CONFIRMING DIAGNOSIS Loss of peripheral vision and disk changes confirm that glaucoma is present. Diagnosis is made by:
❑ testing IOP
❑ measuring the visual field and noting changes, such as an enlarged blind spot and loss of peripheral vision field
❑ observing changes in the cup/disk ratio of the optic nerve head.
Relevant diagnostic tests include:
❑ Tonometry (using an applanation tonopen or air puff tonometer) — This test measures the IOP and provides a baseline for reference. Normal IOP ranges from 8 to 21 mm Hg. However, patients who fall within this normal range can develop signs and symptoms of glaucoma, and patients who have abnormally high pressure may have no clinical effects. Fingertip tension is another way to measure IOP. On gentle palpation of closed eyelids, one eye feels harder than the other in acute angle-closure glaucoma.
❑ Slit-lamp examination — The slit lamp facilitates examination of the anterior structures of the eye: the cornea, iris, and lens.
❑ Gonioscopy — By determining the angle of the anterior chamber of the eye, this test enables differentiation between chronic open-angle glaucoma and acute angle-closure glaucoma. The angle is normal in chronic open-angle glaucoma. However, in older patients, partial closure of the angle may occur, so that two forms of glaucoma may co-exist.
❑ Ophthalmoscopy — This test enables the examiner to look at the fundus to establish if there are any cup/disk ratio changes. (See Optic disk changes.) These changes appear later in chronic glaucoma if the disease isn’t brought under control.
❑ Fundus photography — Pictures of the optic nerve head are made to track changes.
❑ Perimetry or visual field tests — These reveal the extent of damage to the optic neurons, signaled by an enlarged blind spot and loss of peripheral vision.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Simple goiter:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis of simple goiter requires a thorough patient history and physical examination to rule out disorders with similar clinical effects, such as Graves’disease, Hashimoto’s thyroiditis, and thyroid carcinoma. A detailed patient history may also reveal goitrogenic medications or foods or endemic influence. The results of diagnostic laboratory tests include the following:
❑ TSH: high or normal levels
❑ Serum T4 concentrations: low normal or normal
❑ Thyroid scan and uptake: normal or increased (50% of the dose at 24 hours)
❑ Ultrasound of thyroid: nodules may be present, necessitating biopsy for further evaluation.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Halo vision:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. Patients with glaucoma usually see halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
Next, examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Costovertebral angle tenderness:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate and in what amounts? Has he noticed any change in intake or output? If so, when did he notice it? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia, pain or burning during urination, or difficulty starting a stream? Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice it? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders, such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient’s vital signs. Fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Glaucoma:
Diagnosis
(Handbook of Diseases)
Loss of peripheral visual field, cupping of the optical disk, and increased IOP are the triad of signs that indicate glaucoma. Relevant diagnostic tests include the following:
❑ Tonometry (using an applanation, Schiøtz, or air-puff tonometer) measures IOP and provides a baseline for reference.
Normal IOP ranges between 8 and 21 mm Hg, but some patients who fall in the normal range develop signs and symptoms of glaucoma. On the other hand, some patients who have abnormally high pressure have no clinical effects.
Fingertip tension is another way to measure IOP. On gentle palpation of closed eyelids, one eye feels harder than the other in acute angle-closure glaucoma.
❑ Slit-lamp examination provides a look at the anterior structures of the eye, including the cornea, iris, and lens.
❑ Gonioscopy, by determining the angle of the anterior chamber of the eye, allows differentiation between chronic open-angle glaucoma and acute angle-closure glaucoma. The angle is normal in chronic open-angle glaucoma. In older patients, partial closure of the angle may also occur, so two forms of glaucoma may coexist.
❑ Ophthalmoscopy provides a look at the fundus, where cupping of the optic disk is visible in chronic open-angle glaucoma. This change appears later in chronic angle-closure glaucoma if the disease isn’t brought under control. A pale disk appears in acute angle-closure glaucoma.
❑ Perimetry or visual field tests help evaluate the extent of chronic open-angle deterioration by determining peripheral vision loss.
❑ Fundus photography can monitor the disk for any changes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Halo vision:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. Patients with glaucoma usually see halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Costovertebral angle tenderness:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate, and in what amounts? Has he noticed any change in intake or output? If so, when did he notice the change? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia? Ask about pain or burning during urination or difficulty starting a stream. Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright-red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice the pain? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders, such as occlusion of the renal arteries or veins.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Halo vision:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. The patient with glaucoma usually sees halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
Next, examine the patient's eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Costovertebral angle tenderness:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After detecting CVA tenderness, determine the possible extent of renal damage. First, find out if the patient has other symptoms of renal or urologic dysfunction. Ask about voiding habits: How frequently does he urinate, and in what amounts? Has he noticed any change in intake or output? If so, when did he notice the change? (Ask about fluid intake before judging his output as abnormal.) Does he have nocturia? Ask about pain or burning during urination or difficulty starting a stream. Does the patient strain to urinate without being able to do so (tenesmus)? Ask about urine color; brown or bright red urine may contain blood.
Explore other signs and symptoms. For example, if the patient is experiencing pain in his flank, abdomen, or back, when did he first notice the pain? How severe is it, and where is it located? Find out if the patient or a family member has a history of urinary tract infections, congenital anomalies, calculi, or other obstructive nephropathies or uropathies. Also, ask about a history of renovascular disorders such as occlusion of the renal arteries or veins.
Perform a brief physical examination. Begin by taking the patient's vital signs. A fever and chills in a patient with CVA tenderness may indicate acute pyelonephritis. If the patient has hypertension and bradycardia, be alert for other autonomic effects of renal pain, such as diaphoresis and pallor. Inspect, auscultate, and gently palpate the abdomen for clues to the underlying cause of CVA tenderness. Be alert for abdominal distention, hypoactive bowel sounds, and palpable masses.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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