GRAPHIC ERA COLLEGE OF NURSING

Subject: Adult Health Nursing - II

PHYSICAL EXAMINATION OF EYE

STUDENT’S DATA

Name Of The Student

Class
Date Of Care
No. Of Care plan
Area Of Care plan

PATIENT’S DATA

Name Of The Patient

Age
Sex
Religion
Marital Status
Address

In-PatientNo (IPD No.)

Name Of The Ward
Date Of Admission
Date Of Discharge
Educational Status
Occupation
Consultant Doctor
Provisional Diagnosis

Final Diagnosis

CHIEF COMPLAINTS -
HISTORY OF PRESENT ILLNESS -

PAST MEDICAL HISTORY –

PAST SURGICAL HISTORY –

FAMILY HISTORY -
S. Name of the family Relationshi Age/ Sex Marital Occupation Health Educational
p
No. member status status background
with patient

FAMILY TREE -
SOCIO ECONOMIC STATUS -

Housing:-……………………………………………………………………………………… ……………….

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Water supply:-…………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………..

Sanitation:-……………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………….

Income:-…………………………………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………………

PERSONAL HISTORY -

⮞Hobbies :-

⮞Dietary habits :-

⮞Addictions:-

EYE ASSESSMENT

General appearance & Behaviour:

 Gender………………………………………………………………………………….….
 Body built……………………………………………………………………………....….
 Posture and Gait…………………………………………………………………………....
 Hygiene and Grooming………………………………………………………………….…
 Nutritional status…………………………………………………………………………...
 Level of Consciousness…………………………………………………………………….
 Orientation (Time, Place, Person)………………………………………………………….
 Weight: ………………………………………………………………………………….…
 Height:……………………………………………………………………………………...
 Eyebrows……………………………………..Eyelids……………………………………..

 Eyelashes……………………………………..Sclera……………………………………….

 Conjunctiva…………………………….……………………………………………………

 Pupil…………………………………………………………………………………………

 Any abnormalities…………………………………………………………………………..

 Occular history -……………………………………………………………………………

 Visual acuity -………………………………………………………………………………

 Pupillary reflex. -……………………………………………………………………………

 Eye lid symmetry -…………………………………………………………………………..

 Sclera -…………………………………………………………………………………….....

 Extraocular movement and cranial nerves-……………………………………………….

 Cranial nerve testing -…………………………………………………………………….....

OPHTHALMOSCOPY

Type of test -

 Without Glasses
Right Eye………………………………Left Eye………………………………………

 With Glasses / Contact Lens

Right Eye…………………………...….Left Eye………………………………………
 Color Vision ......................................................................................................................
Right Eye………………………………Left Eye ……………………………………..

INTRAOCULAR PRESSURE READING

 Right Eye……………………………….Left Eye………………………………………

 Binocular function
……………………….....……………………………………………………………….
 External Exam ( Lids , Lashes , Cornea , etc)
…………………………………………............................................................................
 Internal Exam ( vitreous , lens , fundus ,etc )
…………………………………………………………………………………………..