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NR 302 Exam 2 Study Guide / NR302 Exam 2 Study Guide (Latest 2021/2022):, Study Guides, Projects, Research of Nursing

NR 302 Exam 2 Study Guide / NR302 Exam 2 Study Guide (Latest 2021/2022): Health Assessment I: Chamberlain College of Nursing

Typology: Study Guides, Projects, Research

2020/2021

Available from 12/06/2021

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NR i 302 iExam i 2 iStudy iGuide i

Test i 2 iReview

Skin/Nails/Hair

  • Inspect i and i palpate i the i skin o Color ▪ Observe iskin i tone ▪ Normally i even i and i consistent i with i genetic i background ▪ Abnormal i finding ● Vitiligo o Complete i absence i of i melanin i pigment i in i patchy i areas i of iwhite ior i light i skin i on i the i face, i neck, i hands, i feet, i and i bodyifolds iand iaround iorifices o Dark i skin i people i are i more i severely i affected o Lesions ▪ Moles ● Normally i are: o Symmetrical o Small isize i(6 imm ior iless) o Smooth i borders o Single i uniform i pigmentation ● Abnormal i signs o Asymmetry o Border i irregularity o Color i variation o Diameter i> i 6 imm o Elevation i or i evolution o Wide i spread i color i change ▪ Pallor ▪ Erythema- i Red ▪ Cyanosis i- i blue ▪ Jaundice i - iYellow o Temperature ▪ Use iback iof i the ihands ▪ Check i bilaterally o Edema ▪ Not i normally i present ▪ Pitting i edema ● 1 i+ iMild ipitting ● 2 i + iModerate i pitting ● 3 i+ iDeep ipitting ● 4 i+ iVery ideep ipitting ▪ Abnormal i findings ● Peau i d’ iorange o Pigskin ior i orange i peel i look ● Anasarca o Edema iover i the i whole i body o Mobility i and i turgor

▪ Test i under i clavicle ▪ Mobility iis ithe iease iof iskin ito irise ▪ Turgor i is i its i ability i to i retrun i to i place i promptly i when i released o Vascularity i or i bruising ▪ Cherry i (senile) i angiomas ● Small i (1 ito i 5 imm), i smooth, i slightly i raised i bright i red idots ithat icommonly i appear ion i the itrunk i in i all i adults iolder ithan i 30 i years

  • Inspect i and i palpate i the i hair o Note icolor iof ihair o Note i texture i of i hair o Distribution ▪ Genital i area ● Females o Inverted i triangle ● Males o Upright i triangle o Hirsutism ▪ Excess i body i hair ▪ In i females, i forms i a imale i pattern i on i face i and i chest
  • Inspect i and i palpate i the i nails o Shape i and i contour ▪ Normally i slightly i curved i or i flat ▪ Nail i edges i are i smooth, i rounded, i and i clean ▪ Profile i sign ● Angle i of i the i nail i base i should i be i about i 160 i degrees ▪ Abnormal i findings ● Clubbing o Angle i of i straightens i to i 180 i degrees o Consistency ▪ Smooth i and i regular o Color ▪ Nail i plate i is iwindow i to ieven, i pink i nail i bed o Capillary i refill ▪ Color i return i less i than i 2 i seconds
  • Teach i skin i self i examination o ABCDE i rule o Well i lit i room iwith i length imirror o Have i someone i check i your i back
  • Adolescence o Increase i in i oiliness i and i acne o Seborrhea i means i oily
  • Aging i adult o Xerosis ▪ Dry iskin o Pruritis ▪ Itching o Lichenification

bone, iand ithe imastoid iprocess ibehind ieach iear. iThere iis inot itenderness itoipalpation. ● Symptoms iassociated iwith imigraine iheadaches- iheadache iof ivascular iorigin. o Aura- ivisual ichanges isuch ias iblind ispots ior iflashes iof ilight, itingling iin ian iarm iorileg, ivertigo. o Prodome- iChange iin imood, ibehavior, ihunger, icravings, iyawning. o N/V, iPhotophobia i(sensitivity ito ilight), iPhonophobia, iAbdominal iPain, iPersonilooks isick, ifamily ihx iof imigraine. ● Hydrocephalus - iObstruction iof idrainage iof iCSF iresults iin iexcessive iaccumulation,iincreasing iintracranial ipressure, i& ienlargement iof ithe ihead. ● Acromegaly- i Excessive isecretion iof iGH ifrom ipituitary igland iafter ipuberty icreates ian ienlarged iskull i& ithicken icranial ibones. o Elongated ihead, imassive iface, iovergrowth iof inose iand ilower ijaw, iheavy ieyebrowiridge, iand icoarse ifacial ifeatures. ● Facial ideformities iassociated iwith ifetal ialcohol isyndrome iand idown isyndrome- o Fetal iAlcohol isyndrome i(FAS) i- inarrow ipalpebral ifissures, iepicanthal ifolds, iflatimidface, ishort inose, ilow inasal ibridge, ithin iupper ilip. o Down iSyndrome i(Trisomy i21) i- ihead iand iface icharacteristics imay iinclude iupslanting iof ieyes iw/ iinner iepicanthal ifolds; iflat inasal ibridge, ismall ibroad, iflatinose, ibrown ineck iw/ iwebbing; ismall ihands iw/ isingle ipalmar icrease. ● Assessment iof iinfant iskull i– ianterior iand iposterior ifontanels, ibulging ifontanels o Assess iFontanels- igently ipalpate iskull iand ifontanels iwhile iinfant iif iclam i& isomewhat isitting iposition i(crying, ilying idown, ior ivomiting imay icause ithe ianteriorifontanel ito ilook ifull iand ibulging). iSkull ifeels ismooth i& ifused iexcept iat ithe ifontanels. iFontanels ifeel ifirm, islightly iconcave, iand iwell idefined iagainst ithe iedges iof ithe icranial ibones. ▪ Anterior- imay isee islight iarterial ipulsations. ▪ Posterior- imay inot ibe ipalpable iat ibirth. ▪ Bulging ifontanel- itrue itense, ioccurs iw/ iacute iincreased iintracranialipressure. ● Discuss ibraden iscale iand ipressure iulcer istages o Braden iScale- imost icommon iused iassessment iscale ifor ipressure iulcer irisk. o Stage iI- i Intact iskin iappears ired ibut iunbroken. iLocalized iredness iin ilightly ipigmented iskin idoes inot iblanch i(turn ilight iwith ifingertip ipressure). iDark iskiniappears idarker ibut idoes inot iblanch. o Stage iII - i Partial iThickness i skin ierosion iwith iloss iof iepidermis ior ialso ithe idermis. iSuperficial iulcer ilooks ishallow ilike iabrasion ior iopen iblister iwith iaired-pink iwound ibed. o Stage iIII - i Full ithickness i pressure iulcer iextending iinto ithe iSubQ i& iresembling iaicrater. iMay isee isubQ ifat ibut inot imuscle, ibone, ior itendon. o Stage iIV - i Full ithickness i pressure iulcer iinvolves iall iskin ilayers i& iextends iinto isupporting itissues. iExposes imuscle, itendon, ior ibone, iand imay ishow islough i(stringy imatter iattached ito iwound ibed) ior ieschar i(black ior ibrown inecrotic itissue).

o Total iscore iranges ifrom i 6 ito i23; ia ilower itotal iscore iindicates ia ihigher irisk ifor ipressure iulcer idevelopment. iThe ihigher inumber ithe ilower ithe irisk. iThe ilowerinumber ithe ihigher ithe irisk.

Neck/Lymph iNodes Assessment iof ineck, itrachea, iand ilymph inodes

  • Inspection iand ipalpation iis iused ito iassess ineck, itrachea, iand ilymph inodes.
  • Neck imuscles ishould ibe isymmetric ip.253 ifor imore iinfo
  • ROM i(Note ifor iany ilimitations)
  • Any inodes ipalpable?
  • Nodes ishe ibe imoveable, idiscrete, isoft, iand inon-tender
  • Trachea iis ion ithe imidline i(note ifor itrachea ishift)
  • Trachea ishould ialso ibe isymmetric ion iboth isidesiAssess i 10 igroups iof ilymph inodes: ip.253 ifor imore iinfo
  1. Preauricular, iin ifront iof ithe iear
  2. Posterior iauricular i(mastoid), isuperficial ito ithe imastoid iprocess
  3. Occipital, iat ithe ibase iof ithe iskull
  4. Submental, imidline, ibehind ithe itip iof ithe imandible
  5. Submandibular, ihalfway ibetween ithe iangle iand ithe itip iof ithe imandible
  6. Jugulodigastric i(tonsillar), iunder ithe iangle iof ithe imandible
  7. Superficial icervical, ioverlying ithe isternomastoid imuscle
  8. Deep icervical, ideep iunder ithe isternomastoid imuscle
  9. Posterior icervical, iin ithe iposterior itriangle ialong ithe iedge iof ithe itrapezius imuscle
  10. Supraclavicular, ijust iabove iand ibehind ithe iclavicle, iat ithe isternomastoid imuscle

You ialso ishould ibe ifamiliar iwith ithe idirection iof ithe idrainage ipatterns iof ithe ilymph inodes i(Fig.i13-7).

Can iyou ifeel ilymph inodes? iYesiThe iNeck Inspect iand iPalpate ithe iNeck iSymmetry

  • Head iposition iis icentered iin ithe imidline, iand ithe iaccessory ineck imuscles ishould ibeisymmetric.
  • The ihead ishould ibe iheld ierect iand istill.
  • Head itilt ioccurs iwith imuscle ispasm.
  • Rigid ihead iand ineck ioccur iwith iarthritis.iRange iof iMotion i(ROM) Note iany ilimitation iof imovement iduring iactive imotion.
  • Ask ithe iperson ito itouch ithe ichin ito ithe ichest
  • turn ithe ihead ito ithe iright iand ileft
  • try ito itouch ieach iear ito ithe ishoulder i(without ielevating ishoulders)
  • extend ithe ihead ibackward When ithe ineck iis isupple, imotion iis ismooth iand icontrolled. iNote ipain iat iany iparticularimovement.

The ifollowing icriteria iare icommon iclues ibut iare inot idefinitive iin iall icases:

  • Acute iinfection—acute ionset, i<14 idays' iduration; inodes iare ibilateral, ienlarged, iwarm, itender,iand ifirm ibut ifreely imovable.
  • Chronic iinflammation i(e.g., iin ituberculosis ithe inodes iare iclumped).
  • Cancerous inodes iare ihard, i>3 icm, iunilateral, inontender, imatted, iand ifixed.
  • Nodes iwith iHIV iinfection iare ienlarged, ifirm, inontender, iand imobile. iOccipital inodeienlargement iis icommon iwith iHIV iinfection.
  • A isingle ienlarged, inontender, ihard, ileft isupraclavicular inode imay iindicate ineoplasm iin ithoraxior iabdomen i(Virchow inode).
  • Painless, irubbery, idiscrete inodes ithat igradually iappear ioccur iwith iHodgkin ilymphoma,icommonly iin ithe icervical iregion. Hypothyroidism i(Myxedema) A ideficiency iof ithyroid ihormone imeans ithat ithe ithyroid ifurnace iis icold. iThis ireduces ithe imetabolic irate iand, iwhen isevere, icauses ia inonpitting iedema ior imyxedema. iUsual icause iis iHashimoto ithyroiditis. iSymptoms iinclude ifatigue iand icold iintolerance. iSigns iinclude ipuffy, iedematous iface, iespecially iaround ieyes i(periorbital iedema); ipuffy ihands iand ifeet; icoarse ifacial ifeatures; icool, idry iskin; iand idry, icoarse ihair iand ieyebrows. Hyperthyroidism i(Graves’ iDisease) Increased iproduction iof ithyroid ihormones icauses ian iincreased imetabolic irate, ijust ilike iramping iup ithe ifurnace. iThis iis imanifested iby igoiter iand iexophthalmos i(bulging ieyeballs). iSymptoms iinclude inervousness, ifatigue, iweight iloss, imuscle icramps, iand iheat iintolerance. iSigns iinclude iforceful itachycardia; ishortness iof ibreath; iexcessive isweating; ifine imuscle itremor; ithin isilky ihair;iwarm, imoist iskin; iinfrequent iblinking; iand ia istaring iappearance.

Assessing iThyroid iGland

  • The ithyroid igland iis idifficult ito ipalpate; iarrange iyour isetting ito imaximize iyour ilikelihoodiof isuccess.
  • Position ia istanding ilamp ito ishine itangentially iacross ithe ineck ito ihighlight iany ipossibleiswelling.
  • Tilt ithe ihead iback ito istretch ithe iskin iagainst ithe ithyroid.
  • Supply ithe iperson iwith ia iglass iof iwater iand ifirst iinspect ithe ineck ias ithe iperson itakes iaisip iand iswallows.
  • Thyroid itissue imoves iup iwith ia iswallow iand ithen ifalls iinto iits iresting iposition.
  • Look ifor idiffuse ienlargement ior ia inodular ilump.iPosterior iApproach
  • To ipalpate, imove ibehind ithe iperson i(Fig. i13-14, iA).
  • Ask ithe iperson ito isit iup ivery istraight iand ithen ito ibend ithe ihead islightly iforward iand itoithe iright. iThis irelaxes ithe ineck imuscles ion ithe iright iside.
  • Use ithe ifingers iof iyour ileft ihand ito ipush ithe itrachea islightly ito ithe iright.
  • Curve iyour iright ifingers ibetween ithe itrachea iand ithe isternomastoid imuscle, iretracting iitislightly, iand iask ithe iperson ito itake ia isip iof iwater.
  • The ithyroid imoves iup iunder iyour ipalpating ifingers iwith ithe itrachea iand ilarynx ias itheiperson iswallows. iReverse ithe iprocedure ifor ithe ileft iside.

Usually iyou icannot ipalpate ithe inormal iadult ithyroid. iIf ithe iperson ihas ia ilong, ithin ineck, iyou isometimes ifeel ithe iisthmus iover ithe itracheal irings. iThe ilateral ilobes iusually iare inot ipalpable;ipalpable ilobes ifeel irubbery ibut ismooth. iCheck ithem ifor ienlargement, iconsistency, isymmetry,iand ithe ipresence iof inodules. Abnormalities: Enlarged ilobes ithat iare ieasily ipalpated ibefore iswallowing ior iare itender ito ipalpation i(see ilarge igoiter iin iFig. i13-14, iB) ior ithe ipresence iof inodules ior ilumps. iSee iTable i13-4, iThyroid iHormoneiDisorders, ip. i277. Anterior iApproach.

  • Stand ifacing ithe iperson.
  • Ask ihim ior iher ito itip ithe ihead iforward iand ito ithe iright.
  • Use iyour iright ithumb ito idisplace ithe itrachea islightly ito ithe iperson's iright.
  • Hook iyour ileft ithumb iand ifingers iaround ithe isternomastoid imuscle.
  • Feel ifor ilobe ienlargement ias ithe iperson iswallows i(Fig. i13-15). 264 iAuscultate ithe iThyroid If ithe ithyroid igland iis ienlarged, iauscultate iit ifor ithe ipresence iof ia ibruit. iThis iis ia isoft, ipulsatile,iwhooshing, iblowing isound iheard ibest iwith ithe ibell iof ithe istethoscope. iThe ibruit iis inot ipresent inormally. iA ibruit ioccurs iwith iaccelerated ior iturbulent iblood iflow, iindicating ihyperplasia iof itheithyroid i(e.g., ihyperthyroidism).

Simple iDiffuse iGoiter i(SDG) Goiter, ia ichronic ienlargement iof ithe ithyroid igland, iis icommon iin iwide iregions iof ithe iworld i(especially imountainous iregions) iwhere ithe isoil iis ilow iin iiodine. iIodine iis ian iessential ielement iinithe iformation iof ithyroid ihormones.

Summary iChecklist: iHead, iFace, iand iNeck, iIncluding iRegional iLymphatics iExamination

  1. Inspect iand ipalpate ithe iskulliGeneral isize iand icontour Note iany ideformities, ilumps, itenderness Palpate itemporal iartery, itemporomandibular ijoint
  2. Inspect ithe ifaceiFacial iexpression Symmetry iof imovement i(cranial inerve iVII) iAny iinvoluntary imovements, iedema, ilesions
  3. Inspect iand ipalpate ithe ineck iActive iROM Enlargement iof isalivary iglands, ilymph inodes, ithyroid iglandiPosition iof itrachea
  4. Auscultate ithyroid i(if ienlarged) ifor ibruit

Ear i– iP. i 777 iand i 787 Assessment iof iear i– itympanic imembrane i(describe iwhat itympanic imembrane iboth inormal iand iabnormal) i– iexample i– irecent ihead itrauma iand iinfection

Absent ior idistorted ilandmarks Air/fluid ilevel ior iair ibubble ibehind ithe idrum iindicates iserous iotitis imediaiPosition-Retracted idrum idue ito ivacuum iin imiddle iear Bulging idrum ifrom iotitis imedia Integrity iof iMembrane-Perforation ishows ias idark ioval iarea ior ias ia ilarger iopening ion itheidrum i(Table i8-1)Vesicles ion idrum Test iHearing iAcuity iWhispered iVoice iTest Person iis iunable ito ihear iwhispered iitems Whisper- iis ihigh-frequency isounds i& iis iused ito idetect ihigh-tone ilossiTuning iFork iTest Conductive iloss ifrom isensorineural iloss i(Tablet i15-7, ip.350)iDevelopmental iCompetence Infants i& iYoung iChildren Low-set iears ifound iwith itrisomy i13, i18, i 21 Large, iprominent iears; imisshapen iears; i& icreases ion iearlobes iare inonspecific ibut ioccuriwith icertain isyndromes i& iunderlying iear istructure iabnormalities Preauricular iskin itags imay ioccur ialone ior iwith iother ifacial ianomaliesiAbnormal iresponse iis ino imovement iof ithe ieardrum Drum ihypomobility iindicated ieffusion ior ia ihigh ivacuum iin ithe imiddle iear iNewborn’s i 1 st^ i 6 iweeks i= idrum iimmobility iis ithe ibest iindicator iof imiddle iear iinfectioniForeign ibody i(Tablet i15-4, ip. i345) The iAging iAdult (Table i8-1) iEar iCanal ior iTympanic iMembrane iAbnormalities Retracted i Drum- i Landmarks-prominent iMalleus i handle-shorter i & i more i horizontaliShort iprocess- ivery iprominent Light i reflex i is i absent i or i distorted Drum i is i dull i& i lusterless i& i does i not imove Signs i indicate i obstructed i Eustachian i tube i & i serous i otitis i media Excessive i Cerumen- i Excessive i cerumen i production i or i impacted i because i of i a i narrow i tortuous i canalior ifaulty icleaning imethod

i. Appears ias ia iround iball ipartially iobscuring ithe idrum ior itotallyioccluding ithe icanal ii. Total iocclusion ithe iperson iexperiences iear ifullness iandiimpaired ihearing B. Acute i(Purulent) iOtitis iMedia- i. Absent ior idistorted ilight ireflex iis ian iearly isign ii. Redness i& ibulging i 1 st^ inoted iin isuperior ipart iof idrum i(parsiflaccida), ialong iwith iearache i& ifever iii. Fiery ired ibulging iof ientire idrum ioccurs, iwith ideep ithrobbingipain, ifever, i& itransient ihearing iloss iv. Pneumatic iotoscopy ireveals idrum ihypomobility C. Otitis iMedia iwith iEffusion- i. Amber-yellow idrum, ian iair/fluid ilevel iwith ifine iblack idividingiline, ior iair ibubbles ivisible ibehind idrum ii. Symptoms: ifeeling iof ifullness, itransient ihearing iloss, ipoppingisound iwith iswallowing i(Serous iOtitis iMedia i& iGlue iEar) D. Perforation- i. Drum irupture ifrom iincreased ipressure ior itrauma ii. Appears iround ior ioval idarkened iarea ion idrum iii. Central iperforations ioccurs iin ipars itensa, imarginal iperforationiat ithe iannulus E. Otitis iExterna- i. Severe iswelling iof icanal; iinflammation; itenderness ii. Canal ilumen- inarrowed ito i¼ iits inormal isize iii. An iinfection iof ithe iouter iear, iwith isevere ipainful imovement iofipinna i& itragus, iredness i& iswelling iof ipinna i& icanal, iscanty ipurulent idischarge, iscaling, iitching, ifever, i& ienlarged iender iregional ilymph inodes iv. Hearing iis inormal ior islightly idiminished v. Swimmer’s iear- icanal ibecomes iwaterlogged i& iswells; iskinfoldsiare iset iup ifor iinfection

Discuss ifunctions iof icerumen

**- Yellow iwax ithat ilubricates iand iprotects ithe iear.

  • Sticky ibarrier ithat ikeeps iforeign ibodies ifrom ientering iand ireaching ithe** itympanicimembrane Use iof iotoscope i– iP. i 119 a. Otoscope ifunnels ilight iinto ithe iear icanal i& ion ithe itympanic imembranei(T.M.) b. Use ilargest ispeculum isize ithat ifits icomfortably iin ipatients iear c. Need ian iotoscope ito iAssess iEar ihealth i. Otoscope iTechniques ip.

Visual ifields- i Assess iperipheral ivision iwith ithe iconfrontation itest iin ichildren iolder ithan i 3 iyears iwhen ithe ipreschooler iis iable ito istay iin iposition. iAs iwith ithe iadult, ithe ichild ishould isee ithe imoving itarget iat ithe isame itime iyour inormal ieyes ido. iOften ia iyoung ichild iforgets ito isay i“now” iori“stop” ias ithe imoving iobject iis iseen. iRather, inote ithe iinstant ithe ichild's ieyes ideviate ior ihead ishiftsiposition ito igaze iat ithe imoving iobject. iMatch ithis inearly iautomatic iresponse iwith iyour iown isighting. i Pg. i 303

Assessment iof iCranial inerve iV:(Trigemenal iNerve) Motor iFunction: i Assess ithe imuscles iof imastication iby ipalpating ithe itemporal iand imasseter imuscles ias ithe iperson iclenches ithe iteeth i(Fig. i23-9). iMuscles ishould ifeel iequally istrong ion ibothisides. iNext itry ito iseparate ithe ijaws iby ipushing idown ion ithe ichin; inormally iyou icannot. Abnormal iFindings: i Decreased istrength ion ione ior iboth isides. iAsymmetry iin ijaw imovement;iPain iwith iclenching iof iteeth. Sensory iFunction: i With ithe iperson's ieyes iclosed, itest ilight itouch isensation iby itouching ia icottoniwisp ito ithese idesignated iareas ion iperson's iface: iforehead, icheeks, iand ichin i(Fig. i23-10). iAsk itheiperson ito isay i“Now” iwhenever ithe itouch iis ifelt. iThis itests iall ithree idivisions iof ithe inerve: i(1) iophthalmic, i(2) imaxillary, iand i(3) imandibular. Abnormal iFindings: i Decreased ior iunequal isensation. iWith ia istroke, isensation iof iface iand ibodyiis ilost ion ithe iopposite iside iof ithe ilesion. Scotoma= iis ia iblind ispot isurrounded iby iareas iof inormal ior idecrease ivisoniHyperopia- i Farsightedness. Presbyopia- i This iglasslike iquality idecreases ithe iability iof ithe ilens ito ichange ishape itoiaccommodate ifor inear ivision Myopia- i Nearsighted. Astigmatism- i is ia irefractive idisorder icaused iby ia ichange iin ithe inormally iround icurvature iof ithe icornea. iThe ichange icauses ilight irefraction ito ifocus ion itwo iareas ion ior inear ithe iretina iresulting iiniblurred ior idouble ivision.

Use iof iophthalmoscope i– i(only iwith imyopia iand ihyperopia)

  • Acute iglaucoma- i results ifrom isudden iincrease iin iintraocular ipressure icaused i by iblockage iin ifluid iflow ifrom ithe ianterior ichamber. iAcute iglaucoma irequires iimmediate imedical iattention. - Ectropian- i The ieversion iof ithe ilower ieyelid icaused iby imuscle iweakness.
  • Entropian- i The iinversion iof ithe ilid iand ilashes icaused iby imuscle ispasm iof ithe ieyelid.
  • Ptosis - ione ieyelid idrooping. - Blepharitis- i The iinflammation iof ithe ieyelids.
  • Anisocoria- i Unequal ipupil isize.
  • Periorbital iedema- i Swollen, ipuffy ilids, ioccurs iwith icrying, iinfection, iand isystemiciproblems iincluding ikidney ifailure, iheart ifailure, iand iallergy.
  • Exophoria- i Outward iturning iof ithe ieye.
  • Strabismus- i A icondition iin iwhich ithe iaxes iof ithe ieyes icannot ibe idirected iat ithe isameiobject. - Esophoria - iInward iturning iof ithe ieye.
  • Mydriasi- i Enhancing idistant ivision.