1. Chapter 39: Assisting with eye and ear care
Professor fowler
2nd Edition

2. Study of the eye Eye instruments
Visual acuity and refractive errors – FIGURE 39-1 page 831 correct lens

3. Assessing visual acuity of the eye
Distance acuity – PROCEDURE 39-1
Defects are either congenital, inherited, or acquired through disease or injury
Measured using Snellen chart – figure 39-2 page 832
Ishihara test is printed in either card or booklet form with a single color-dot illustration containing a number or curved lines and shapes
20/20 vision is normal, which means patient can read line 20 from 20 feet away
Shown 14 plates total – 10 have to be correct to be considered “WNL”
Right eye (OD), Left eye (OS), and both eyes (OU) – abbrev not used often anymore
Stored out of direct sunlight so colors do not fade
Snellen E chart for preschool children, illiterate patients, or those with language barrier (patient points the direction that the E is facing)
Contrast sensitivity
Near vision acuity – PROCEDURE 39-2
Measures the patients ability to distinguish faint differences in shades of gray
Done if patient complains of difficulty reading or performing other close-range tasks
Contrast sensitivity is affected by most major eye conditions (macular degeneration, cataracts, glaucoma, and diabetic retinopathy
Use the Jaeger card
20/20 is normal near vision, with card inches from face, which is paragraph J2
FIGURE 39-6 page 836 Pelli-Robson chart
TABLE 39-1 page 836 tests and procedures related to the eye
Well lit room
Color vision impairment – PROCEDURE 39-3
Inability to distinctly differentiate colors of the spectrum

4. eye Irrigation of the Eye – PROCEDURE 39-4
Wear sunglasses
Necessary to remove foreign substances or chemicals
For minor eye problems, avoid rubbing and apply cold compress
Sterile technique
Protective eyewear when working with machines or tools with the possibility of flying objects
Instillation of Eye Medications – PROCEDURE 39-5
If chemical in eye, flush with water for 20 minutes and seek immediate medical attention
Only ophthalmic or optic solutions
MUST BE STERILE
Inform patient to discard meds after prescribes treatment time has elapsed
Changes in the Aging Eye
Depth perception and night vision common issues
Never share eye meds
Never touch eye with dropper
Professionalism: The Life Span page 839
Patient Safety Guidelines
Assisting the Visually-Impaired Patient
Eye exams every 1-2 years is important to monitor changing conditions in the patient vision

5. The study of the ear
Otology: study of the ear – audiology: study of hearing
Irrigation of the ear – PROCEDURE 39-6
Necessary to remove impacted cerumen (earwax) or a foreign matter form the ear
Otorhinolaryngologist (ENT): MD who specializes in the ear
Instillation of ear medication – PROCEDURE 39-7
Ear is organ or hearing and balance
Instruments used in ear exams
TABLE 39-2 tests and procedures related to the ear
Otoscope: lighted instrument with a small, disposable speculum that is inserted into the ear canal to examine the tympanic membrane
tuning fork
audiometer

6. hearing Hearing Acuity Hearing Assessment – PROCEDURE 39-8
Sensorineural hearing loss: damage to the nerve and/or the Organ of Corti
Tuning fork is metal, fork shaped instrument that produces vibrations when struck – when held to patients ear or other locations on the head, patient should be able to hear
Hereditary, loud noises, viral infection
Conduction hearing loss: due to obstruction of sound waves
Audiometer: an electronic instrument that measures hearing more precisely
Foreign materials, excess cerumen, calcification of ossicles, infection in middle ear, malformation, or combination
Additional diagnostic tests
Tympanometry: used to measure pressure in middle ear
Hearing acuity: sharpness of hearing
Right ear (AD), left ear (AS), and both ears (AU) – abbrev not used often anymore
Electronystagmography (ENG): evaluates balance through measurement of the movement of the eyes – used for patients with vertigo

7. Hearing impaired
Accommodations (hearing amplifiers, etc) are a good idea
Never put anything in the ear canal
Earwax is protective substance – attempting to remove is dangerous and could cause eardrum perforation
Speak clearly without raising your voice
Connection between loud noises and deafness
Presbycusis: decline in hearing acuity – normal part of aging
Devices for the hearing impaired (light up phones, etc)
Signs: speaking louder, turning up the TV, not hearing what is said, narrowing of ear canal, dryness of earwax, lessened flexibility of the eardrum and sclerosis of the ear lobes
Ear safety guidelines

8. Nose and throat
Exam of nose is part of PE and is considered routine – will use nasal speculum
PROCEDURE 39-9