Question

Th e nurse reads in the progress note that the patient’s eyes are normal for accommodation. 1\. How is this tested? 2\. What is a normal response to the assessment?

Short answer

1. Accommodation is tested by moving an object closer to a patient’s nose and watching the eyes' response. 2. A normal response is both eyes converging towards the nose with pupils constricting, known as accommodation. 'Normal for accommodation' in this context indicates that the patient's eyes are able to focus properly on near objects, their pupils constrict as they should, and the eyes converge normally.

Step-by-step solution

Understanding the Accommodation Test

The term 'accommodation' refers to the process by which the eye changes optical power to maintain a clear image (focus) on an object as its distance varies. In the clinical setting, the accommodation reflex is tested by moving an object from a distance towards the patient's nose. The observer can notice the 'convergence' of the eyes and 'contraction' of the pupils.

The Normal Response to the Accommodation Assessment

In a normal response to the accommodation assessment, the eyes should converge towards the nose as the object moves closer, and the pupils will constrict to maintain focus on the object. This is referred to as the constriction of pupils, and it is a normal reaction to accommodate a near vision.

The Interpretation of 'Normal for Accommodation' in the Progress Note

When it's mentioned in the nurse's progress note that 'the patient’s eyes are normal for accommodation', it indicates that the patient's eyes are functioning properly in terms of focusing on near objects, their pupils are constricting properly, and the eyes have normal convergence.

Key concepts

Nursing Assessment

Nursing assessment of ocular functions is a critical step in routine health evaluations and when visual impairment is suspected. The assessment includes several tests to evaluate the strength, coordination, and health of the eyes and neurological function.

During the assessment, a nurse evaluates the reflex actions of the eye, including the accommodation reflex test, which checks how the eyes adjust their lens shape to focus on near and distant objects. This evaluation provides insight into the function of eye muscles and cranial nerves. Additionally, a nurse may assess for signs of ocular diseases, check visual acuity, and look for any anatomical abnormalities.

The accommodation reflex test is a simple yet effective part of the nursing assessment, providing vital information about a patient's ophthalmic health. If a patient's eyes are noted as 'normal for accommodation', it means their eyes are functioning properly, indicating that the neurological pathways involved in eye focusing are intact.

Ocular Accommodation

Ocular accommodation refers to the eye's ability to change its focus from objects that are far away to those that are close. This dynamic process involves the reshaping of the crystalline lens through the action of the ciliary muscles.

The ciliary muscles contract to lessen the tension on the zonule fibers, allowing the lens to become more convex (thicker), thus increasing its optical power for focusing on nearby objects. This action is crucial for activities involving near vision, such as reading. The accommodation reflex test is used to check the functioning of this process by observing the changes in lens shape as an object moves closer to the eyes.

Failure to accommodate properly can indicate issues such as presbyopia, a common condition in older adults, where the lens becomes less flexible and impairs near vision.

Convergence of the Eyes

Convergence of the eyes is an oculomotor coordination activity that occurs when the two eyes move inward together to maintain single binocular vision as an object approaches. This movement is essential for maintaining depth perception and focus on objects that are close to the observer.

In the accommodation reflex test, the nurse looks for this inward turning of the eyes to ensure that the extraocular muscles involved in eye movement are healthy and functioning properly. Any impairment in convergence can point to issues with muscle control, cranial nerve function, or indicate a neurological disorder. In a normal response, both eyes will converge symmetrically and smoothly as the object moves closer to the patient's nose.

Pupillary Constriction

Pupillary constriction, or miosis, is the narrowing of the pupil to limit the amount of light entering the eye. It is part of the near response, which includes ocular accommodation and convergence of the eyes. When an object moves closer, not only do the eyes converge, but the pupils also constrict to increase the depth of focus and improve the quality of the visual image.

During the accommodation reflex test, the nurse observes the pupillary constriction as the object moves closer to the patient's face. This response is mediated by the parasympathetic nervous system through the third cranial nerve, and it is a vital component in maintaining sharp vision at various distances. Adequate pupillary response indicates normal function of the autonomic nervous system controlling the eye muscles, whereas abnormal constriction could point to nerve damage or ocular health issues.