00:01
Now, another really important
assessment piece
when we're talking about the
neurological status of the patient.
00:07
Now, looking at pupils
is very important.
00:10
These can be subtle changes
that can tell us a lot
about a patient's condition.
00:16
So when we talk about pupils,
think about a couple of things.
00:20
So one of these are,
are the pupils reactive to light?
So for introduced light
into the patient's pupils,
do they react?
And next looking at the response,
meaning do they have
a consensual response?
So what I'm referring to
is if I take my penlight
in my patient's eyes,
go down one side
and shine light in one eye,
do they both respond?
That is meaning a
consensual response,
and that is good,
and that's normal.
00:47
Now, sometimes
you may take your penlight,
do the same thing,
but both pupils do not respond.
00:54
That is what we call a
nonconsensual response.
00:57
Now, that is not normal
and that needs to be
reported to the provider.
01:01
And one other thing that we note
is the size of the pupils.
01:05
This can also tell us a lot.
01:07
So it's important to assess these
at the beginning of the shift.
01:10
And as you can see here,
there's a guide about
what size the pupils are.
01:14
And if you have a penlight,
this guide is usually on that
penlight for you to refer to.
01:20
Now, when we talk about pupils,
many times you're gonna
hear the word of PERRLA
meaning, Pupils are Equal, Round,
Reactive and Light Accommodating.
01:31
So anytime you hear PERRLA
that's a very common
neurological assessment
that includes some
of these components.
01:38
So let's just talk a little
bit further about pupils.
01:41
So anytime
you're talking to neuro,
we say that, the eyes are
the window to the soul,
they just tell us a lot.
01:48
So if the pupils indeed
are not PERRLA
meaning Pupils are Equal, Round, and
Reactive and Light Accommodating,
now this can mean a lot of things.
01:58
This can mean the patient
has suffered from a head injury,
it could be certain
medications or drugs,
or a patient could have a
severe stroke or a brain bleed
that may be changing.
02:09
Now, just note this some drugs
will make pupils very pinpoint
meaning very small.
02:15
Now, some others will
actually dilate the pupil
and it'll be much larger.
02:19
Now, this is a good
point of reference,
especially if you work in the
emergency room, for example,
and get someone that is in the
emergency room and is being treated.
02:29
Now, let's look more at
these pupil assessments.
02:33
Now, one way
that we assess pupil response is,
and if you can dim the lights,
this really helps you out.
02:39
So if you can dim the lights,
go ahead and do so.
02:42
Then you're gonna have the client
look at an object in the distance
kind of like if you were
going to go to the eye doctor.
02:48
And this again is where
we get our penlight
to shine this into their eyes
from each side.
02:54
Now, here's where we've got to
watch their pupils closely.
02:58
Now, we've got to see
that the pupils constrict
and respond to the light
and making note of the size
and shape of their pupils.
03:06
Now remember,
when we shined in one side,
we should have a
consensual response,
meaning both pupils reacted.
03:14
And remember to go from one side
and compare sides to the other.
03:19
Now let's take a
look at pupil sizing.
03:21
As you can see here,
it goes from really smaller 1mm
all the way to what we call a
blown pupil at 9mm.
03:29
Now I'll be honest, I don't think
I've ever really seen one at 9mm,
maybe more like a 6 or 7.
03:35
But there's a lot of variants
in different patients.
03:38
Now, a blown pupil
or pupil variations
can be very dangerous and really
important to get a baseline
and assess these in
your patient regularly.
03:47
especially if you're talking about
any neurological patient.
03:52
Now, when we talk about pupils,
if you take a look at the
middle of this graphic here,
this is really normal size.
03:59
This is typically what
we're going to see
as you remember that PERRLA
the pupils are equal they're round,
and they react normally.
04:07
Now, if you look at the other side,
sometimes pupils can react to light
either really slow or
even maybe very brisk.
04:16
So notice, well, you can
have pinpoint pupils.
04:18
This could be because of a certain
type of brain damage or drugs.
04:22
You can have dilated pupils,
which can be an issue
and also bilateral dilated pupils.
04:28
Now if they're both dilated,
and they're not reactive at all,
this is a very ominous sign
and can mean a medical emergency
for your patient.
04:38
So let's talk about pupils
and when do you even call
the health care provider?
I know we talked a lot about them,
but here's some really just
two really easy things to know.
04:48
Number one,
make sure you compare sides.
04:51
Number two,
if the pupils change
and are no longer similar size
or reactive to light.
04:58
Call the healthcare provider.
05:00
Now, if they're no longer
responding to light,
and you don't have that
consensual response,
also make sure
to call the health care provider.
05:10
Now, if we take a look
at this graphic,
now let's ask the question,
we've got quite
a few size variations here.
05:17
Now, which of these pupils
are someone on opioids?
We've got the one very small,
more pinpoint,
7 which is pretty large,
and 4 somewhere in between.
05:29
So the 1 mm is again,
what we call pinpoint.
05:32
And this usually means your patient
is on opioids of some extent.
05:37
Now again,
you want to assess this
especially if someone's
coming in the emergency room.
05:41
And sometimes we may be giving
these medications to our patients.
05:44
So just assess the history.
05:48
So because the neurological
system is so complex.
05:52
Now, depending on why
your patients there,
sometimes we have to do specialized
neurological assessments.
05:59
Now, we may need to take a deep dive
and maybe assess
the patient's reflexes, for example.
06:04
Now, if you're on a particular unit
where that takes care of stroke,
you may perform as a nurse and
this is a special certification.
06:12
This is called the NIHSS,
or the National Institute
of Health Stroke Scale.
06:19
This is an advanced
neurological assessment
that the nurse indeed
has the scope of practice
to use this advanced
assessment with their patients.
06:27
Now, we may also use a specialized
medication related assessment
like the ICU Coma Scale.
06:33
And also don't forget about because
there's neurological damage,
a swallowing assessment is key.
06:39
So many times a speech therapist
is going to be consulted
on that patient's case
to make sure they've
been safely swallowing
and they don't aspirate.
06:48
And lastly, assessment of
cranial nerves is also important.
06:52
And this is typically going
to be done by the physician.