8.3 Subjective Assessment
Open Resources for Nursing (Open RN)
Now that we have reviewed the anatomy of the eyes and ears and their common disorders, let’s discuss common eye and ear assessments performed by nurses.
Subjective Assessment
Nurses collect subjective information from the patient and/or family caregivers using detailed questions and pay close attention to what the patient is reporting to guide the physical exam. When collecting subjective data from children, information is also obtained from parents and/or legal guardians. Children aged 2-24 months commonly experience ear infections. Vision impairments may become apparent in school-aged children when they have difficulty seeing the board from their seats. Focused interview questions include inquiring about current symptoms, as well as any history of eye and ear conditions. See Table 8.3a and Table 8.3b for suggested interview questions related to the eyes and ears.
| Symptoms | Questions |
Clinical tips |
| Conjunctivitis (Red, irritated eyes) | 1. Have you noticed any discharge from your eye?
2. Do you have any itching or burning sensation in your eyes? 3. Have you had recent exposure to allergens or someone with pink eye? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: What were you doing when you first noticed the redness? Does anything relieve the irritation? Quality/Quantity: Is the discharge watery or thick? How much discharge is there? Region/Radiation: Is it affecting one or both eyes? Severity: On a scale of 1-10, how would you rate the discomfort? Timing: When did the symptoms begin? Understanding: What do you think might be causing these symptoms? |
The health care provider will assess viral vs. bacterial causes by evaluating the type of discharge. Viral is often watery, while bacterial is more purulent. Educate the patient about hand hygiene to prevent the spread. |
| Cataracts (Blurry vision, glare) | 1. Have you noticed any changes in your vision, such as blurriness or difficulty seeing at night?
2. Do you experience glare or halos around lights? 3. Have you had any recent eye injuries or surgeries? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: Is it worse in bright light or low light? Does wearing sunglasses help? Quality/Quantity: Can you describe the visual changes you’re experiencing? How much has your vision been affected? Region/Radiation: Is the blurriness affecting central vision, peripheral vision, or both? Severity: How much is this impacting your daily activities? Timing: When did you first notice the vision changes? Understanding: Do you have any concerns about losing your vision? |
Evaluate the patient’s daily functioning and safety, especially for driving. Educate about the possibility of surgery as a treatment option.
The use of the ophthalmoscope is used by trained practitioners to examine the eyes. |
| Glaucoma (Peripheral vision loss) | 1. Have you noticed any difficulty seeing out of the corners of your eyes?
2. Do you experience any eye pain or pressure? 3. Have you ever been diagnosed with high eye pressure or glaucoma? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: Is there anything that worsens or alleviates the pain or pressure? Does medication help? Quality/Quantity: How would you describe the pain—dull, sharp, or throbbing? How often do you experience it? Region/Radiation: Is the pain localized, or does it radiate to other parts of your head? Severity: On a scale of 1-10, how severe is the discomfort or vision loss? Timing: When did you first start experiencing these symptoms? Understanding: What do you understand about glaucoma and its management? |
Early detection is critical. Regular eye examinations and intraocular pressure checks by a health care provider are important. Educate on the importance of medication adherence to prevent vision loss. |
| Symptoms | Questions |
Clinical tips |
| Otitis Externa (Ear pain, itching, discharge) | 1. Are you experiencing ear pain or itching?
2. Have you been swimming or exposed your ear to water recently? 3. Have you noticed any discharge or fluid coming from your ear? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: What makes the pain or itching worse—touching the ear or moving the jaw? Does anything relieve the symptoms? Quality/Quantity: How would you describe the pain—dull, sharp, throbbing? How intense is the itching or pain? Region/Radiation: Is the pain localized to one ear or both? Does it spread to your neck or jaw? Severity: On a scale of 1-10, how severe is the pain or discomfort? Timing: When did the symptoms begin? Understanding: Do you have any concerns about your ear health? |
Educate the patient on keeping the ear dry and avoiding inserting objects into the ear canal. Prescribe appropriate ear drops if infection is suspected.
The use of the otoscope is used by trained practitioners to examine the ears. |
| Tinnitus (Ringing in the ears) | 1. Do you hear ringing, buzzing, or other noises in your ears that others cannot hear?
2. Have you been exposed to loud noises recently? 3. Do you have any other symptoms like dizziness or hearing loss? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: Does anything make the ringing worse, such as caffeine or stress? Does anything help reduce the noise? Quality/Quantity: Can you describe the noise you’re hearing? How loud or frequent is it? Region/Radiation: Is it in one ear or both? Severity: How much does the tinnitus interfere with your daily life? Timing: When did you first notice the ringing? Understanding: What do you believe is causing the tinnitus? |
Advise the patient to avoid loud noises and use ear protection. Consider referral to audiology for further evaluation. |
| Cerumen Impaction (Ear fullness, hearing loss) | 1. Do you feel a sensation of fullness or blockage in your ear?
2. Have you noticed a decrease in your hearing or sounds being muffled? 3. Do you clean your ears regularly with cotton swabs or other objects? If the client’s response is affirmative, ask: Do you have the itching now? Additional probes may include: Provocation/Palliation: Does anything make the sensation of fullness better or worse? Have you tried using ear drops? Quality/Quantity: How would you describe the hearing loss—complete, partial, or intermittent? How much has your hearing been affected? Region/Radiation: Is it affecting one ear or both? Severity: On a scale of 1-10, how much does this affect your hearing? Timing: When did you first notice the blockage? Understanding: Do you know what might have caused the earwax buildup? |
Educate patients about the risks of using cotton swabs for ear cleaning. Suggest safe ear-cleaning methods or professional removal. |
