A patient’s health is ultimately in the hands of the critical care nurses caring for them.
They have to quickly evaluate their patients and devise a plan of action to treat them. Because of this, they must be able to detect when their patients are ill so that they may get prompt care.
Nurses in intensive care may tell a lot by glancing at their students.
Performing pupil measurement on the patient’s pupils will provide insight into their current condition and predict what may happen in the future, helping you make more informed treatment choices.
This article will explain how to examine a patient’s pupils and use that information to help you make critical decisions about their care.
A pupillary examination is a basic component of the neurological exam
The critical care nurse should do a pupillary examination as part of the neurological evaluation.
The lack of a normal pupillary response may be a warning sign of oncoming neurological impairment, whereas a normal response can signal that the brainstem is intact. The optic nerves of your patient need to be stimulated with intense light to elicit a reaction from their pupils. Sometimes, you may not have access to these stimuli (e.g., in low-light conditions).
The pupilometer is also simpler and more efficient to use.
The pupil acts as a window to the brain and spinal cord
The pupils may be a diagnostic tool for health care providers to determine whether a patient has had a traumatic brain injury or to evaluate brainstem function.
This may aid in deciding whether the patient requires an intensive care unit admission. Pupil assessment may also be used in surgery to get insight into the patient’s eye movement, light responses, and pain sensitivity.
Components of pupillary examination include size, shape, reaction to light, and symmetry
Assessing the patient’s pupils is essential to a comprehensive neurological examination.
The size of the pupil, its shape, its reactivity to light, and symmetry are all evaluated. It is possible for the pupil size to be tiny or big, to constrict or dilate in response to light, and to be the same on both sides. The examination of the patient’s pupil function will help determine whether the patient has neurologic deficits that could lead to further complications, such as increased ICP (intracranial pressure), decreased cerebral perfusion pressure (the amount of blood entering the brain), and visual loss from compression on optic nerves/chiasm from swelling around eyes due to head trauma or hemorrhage in the temporal lobes causing papilledema, which is blurred vision because of swelling around optic nerves when there.
Focal findings during the pupillary examination require further assessment.
After a pupillary exam, the patient needs further testing if you notice any of the following focal findings:
The eyes have enlarged pupils. The size and behavior of the pupil in response to illumination may vary widely. This is most likely due to a neurological disorder, such as a brainstem tumor or a concussion (in which case there may also be other neurological signs).
Smaller-than-average pupils: Increased intracranial pressure from bleeding into the subarachnoid space or tumors pushing on nearby tissues in the brainstem may produce miosis, which can manifest as anisocoria. Autonomic dysfunction and oculomotor nerve damage are two other potential causes.
Uneven pupils may result from moderate trauma, with swelling around one eye but not both, or a symptom of temporal cerebral artery thrombosis if accompanied by a headache. This observation, however, could raise suspicions of increased intracranial pressure due to bleeding inside the skull cavity when examining a patient who has had a severe head injury and is showing signs of altered consciousness states and seizures.
If your patient’s pupils don’t contract when exposed to bright lights, there are a few things to remember: cerebral hemorrhage leading to optic nerve injury and elevated intracranial pressure.
Altered pupillary structures may require additional evaluation.
If the size, shape, or response to light of the patient’s pupils differs, you might need to perform a second pupillary examination.
By shining a light on one side of a patient’s face and examining both pupils, you can also determine whether or not their pupils are symmetrical. It could indicate a one cranial nerve 2 or 3 issue if you observe that one pupil is responding differently than the other (optic nerve).
Ocular Reflex Responses
When evaluating the students, several reflexes are put to the test, including:
- Pupillary Light Reflex: The pupillary light reflex is fundamental to the ocular examination. Nurses can use it to gauge the robustness and integrity of the afferent pathway by medical professionals. The normal pupillary light reflex includes near-reflexes, far-reflexes, accommodation, convergence, and constriction in response to light. Under normal circumstances, a patient’s pupils will constrict when they look at an object (or anything bright); this is known as a “direct response” because it happens immediately after exposure to light.
- Pupillary Dark Response: The pupillary response to light and dark is assessed using the pupillary dark response. Because of the pupillary light reflex, the pupil contracts in response to darkness and further contracts in response to darkness. This will occur smoothly and in less than 30 seconds in a healthy patient.
- The Accommodation Response: The Accommodation Response is the capacity to concentrate on nearby as opposed to distant objects. When patients need critical care, evaluate their vision for close-up, midrange, and distant items. This is significant because an ocular disease is one of the most frequent causes of vision loss in critical illness. Doctors should use Snellen charts or other visual aids for visual acuity testing at a distance of 6 meters, which provides an approximate measurement of 20/20 vision (or 6/6).
The Pupilometer: The Best Neurological Tool for Critical Care Nurses
Every neuro exam requires critical care nurses to use the right neurological tools to assess a patient’s neurological status. The NPi pupilometer is one of the essential tools you can use during this exam.
It is the gold standard for measuring pupillary response and assessing brain stem reflexes. It can help determine whether or not a patient has suffered any damage to their brain stem and whether they are in danger of losing consciousness due to their condition.
Why Use the Pupilometer?
The pupilometer is a vital part of any neuro exam because it allows you to assess whether or not your patient has suffered from an injury that could affect their brain stem.
This is especially important in the critical care setting, where every second counts when diagnosing and treating patients in danger of losing consciousness. When used correctly by trained nurses, this device can help identify signs of brain stem damage and inform the physician whether or not a patient should be admitted to the ICU for further observation.
When misused, however, it can cause more harm than good by causing confusion among the staff and potentially leading to misdiagnosis of your patient’s condition.
Conclusion:
Proper pupil evaluation is a critical part of your patient’s neurological examination. It can help you determine whether your patient has suffered any brain damage and prevent misdiagnosing other conditions. A pupil evaluation is also helpful in assessing the effectiveness of medications used to treat specific brain injuries, helping you make informed decisions about treatment options.
