Eyes, Ears, Nose, Throat, and Mouth Assessment

The nurse, Nancy from Harper College, begins the assessment by introducing herself and asking Mr. Hoffman about his vision and any issues with his mouth or throat. She discovers he wears bifocals and has no history of tonsil removal.

A visual acuity test is performed using a Snellen eye chart from 20 feet away. Mr. Hoffman's vision is assessed for both eyes individually, with his right eye reading line 7 (missing one letter) and his left eye also reading line 7. Both eyes show a vision of 20/25, meaning he reads at 20 feet what a normal eye reads at 25 feet.

The nurse examines the conjunctiva (moist and pink), sclera (China white and moist), and the symmetry of eyebrows and eyelids. She then tests extraocular movements (EOMs) by having Mr. Hoffman follow a pen in the six cardinal positions of gaze, observing conjugate movement. Convergence is also tested. Pupils are examined for equality, roundness, and reactivity to light and accommodation (PERRLA).

The ears are inspected for symmetry and correct placement on the head. Palpation is performed to check for pain or tenderness, and the skin behind the ears is assessed. Cranial nerve VIII (acoustic nerve) is tested by whispering words for Mr. Hoffman to repeat.

The nose is observed for symmetry. The nurse palpates the nose for tenderness and checks the septum's position. Nares patency is assessed by having Mr. Hoffman breathe in and out with one nostril plugged at a time.

The lips are inspected for color, moisture, and lesions. Inside the mouth, the teeth are checked for condition and missing teeth, gums for pinkness and tightness, and the buccal mucosa for lesions. The tongue's dorsal and ventral surfaces are examined, and the floor of the mouth is inspected. Finally, the soft palate, uvula, tonsils, and posterior pharynx are inspected. Cranial nerves IX and X are tested by observing the uvula and soft palate rise when Mr. Hoffman says 'ah'.