DE LA SALLE LIPA
COLLEGE OF NURSING
Health Assessment NCM 101
Procedural Checklist in
Assessment of the Eyes and Ears
NAME: __________________________________________________________
YEAR / SECTION: _________________ RATING: __________
General Objective:
Given actual or simulated situations/conditions, the students will be able to systematically assess,
observe and perform assessment of the eyes and ears.
Specific Objectives:
1. Describe the structure and function of the eyes and ears.
2. Interview the client for an accurate nursing history of the eyes and ears.
3. Perform physical assessment of the eyes and ears.
4. Differentiate between normal and abnormal findings.
5. Analyze the data from the interview and physical assessment of the eyes and ears and to
formulate nursing diagnosis and referrals.
CRITERIA:
Item Descriptors Verbal Interpretation
Weight
1 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times.
0.75 Very Performed the procedure with less confidence, observing
Satisfactory work ethics (prudent, accepts criticisms and suggestions),
able to rationalize scientifically and shows minimal diligence
in documenting observations.
0.5 Satisfactory Performed the procedure but requires close supervision and
shows potential for improvement.
0.25 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
No. STEP BY STEP PROCEDURE 1 0.75 0.5 0.25 REMARKS
A. EYES
, 1.A Assess for current symptoms:
A. Recent changes in vision,
B. Spots or floaters in front of eyes?
C. Blind spots, halos, or rings around
lights?
1 D. Trouble seeing at night?
E. Double vision?
F. Eye pain?
G. Redness or swelling in eyes?
H. Excessive watering or tearing or
other discharge from eyes?
1.B Past History:
Previous eye or vision problems
(medication, surgery, laser treatments,
corrective lenses)?
1.C Family History:
Family history of eye problems or vision
loss?
1.D Lifestyle and Health Practices:
A. Exposure to chemicals, fumes, smoke,
dust, flying sparks, etc.?
B. Use of safety glasses?
C. Use of sunglasses?
D. Medications (corticosteroids,
lovastatin, pyridostigmine, quinidine,
Risperdal, and rifampin) may have ocular
side effects?
E. Has vision loss affected ability to work
or care for self or others?
F. Date of last eye examination?
G. Have glasses or contacts? Are they
worn regularly?
H. Live or work around frequent or
continuous loud noise?
I. Use of ear protection from noise or
while in water?
Gather equipment and explain the
procedure to the patient. Wear gloves.
Perform Vision Test:
2 A. Distant visual acuity (with Snellen
chart, normal acuity is 20/20 with or
without corrective lenses).
B. Near visual acuity (with a handheld
vision chart, normal acuity is 14/14
with or without corrective lenses).
COLLEGE OF NURSING
Health Assessment NCM 101
Procedural Checklist in
Assessment of the Eyes and Ears
NAME: __________________________________________________________
YEAR / SECTION: _________________ RATING: __________
General Objective:
Given actual or simulated situations/conditions, the students will be able to systematically assess,
observe and perform assessment of the eyes and ears.
Specific Objectives:
1. Describe the structure and function of the eyes and ears.
2. Interview the client for an accurate nursing history of the eyes and ears.
3. Perform physical assessment of the eyes and ears.
4. Differentiate between normal and abnormal findings.
5. Analyze the data from the interview and physical assessment of the eyes and ears and to
formulate nursing diagnosis and referrals.
CRITERIA:
Item Descriptors Verbal Interpretation
Weight
1 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times.
0.75 Very Performed the procedure with less confidence, observing
Satisfactory work ethics (prudent, accepts criticisms and suggestions),
able to rationalize scientifically and shows minimal diligence
in documenting observations.
0.5 Satisfactory Performed the procedure but requires close supervision and
shows potential for improvement.
0.25 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
No. STEP BY STEP PROCEDURE 1 0.75 0.5 0.25 REMARKS
A. EYES
, 1.A Assess for current symptoms:
A. Recent changes in vision,
B. Spots or floaters in front of eyes?
C. Blind spots, halos, or rings around
lights?
1 D. Trouble seeing at night?
E. Double vision?
F. Eye pain?
G. Redness or swelling in eyes?
H. Excessive watering or tearing or
other discharge from eyes?
1.B Past History:
Previous eye or vision problems
(medication, surgery, laser treatments,
corrective lenses)?
1.C Family History:
Family history of eye problems or vision
loss?
1.D Lifestyle and Health Practices:
A. Exposure to chemicals, fumes, smoke,
dust, flying sparks, etc.?
B. Use of safety glasses?
C. Use of sunglasses?
D. Medications (corticosteroids,
lovastatin, pyridostigmine, quinidine,
Risperdal, and rifampin) may have ocular
side effects?
E. Has vision loss affected ability to work
or care for self or others?
F. Date of last eye examination?
G. Have glasses or contacts? Are they
worn regularly?
H. Live or work around frequent or
continuous loud noise?
I. Use of ear protection from noise or
while in water?
Gather equipment and explain the
procedure to the patient. Wear gloves.
Perform Vision Test:
2 A. Distant visual acuity (with Snellen
chart, normal acuity is 20/20 with or
without corrective lenses).
B. Near visual acuity (with a handheld
vision chart, normal acuity is 14/14
with or without corrective lenses).
