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    NCM 101 Skills Lab Performance Checklist Assessment of Eyes, Ears and Nose

    Uploaded by

    Jerelyn Victoriano
    This document contains performance checklists for assessing the eyes, ears, and nose. It provides detailed instructions on preparing for the assessment, conducting the assessment, and documenting findings for each body system. The eye assessment checklist includes 14 steps to examine the eyelids, conjunctiva, cornea, iris, pupil, lens, lacrimal apparatus, visual acuity, peripheral vision, accommodation, and eye movements. The ear assessment checklist includes 9 steps to examine the external ear, auditory canal, tympanic membrane, and auditory function. The nose assessment checklist includes 7 steps to examine the external nose, nasal passages, and sinus function. Each checklist scores the student's performance and is signed by the student and clinical instructor

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    NCM 101 Skills Lab Performance Checklist Assessment of Eyes, Ears and Nose

    Uploaded by

    Jerelyn Victoriano
    110 views4 pages
    This document contains performance checklists for assessing the eyes, ears, and nose. It provides detailed instructions on preparing for the assessment, conducting the assessment, and documenting findings for each body system. The eye assessment checklist includes 14 steps to examine the eyelids, conjunctiva, cornea, iris, pupil, lens, lacrimal apparatus, visual acuity, peripheral vision, accommodation, and eye movements. The ear assessment checklist includes 9 steps to examine the external ear, auditory canal, tympanic membrane, and auditory function. The nose assessment checklist includes 7 steps to examine the external nose, nasal passages, and sinus function. Each checklist scores the student's performance and is signed by the student and clinical instructor

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    CHECKLIST-EENS

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    This document contains performance checklists for assessing the eyes, ears, and nose. It provides detailed instructions on preparing for the assessment, conducting the assessment, and documenting findings for each body system. The eye assessment checklist includes 14 steps to examine the eyelids, conjunctiva, cornea, iris, pupil, lens, lacrimal apparatus, visual acuity, peripheral vision, accommodation, and eye movements. The ear assessment checklist includes 9 steps to examine the external ear, auditory canal, tympanic membrane, and auditory function. The nose assessment checklist includes 7 steps to examine the external nose, nasal passages, and sinus function. Each checklist scores the student's performance and is signed by the student and clinical instructor

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    110 views4 pages

    NCM 101 Skills Lab Performance Checklist Assessment of Eyes, Ears and Nose

    Uploaded by

    Jerelyn Victoriano
    This document contains performance checklists for assessing the eyes, ears, and nose. It provides detailed instructions on preparing for the assessment, conducting the assessment, and documenting findings for each body system. The eye assessment checklist includes 14 steps to examine the eyelids, conjunctiva, cornea, iris, pupil, lens, lacrimal apparatus, visual acuity, peripheral vision, accommodation, and eye movements. The ear assessment checklist includes 9 steps to examine the external ear, auditory canal, tympanic membrane, and auditory function. The nose assessment checklist includes 7 steps to examine the external nose, nasal passages, and sinus function. Each checklist scores the student's performance and is signed by the student and clinical instructor

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    Republic of the Philippines

    TARLACSTATEUNIVERSITY
    COLLEGE OF SCIENCE
    DEPARTMENT OF NURSING
    Lucinda Campus, Brgy. Ungot, Tarlac City Philippines
    Tel.no.: 4931865 Fax: (045) 982-0110 website: www.tsu.edu.ph
    Accredited Level 2 status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines, Inc,
    (AACCUP)

    NCM 101 SKILLS LAB


    PERFORMANCE CHECKLIST
    ASSESSMENT OF EYES, EARS AND NOSE

    Name:___________________________ Date:_______________
    Year & Group: ____________________ Score:______________
    Instructor/Evaluator: _______________

    A. EYES
    ASSESSMENT PROCEDURE 2 1 0 Comment
    PREPARATION
    1. Introduce yourself and verify the client’s identity. Explain to
    the client what you are going to do, why it is necessary, and
    how the client can cooperate.
    2. Perform hand hygiene and observe other appropriate infection
    control
    3. Assemble equipment and supplies:
    Clean gloves Cover card
    Snellen Chart Object
    Newspaper/magazine Penlight
    4. Provide for client privacy and dignity.
    ASSESSMENT
    1.Determine client’s history of the following:
     Vision difficulty
     Eye pain
     Childhood strabismus
     Redness or swelling
     Excessive or lack of tearing
     Use of glasses or contact lenses
    2. Inspect eyelids and eyelashes.
     Position and appearance
     Blinking
    3. Inspect conjunctiva and sclera for clarity and appearance by
    separating lids with thumb and index finger and asking client to move
    up, down and to other side.
    4. Inspect cornea (using oblique lighting) for appearance.
    5. Inspect iris and pupil for the following:
     Shape
     Equality
     Color
    6. Inspect lens for clarity.
    7. Inspect and palpate lacrimal apparatus
     Appearance
     Response to pressure applied at nasal side of lower orbital
    rim
    8. Check visual acuity.
     Check distance vision with Snellen chart 20 feet from client.
     Check near vision with newspaper approximately 14 inches
    from client’s head.
    9. Check for peripheral vision.

    1|JSV
     Face client at a distance of 2-3 feet, client and examiner look
    directly ahead and cover eye directly opposite each other.
    10. Check accommodation.
     Ask client to stare at an object 3-4 feet away, and move
    object in towards client’s nose.
    11. Check for extraocular movements.
     Ask client to follow object as it is moved in six cardinal
    fields.
    12.Check response to light.
     Check corneal light reflex by asking client to look straight
    ahead and then shining light toward facial midline.
     Check direct pupil response by asking client to look straight
    ahead and approaching each eye from the client’s side with a
    penlight.
     Check consensual pupil response by asking client to look
    straight ahead and approaching each eye from the client’s
    side with a penlight.
    13.Check for abnormal eye movement using cover or non-cover test.
     Ask client to look straight ahead, covering one eye with a
    cover card, and observe uncovered eye for movement.
    14. Document findings in the client record.
    EVALUATION
    1.Perform a detailed follow-up examination of other individual
    system based on findings that deviated from expected or normal for
    the client.
    2. Relate findings to previous assessment data if available.

    Score: /40 Grade:_________

    B. EARS
    ASSESSMENT PROCEDURE 2 1 0 Comment
    PREPARATION
    1. Introduce yourself and verify the client’s identity. Explain to the
    client what you are going to do, why it is necessary, and how the
    client can cooperate.
    2. Perform hand hygiene and observe other appropriate infection
    control.
    3. Assemble equipment and supplies:
    Clean gloves Tuning fork
    Ruler Otoscope
    Watch with second hand
    4. Provide for client privacy and dignity.
    ASSESSMENT
    1.Determine the client’s history of the following:
     Classic symptoms of ear disease: deafness, tinnitus,
    discharge (otorrhoea), pain (otalgia) and vertigo.
     Previous ear surgery, or head injury.
     Family history of deafness.
     Systemic disease (eg, stroke, multiple sclerosis,
    cardiovascular disease).
     Ototoxic drugs (antibiotics (eg, gentamicin), diuretics,
    cytotoxics).
     Exposure to noise (eg, pneumatic drill or shooting).
     History of atopy and allergy in children.
    2.Inspect external ear for the following:
     Size and shape
     Position
    2|JSV
     Lesions and discolorations
    3.Palpate for external ear.
    4.Palpate mastoid process for the following;
     Tenderness
     Temperature
     Edema
    5.Inspect auditory canal using otoscope for the following:
     Cerumen
     Appearance
     Tenderness
    6.Inspect tympanic membrane using otoscope for the following:
     Color
     Consistency
     Landmarks
    7.Assess auditory function for the following:
     Gross hearing ability: Whisper words 1-2 feet behind
    client; hold watch 1-2 inches from client’s ear.
     Laterization of sound
    Weber Test: Place activated tuning fork on center top of
    client’s head.
     Comparison of air conduction (AC) to bone conduction
    (BC) – Rinne Test: Place tuning fork on mastoid process
    until no longer heard, and then move it to front of ear.
    8.Perform Romberg test for equilibrium by waving client stand with
    feet together first with eyes open, then with eyes closed (put your
    arms around client to prevent fall).
    9. Document. findings in the client record.
    EVALUATION
    1.Perform a detailed follow-up examination of other individual
    system based on findings that deviated from expected or normal for
    the client.
    2. Relate findings to previous assessment data if available.

    Score: /40 Grade:_________

    C. NOSE

    ASSESSMENT PROCEDURE 2 1 0 Comment


    PREPARATION
    1. Introduce yourself and verify the client’s identity. Explain to the
    client what you are going to do, why it is necessary, and how the
    client can cooperate.
    2. Perform hand hygiene and observe other appropriate infection
    control.
    3. Assemble equipment and supplies:
    Clean gloves Penlight
    4. Provide for client privacy and dignity
    ASSESSMENT
    1.Determine client’s history:
     Allergies/atopic disease.
     Smoking.
     Pets at home.
     Occupation.
     History of previous surgery.
     Previous trauma.
     General medical history.
    3|JSV
     Seasonal or daily variation in symptoms.
    2.Observe external nose for the following:
     Skin appearance
     Shape
     Nares
    3. Palpate external nose for firmness.
    4. Inspect for internal nose for the following:
     Appearance
     Landmarks: Turbinates, septum
    4. Assess function of nose for patency (with client’s mouth closed
    and one nares occluded, feel for air).
    5.Palpate and percuss sinuses, both frontal and maxillary.
    6. If palpation and percussion suggest sinusitis, transillumination
    should be performed.
    6. Document findings in the client record.
    EVALUATION
    1.Perform a detailed follow-up examination of other individual
    system based on findings that deviated from expected or normal for
    the client.
    2. Relate findings to previous assessment data if available.

    Score: /24 Grade:________

    Shown To Me: ________________________________


    Student’s Signature over Printed Name

    Shown by:
    _____________________________________________
    JERELYN S. VICTORIANO, RN-EMT, MAN, LPT
    Clinical Instructor

    Noted by:
    ____________________________
    REGIE S. JIMENEZ, RN, MSN
    Program Chairperson

    _____________________________________
    PROF. MARY JANE N. RIGOR, RN, MSN
    Dean

    4|JSV

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