Respond using answering the following questions as you read the responses
This week we reviewed assessments of the head and neck. One of these assessments is the ophthalmic examination. This exam is not something I have encountered in my clinical experience and aside from simply being an evaluation, it also involves new equipment. I anticipate this assessment perhaps being the most challenging for me because of these factors. Like any other assessment, becoming efficient and comfortable will take practice and getting familiar with viewing normal findings so that abnormalities can be distinguished more easily. Primary care providers are the first line of defense for many conditions and their complications; if they are not able to identify or treat a condition, they are able to refer so that a patient receives timely specialized care (Wiggins et al., 2014). For example, an ophthalmic exam is particularly important to diabetic patients, who can eventually develop retinopathy.
Differences I anticipate seeing in ophthalmic examinations across the lifespan are age related changes. For example, cataracts can be found in younger patients or even in children and adolescents, but they are most often found in adult patients. Cataracts are slow to develop and can be influenced by diseases, medications, poor diets, alcohol, and smoking (Dains et al., 2020; Nizami & Gulani, 2020), which adults have had more exposure to than children. A good way to anticipate atypical, age-related findings would be to familiarize myself with structural differences and conditions that become more common as patients grow older. I found an article by Investigative Ophthalmology & Visual Science that highlights many of these changes as well as provides images for references. It was informative, expanded on what was reviewed in this week’s text, and can be found here:
One challenge that I anticipate facing during the head, eyes, ears, nose and throat (HEENT) exam is in assessing the thyroid and isthmus. Without having much prior experience assessing these it is difficult to know what is unusual for size. If someone has a goiter or very enlarged thyroid it will be easier to detect than someone overweight with a slightly enlarged thyroid, but subtle or slight variations may not be as easily detected. In addition learning to properly use the otoscope and ophthalmoscope takes practice, I anticipate a learning curve in operating these tools while honing my technique.
Differences I anticipate when assessing patients across the lifespan include loss of skin elasticity with age, as well as changes in dentition with poorer dentition expected in the older population as noted by Bickley (2017) p.223. Assessing an infant would be much different than an adult, where you would measure head circumference in an infant you would not in an adult. Cooperation, response and feedback will be different from patient to patient, while there are deviations from the norm you would expect most teens and adults to be able to accurately provide verbal feedback or reliable response.
Chen & Zeng (2020) review how a thorough head, eyes, ears, nose, and throat (HEENT) exam can help provide clues to systemic illness. Utilization of an ophthalmoscope as part of the HEENT exam is needed to magnify the image of the fundus and observed changes in retina and vasculature as reported by McGinnity & Williams (2019). The usage of an otoscope can also assist provider in diagnosing many conditions including acute otitis media, traumatic perforation of tympanic membrane and cholesteatoma as noted by Falkson (2020). It seems that practice with tools and the exam itself will help to improve our assessment skills.
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