Class notes
Holistic Health Assessment II weeks 9-12
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This includes all content from weeks 9-12 including; HEENT assessment, Neuro assessment, peripheral vascular assessment.
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HOLISTIC HEALTH MIDTERM #2 STUDY GUIDEWeek 5: HEENT
EYES:
EXTERNAL ANATOMY
Two Canthus: upper and inner
You have a lower lid which can act as a pocket for medications but can also be a site for infection (stye’s)
Conjunctiva-> piece of saran wrap over the eye for protection, it is clear.
-Conjunctivitis is when it is red and inflamed
Lacrimal Apparatus-> how we make and drain our tears
-creates tears to was across eye for protection and maintenance.
Puncta-> tiny “dot” on the medial aspect of lower eye.
-can have blockages (portal of entry for bacteria)
-This is why we tell people to not touch their eyes, so no microbes get in.
Your nasal cavity is connected, when crying and draining tears, this is why you become stuffy when you cry.
EXTRAOCULAR MUSCLES
This is what is pulling your eyes in each direction and keep them looking forward.
When there are issues with these 6 muscles, eyeball movement can be abnormal (shaky eyes)
Strabismus (Lazy Eye) occurs when one of the 6 muscles is too long, the ONLY correction for this is surgery.
The fogged glasses are not a part of best practice anymore.
The surgery involves cutting or lengthening one of the muscles to realign the eyes, muscles become fatigued,
and this happens when people are tired, their eyes will be shaking because muscles are fatigued.
INTERNAL ANATOMY
Outer fibrous sclera
-> cornea (could be scraped)
Middle vascular choroid
-> Iris
-> Pupil
-> Lens
,Inner nervous retina
-> Optic disc
-> Retinal vessels
-> Macula
VISUAL REFLEXES
-Pupillary light reflexes -> When your eyes react to light the pupils will constrict to preserve the eyes from
taking in too much light that would harm the eyes and retinal structures.
Consensual response-> the ideology that eyes work together and that it is not one eye sees half the world, the
other sees the other half, it is that they are both connected. This is why if light is introduced to one pupil it has
the same effects as the other.
Accommodation-> special awareness, depth perception, where you are in the universe.
DEVELOPMENTAL CONSIDERATIONS
Older Adults:
Presbyopia-> problem with accommodation, when reading must hold things further away to read and has
trouble discerning fine print, will use cheater or magnifying glass.
Macular Degeneration-> Disease process leads to blindness and degeneration of macula. The macula is the
area of finest visual interpretation, not being able to have this control is very bad, this is hard to cope with and
resolve, little to no cure.
Cataracts-> surgically corrected, this is a problem with the lens. Looks like a drop of milk in the eye, lens
becomes blurry, low risk surgery easy to cope.
Glaucoma-> issues with eye pressure (aqueous humor). Medications will cause this and you will have optic
nerve pain, pupil dilation is required (eye pressure, like blood pressure of the vessels in your eye).
Diabetic Retinopathy-> pools of blood, those blood vessels will burst because such fine vessels in eye, when
there is too much sugar in the blood, not enough space for cells they will burst.
HEALTH PROMOTION: SCREENING FOR GLAUCOMA
-Glaucoma can be very easily prevented or caught early.
Some risk factors are:
Age over 60 years, if you develop glaucoma, higher risk of blindness.
Black-> bodies are different because of process of sodium.
Female, Family history, Glucocorticoids, Diabetes, HTN, meds.
, SUBJECTIVE
HEALTH HISTORY:
-Any vision difficulty (blurred, lower acuity, blind spot, 4 way stop analogy), blurry vision could be
hypoglycemia.
-Any eyeball pain, NOT NORMAL!
-Strabismus, fatigue will muscle
-Diplopia, double vision
-Redness and swelling, usually means allergy
-Watering/ discharge-> lacrimal apparatus creates and secretes things can’t be drained, if you push on it things
should not come out of puncta.
-History glasses, contact, self-care behaviors.
Infants / Children
Mother’s vaginal infection could pass onto baby eye during delivery. Eye ointment applied to every baby as a
prophylactic measure.
Vision testing during delivery,
Newborns should have whirly eyes (bird eyes) this is normal, eye control will come with age.
Older adults
Movement + visual difficulties
Glaucoma testing
Dryness of eyes can be due to anticholinergic effects of meds
Do you stop doing things you enjoy because of problems with your vision?
OBJECTIVE
PHYSICAL EXAM:
Equipment:
Snellen, Jagger, penlight, ophthalmoscope
Confrontation Test:
Used for assessing peripheral vision, you cannot do this test if you have bad vision
Cover eye on same side as patient, introduce object midway.
EXTRAOCULAR MUSCLE FUNCTION
Inspect: do you they have lazy eye?
->Corneal light reflex (Hirschberg Test), those two little dots on the pupil, is it equal or is one pulling
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