How to Check Pupils with a Pen Light

Introduction

• Assessing neurostatus in patients involves checking pupil reflexes.
• Pen lights are essential tools for this procedure.
  • Available in disposable or battery-operated versions.
  • Useful for gauging pupil size and reflexes.

Pupil Assessment

• Normal Pupil Size:
  • Typically 3 to 5 mm in diameter.
  • Should be round in shape.
• Pupil Responses to Check:
  1. Direct Response:
     • Shine light into one eye.
     • Observe the constriction of the same pupil.
  2. Consensual Response:
     • Shine light into one eye.
     • Observe the pupil in the opposite eye for simultaneous constriction.
• Room Conditions:
  • Room should be dim to effectively observe pupil responses.

Accommodation

• Observes how pupils adjust when focusing on an object moving closer to the face.
  • Use a finger or the penlight as the focusing object.
  • Check if pupils constrict as the object moves closer.

Documentation

• Use the acronym "PERRLA":
  • Pupils Equal, Round, Reactive to Light, and Accommodation.

Skill Demonstration

• Procedure:
  1. Initial Observation:
     • Check for round, equal pupils.
     • Measure pupil size using penlight gauge.
  2. Direct and Consensual Response:
     • Shine light in one eye; observe direct pupil response.
     • Check opposite eye for consensual response.
     • Use the swinging test by alternating light every 2-3 seconds between eyes.
  3. Accommodation Response:
     • Hold an object a few feet from the patient's face.
     • Slowly move it towards the nose.
     • Observe pupils adjusting focus.

Conclusion

• Document findings as "PERRLA."
• Refer to additional nursing skill videos for further learning.
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