PAMANTASAN NG LUNGSOD NG MARIKINA
COLLEGE OF HEALTH SCIENCES
bsnursing@[Link]
CHEd COPC 030 s. 2018
CHEd Recognized LUC by en Banc Resolution No. 431-2021
ASSESSMENT OF THE EYES AND EARS
Name: ______________________________ Date: ______________
Year Level: ____ Section: ____ Group: ____ Final Grade: ________
Directions. Please rate the students’ level of competency on each expected skill using the scale provided. The Clinical Instructor (CI)
shall tick the box that corresponds to the scale indicated below. You may include comments or suggestions on the REMARKS column.
The CI must compute all the scores from the Knowledge, Skills, and Attitude categories using the formula provided. Hence, the FINAL
GRADE must ONLY be notated by the Clinical Instructor accordingly.
Scale Rating Rating Description
3 Exceptional Fully meets competency requirement to perform the skill.
2 Satisfactory Meets enough of the competency requirement to adequately perform the skill
1 Poor Insufficient or below the competency requirement to adequately perform the skill
0 Not Done Unable to perform the competency requirement of the skill
A. KNOWLEDGE
No. PERFORMANCE POINTS 3 2 1 0 Remarks
1 States the objectives/ purpose of the activity
2 Uses appropriate terms
3 States the steps of procedure in order.
4 Explains the rationale of every step.
Score
B. SKILLS
No. Content/ Pattern 3 2 1 0 Remarks
1 Collection of Subjective Data - EYES (e.g. current
symptoms, past history, family history, lifestyle, and health
practices)
2 Gather equipment
3 Explain procedure to client
4 Provide privacy
5 PERFORM VISUAL ACUITY TEST
A. Assess near vision by providing adequate
lighting and asking the client to read from a
magazine or newspaper.
6 B. Assess distance vision by asking the client to
sit or stand 6 meters (20 ft) from the Snellen’s
chart, cover the eye not being tested and
identify the letters or characters
7 C. Take three readings: right eye, left eye, and
both eyes.
8 PERFORM EXTRAOCULAR MUSCLE FUNCTION TEST
A. Corneal light reflex (using penlight to observe
parallel alignment of light reflect on corneas)
9 B. Cover test (using an opaque card to cover an
eye to observe for eye movement)
10 C. Position test (observing for eye movement)
11 EXTERNAL EYE STRUCTURES
A. Inspect eyelids and lashes (width and position
of palpebral fissures, ability to close eyelids,
direction of eyelids in comparison with eyeball,
color, swelling, lesions, or discharge.
12 B. Inspect positioning eyeballs (alignment in
sockets, protruding, or sunken)
13 C. Inspect bulbar conjunctiva and sclera (clarity,
color, and texture)
14 D. Inspect the palpebral conjunctiva (eversion of
upper eyelid is usually performed only with
complaints of eye pain or sensation of
something in the eye)
15 E. Inspect the lacrimal apparatus over the lacrimal
glands (lateral aspect of the upper eyelid) and
the puncta (medial aspect of the upper eyelid).
Observe for swelling, redness, or drainage.
NCM 101A – HEALTH ASSESSMENT | College of Health Sciences | 2024
PAMANTASAN NG LUNGSOD NG MARIKINA
COLLEGE OF HEALTH SCIENCES
bsnursing@[Link]
CHEd COPC 030 s. 2018
CHEd Recognized LUC by en Banc Resolution No. 431-2021
16 F. Palpate the lacrimal apparatus, noting drainage
from the puncta while palpating the
nasolacrimal duct.
17 G. Inspect the cornea and lens by shining a light
to determine transparency.
18 H. Inspect iris and pupil for shape, color of the iris
and size and shape of the pupil.
19 I. Test pupillary reaction to light (in a darkened
room, have client focus on a distant object,
shine a light obliquely into the pupil, observe
the pupil’s reaction to light – normally pupils
constrict).
20 J. Test accommodation of pupils by shifting gaze
from far to near, normally pupil constricts).
21 Collection of Subjective Data - EARS (e.g. current
symptoms, past history, family history, lifestyle, and health
practices)
22 Gather equipment
23 Explain procedure to client
24 Provide privacy
25 EXTERNAL EAR STRUCTURES
A. Inspect the auricle, tragus, and lobule for size
and shape, position lesions/ discoloration, and
discharge.
26 B. Palpate the auricle and mastoid process for
tenderness.
27 HEARING AND EQUILIBRIUM TEST
A. Perform whisper test by having the client place
a finger on the tragus of one ear. Whisper a
two – syllable word 30.4 – 60.9 cm (1 – 2 ft)
behind the client. Repeat on the other ear.
28 B. Perform Weber test by using a tuning fork
placed on the center of the head or forehead
and asking whether the client hears the sound
better in one ear or the same in both ears
29 C. Perform Rinne test by using a tuning fork and
placing the base on the client’s mastoid
process. When the client no longer hears the
sound, note the time and interval, and move
the tuning fork in front of the external ear.
When the client no longer hears the sound,
note the time and interval.
30 D. Perform the Romberg test to evaluate the
equilibrium by asking the client to position feet
together and arms at the side, close eyes for
20 seconds. Observe for swaying.
Score
C. ATTITUDE
No. PERFORMANCE POINTS 3 2 1 0 Remarks
1 Answers the questions
2 Shows effort to improve performance
3 Works harmoniously with the clinical instructor and
groupmates.
4 Reports in clean uniform, well – groomed, and neat
Score
Comments/ Suggestions:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Computation of Grades:
1. Get all the sum of all points for the entire procedure.
2. Use the formula below to get the final grade for the particular competency checklist.
FORMULA: RAW SCORE/ PERFECT SCORE X 75 + 25 = FINAL GRADE
FINAL GRADE: _____________
NCM 101A – HEALTH ASSESSMENT | College of Health Sciences | 2024
PAMANTASAN NG LUNGSOD NG MARIKINA
COLLEGE OF HEALTH SCIENCES
bsnursing@[Link]
CHEd COPC 030 s. 2018
CHEd Recognized LUC by en Banc Resolution No. 431-2021
Evaluated by: Conforme:
______________________________ ______________________________
Signature Over Printed Name Signature Over Printed Name
Clinical Instructor Student Nurse
NCM 101A – HEALTH ASSESSMENT | College of Health Sciences | 2024
