Pupil size chart for nurses2/7/2024 Both pupils should react equally to light. Pupil reaction should be documented as per local policy, for example B (brisk), S (sluggish) or N (no reaction). There should also be a consensual reaction to the light source, that is the opposite pupil also constricts when the light source is applied to one eye (Jevon, 2007). Pupil reaction to light should be brisk and after removal of the light source, the pupil should return to its original size. It should be round abnormal shapes may indicate cerebral damage oval shape could indicate intracranial hypertension (Fairley, 2005). The average size is 2-5mm (Bersten et al, 2003). Pupil size should be measured, ideally with reference to a neurological observation chart or similar. Compression of this nerve will result in fixed dilated pupils (Fairley, 2005).Īny changes in the patient’s pupil reaction, size or shape, together with other neurological signs, are an indication of raised intracranial pressure (ICP) and compression of the optic nerve. Relaxation and contraction of the muscles of the iris causes it to dilate (in darkness) or constrict (in bright light).Įvaluation of pupillary reaction is effectively an assessment of the third cranial nerve (oculomotor nerve), which controls constriction of the pupil. The pupil is the ‘black hole’ in the centre of the iris, a flattened muscular diaphragm which is attached to the ciliary body (Marcovitch, 2005). The aim of this second practical procedure on neurological assessment is to understand how to perform pupillary assessment. Although not part of the Glasgow Coma Scale (covered in part three of this series next week), examination of the pupils is an essential adjunct to it, especially when the patient’s level of consciousness is impaired (Bersten et al, 2003). Pupillary assessment is an important part of neurological assessment because changes in the size, equality and reactivity of the pupils can provide vital diagnostic information in the critically ill patient (Smith, 2003).īoth pupils should be the same shape, size and react equally to light. ![]() Unable to assess Romberg and Pronator drift.Phil Jevon, PGCE, BSc, RGN, is resuscitation officer/clinical skills lead, honorary clinical lecturer, Manor Hospital, Walsall.Ĭlick here for more articles in our Practical Procedures series. Sensation intact to light touch bilaterally, R>L. Left lower extremity residual weakness, rated at 1/5, right lower extremity strength 4/5. Right hand grip and upper extremity strength strong at 4/5. Upper extremity hand grips, nonsymmetrical due to left-sided weakness. Left pupil 2mm, round nonreactive to light and accommodation. Reaction intact and accommodation intact right eye. Bilateral hearing aids in place with corrective lenses on. History of CVA with left-sided hemiplegia. Posture remains erect in wheelchair, with intermittent drift to left side. Dress is appropriate, well-groomed, and proper hygiene. Patient cooperative with exam and exhibits pleasant and calm behavior. Speech is clear affect and facial expressions are appropriate to situation. Patient is alert and oriented to person, place, and time. Sample Documentation of Unexpected Findings Balance is stable during heel-to-toe test. Cerebellar function intact as demonstrated through alternating hand movements and finger-to-nose test. Upper and lower extremity strength and hand grasps are 5/5 (equal with full resistance bilaterally). No deficits demonstrated on Mini-Mental Status Exam. ![]() Sensation intact in all extremities to light touch. Gait is coordinated and erect with good balance. Speech is clear and facial expressions are symmetrical. Patient is cooperative and appropriately follows instructions during the exam. Patient denies any new onset of symptoms of headaches, dizziness, visual disturbances, numbness, tingling, or weakness. 6.11 Sample Documentation Sample Documentation of Expected Findings
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