ice13j

• eye function is limited at birth
• 80% of babies are far sighted
• farsightedness decreases at age 7-8
• Macula - area of keenest eye sight - - this does not fully develop until 8 months. This is the reason for bad eyesight in infants.

• Lacrimal gland is involuted - turns inside out
• Lacrimal gland is located in corner of eye - it causes dry eyes
• Pupil size decreases
• Presbyopia occurs - lost of elasticiy in lens = makes things up close hard to see
• Diminished acuity occurs- vision becomes blurry and diminished reaction to changes occurs

• Cataracts - plaque buildup on lens - can cause permanent blindness if not corrected
• Glaucoma - increases pressure behind eyes
• Macular Degeneration - Lose central vision

cross eyes

Protruding eye

Sunken eyes

External - Transparent protective covering

• Outer layer of Internal Anatomy of eye
• white tough/protective covering of eye

• Eyebrows
• Eyelids/lashes
• Eyeballs
• Exophthalmos
• Enophthalmos
• Conjuctiva
• Sclera
• Lacrimal Duct

• Cornea
• Lens
• Iris
• Pupil
• Pupillary light reflex

outer layer of anterior eyeball - very sensitive to touch

• Middle layer of anterior eyeball
• Biconvex disc located posterior to pupil
• functions as a refracting medium

• Direct
• Consensual
• Accomodation
• Record as PERRLA - when everything is normal
• PERRLA - pupils equally round reactive to light and accomodate

Snellen Eye Chart

• Test for near sightedness (to test if you can see far away)
• test each eye alone
• test with both eyes uncovered
• use E chart and shapes chart - for pts non verbal and dont know alphabet

a magazine

• Nearsighted
• cant see far
• use snellen chart

• Farsighted
• Cant see near
• use a magazine to test

• a type of hyperopia
• used to describe aging process

• Gross measure of peripheral vision
• put fingers out to side - see when person can see your fingers
• people with strokes lose their peripheral vision
• sometimes migraines can cause loss of peripheral vision - see black from the side

• Corneal Light Reflex- Looking for light reflex to show on both eyes at same time on eye
• Cover test - look at something far away, cover one eye, sign of a lazy eye is when it goes to corner when covered...once you uncover - you see eye in corner trying to go back
• 6 Cardinal Positions of Gaze - put pen in front of them, have them move their eye/ not head... Nystagmus - eye movement

• used to look at back or eye
• can identify if lesions are present
• see optic disc - orange glow normal color is creamy yellow-orange to pink
• when looking in right eye - you look with right hand and your right eye R-R-R/L-L-L
• begin 15 degrees lateral
• Once light hits optic disc -eye turns red, then follow back to see back of eye
• must be done in dark room

• Very rare in females
• only affects 4-8% of males
• x-linked trait

The covered eye maintains its position when uncovered

• Eustachian Tube - lies horizontal - fluid collects= prone to ear infections, its shorter and wider compared to adults
• Adults - it grows downward=drains better
• Lumen - opening - more lymphoid tissue in child = occluded easier
• External Canal - slopes more compared to adults, increase of infection

• 20-40 years of age occurs
• gradual hardening inside ear, causes stepes to become fixed to oval window
• impedes transmission of sound
• can cause deafness
• = conductive hearing loss has to do with structures in ear

Cilia have a protective function but in older adults cilia become stiff

Cerumen (air wax) - drier

Presbycusis - degeneration of auditory nerve- gradual progression of hearing loss= sensory neural loss bc damage to the nerve

Longer auditory reaction time - hearing aids help, talk slow, lower voice to help them, dont yell at them

• Is there discharge? color/amount
• If there is pus looking discharge = infection
• if blood is present = ruptured tympanic membrane
• lots of exposure to loud sounds?
• Tinnitus? ringing of ears

• Otoscope - hold upside down
• Tuning Fork
• Pneumatic bulb attachment - attach to otoscope

• size and shape
• skin condition
• tenderness
• external meatus

For child - pull pinna down and back to straighten canal for child 1-9years of age

for adult - pull up and back - at top of ear to straighten canal

• should look pearly gray
• if infected it looks pink or red
• cone of light - light that hits tympanic membrane
• note- if a baby is crying this can make it look red

• attach a bulb - this shoots air into ear
• normal - is to see tympanic membrane move
• abnomal- no movement of if it looks bulging - this is sign of infection

• Voice Test
• Weber Test
• Rinne Test
• Rombert Test

speak into ear

• the goal it to get tuning fork to vibrate
• hit fork against hand- then place on top of head.ask do you hear in both ears?
• This tests for equal lateralization of ears

• Get the tuning fork vibrating, hold on mastoid bone (place very bottom part on mastoid), then ask pt to tell you when they no longer hear it, then place the vibrating part near ear canal- person should hear this 2x longer thatn they heard it thru the mastoid bone
• should be 2:1 ratio

• This test compares air conduction and bone conduction sound.
• Document as AC is greater than BC

• Looks at equilibrium
• (+) test - extreme swaying = sign of inner ear infection
• Worst response is pt wil fall over, so be ready to catch
• "say close yr eyes" observe pt
• normal response is a little swaying = (-) test

• Precordium - anterior chest wall overlying heart and great vessels
• Mediastinum - middle third of thoracic cage where heart and great vessels lie

• 2nd - 5th intercostal space right border of sternum to mid clavicular line (MCL)
• base is at 2nd intercostal area, apex points down to 5th intercostal area and MCL

• Superior Vena Cava
• Inferior Vena Cava
• Pulmonary Artery
• Pulmonary Vein
• Aorta

• Pericardium - surrounds heart, double walled structure, fluid lies between the double wall called pericardial fluid
• Myocardium- muscle wall of heart - this does all the work- responsible for all pumping
• Endocardium - Inside lining of heart chamber

• Rt atrium
• Rt Ventricle
• L atrium
• L Ventricle

• AV Valves - tricuspid (right), Mitral (left)
• Semilunar Valves - Pulmonic (rt) (Aortic (left)

• tricupid rt
• Mitral lt

• pumlomin - rt
• aortic - lt

Vena Cava -> RA ->tricuspid->RV ->Pulmonic Valve ->Pulmonary artery ->LUNGS ->Pulmonary Vein ->LA ->Mitral Valve->LV->Aortic Valve->Aorta->Body

• This is the only time an artery is carrying de-oxygenated blood
• This is the only time a vein is carrying oxygenated blood
• if there is an abnormality the flow goes the opposite way

• Ventricles are relaxed
• Mitral valve is wide open
• bc atrial pressure is higher then ventricular pressure - blood flows down into ventricles

Presystole- atrial kick -at the very end of diastole - heart says im going to take the last bit of blood into ventricle- causing valve to close - that closure is the first heart sound (lub) S1

• ventricular pressure rises - and when it starts to peak, then it drops causing the SL valves to close - this causes the 2nd heart sound (dub) S2
• As ventricular pressure drops below atrial presure- the whole process starts all over again
• the reason for valve closure is to prevent backflow

less than

close

closes (mitral - left)

closes (aortic is left)

closure of AV valves (mitral, tricupid) "lub"

Heard louder at apex

closure of SL valves (aortic, pulmonic) "dub"

Heard louder at base

• hear a lub, dub, dub - this is abnormal
• enough pressure change on right and left causes you to hear a closure of SL valves individually

• Ventricular Gallop
• caused by ventricles vibrating during filling
• reason for vibration is bc its resistant to filling
• this is heard right after S2, sounds like lub, dub, beat ---this is abnormal in most cases
• children and pregnant women can have a normal S3
• adults not pregnant and older than 35 this is abnormal - usually CHF
• known to sound like "kentucky"

• atrial gallop
• due to resistant venticles
• unusual beat is at beginning rather than at end - sounds like "Tennessee"
• usually only heard in elderly people

• cause a swooshing sound
• usually caused by a turbulent blood flow
• increased velocity - speed
• decreased viscosity - common in anemic people
• structural defects - most common
• unusual openings between chambers

• CO=SV x HR
• heart pumps 4-6 liters/min = normal

Carotid Artery - coincides with ventricular systole

• Jugular Veins- important bc jugular veins dump blood into vena cava - backflow goes into jugular veins when there is a problem
• Internal
• External

• Fetal heart functions at 3rd week of gestation
• heart position is more horizontal
• lies at 4th intercostal space
• at age 7 it moves down to 5th intercostal space

• blood volume increases 30-40%
• increased SV, CO, HR
• arterial blood pressure decreases (2nd trimester) - goes down bc estrogen and increased volume cause peripheral vasodialtion

• SBP increases (not diastolic)
• increases in systolic causes atherosclerois (plaque buildup) (type of arteriosclerosis)
• Arteriosclerosis - hardening of vessels - more common in elderly
• Left ventricular wall thickens
• ventricular arrhythmias
• changes in ECG
• Increased incidence of CAD

• How long has this been happening?
• Family history
• smoking
• SOB
• Location of pain
• orthopnea
• cough - CHF - sputum is pink and frothy

blood to go down to lower extremities - causing edema

• during day heart has to work very hard, but at night when resting heart is able to move fluids to rid body of it
• people w/ CHF pee very little during day, but a lot at night

• Men - down left arm
• Women - back and jaw pain

• dont press both at same time
• important to assess one at a time bc u can cause person to pass out - bc of vagal stimultion