves in
the inner ear is referred to a
“perceptive” or “sensorineural
hearing.”
 Therefore, a conductive hearing loss
would be related to a dysfunction of the
external or middle ear (e.g., impacted
ear wax, otitis media, foreign object,
perforated eardrum, drainage in the
middle ear, or otosclerosis).
 A sensorineural loss would be related to
dysfunction of the inner ear (i.e., organ
of Corti, cranial nerve VIII, or temporal
lobe of brain)
 NURSING DIAGNOSES
 Health Promotion Diagnoses
1. Readiness for enhanced
communication related to expressed
desire for hearing aid
 Risk Diagnoses
1. Risk for Injury related to hearing
impairment
2. Risk for Loneliness related to hearing
loss
 Actual Diagnoses
1. Risk for Injury related to hearing loss
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2. Acute Pain related to infection of

external or middle ear
3. Impaired Social Interaction related
to inability to interact effectively with
others secondary to hearing loss

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