Critical Care Nursing: How Pupil Evaluation Helps in Diagnose

Nurses that specialize in critical care are the ones who are ultimately accountable for a patient's well-being.

They have to make snap judgments and evaluate their patients in a short amount of time to deliver the correct therapy to them. For this reason, they need to identify when anything is wrong with their patients so that they may begin treatment as quickly as possible.

Examining a patient's pupils is one method nurses working in intensive care might use to determine this.

You will be able to understand how your patient is doing and what can happen in the future if you do a pupil evaluation. This will enable you to make better decisions on how to treat them.

A pupillary examination is a basic component of the neurological exam

Pupillary evaluation is one of the most fundamental aspects of the neurological exam, and it needs to be included in critical care nursing.

The intactness of the brainstem may be deduced from a normal pupillary response, but the lack of an acceptable response can also serve as a critical warning indicator for the oncoming degradation of neurological function. It is necessary to use intense light to stimulate the optic nerves of your patient to elicit a response from their pupils. You may not have access to this stimulus in some circumstances (e.g., low-light conditions).

In addition, you will find that using the pupilometer is simpler and more accurate.

The pupil acts as a window to the brain and spinal cord.

Medical personnel may use the patient's pupils to determine whether a patient has experienced a traumatic brain injury. Doctors can also use pupils to evaluate brainstem function.

Because of this, they will be better able to decide whether the patient needs to be sent to an intensive care unit for additional examination and treatment. During surgery, a physician may also evaluate the patient's pupils to get information regarding the patient's eye movement, pain sensitivity, and response to light reflexes.

Components of pupillary examination include size, shape, reaction to light, and symmetry.

A comprehensive neurological assessment must include a pupillary examination, which is essential to this test.

The size of the pupil, its shape, its reactivity to light, and its symmetry are all factors that are evaluated. The pupil size may be tiny or big, and it can be either constricted or dilated during the light response. Additionally, the size of the pupil on both sides should be the same. The evaluation 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.

During the pupillary examination, you need to do further testing on the patient if you see any of the following focused findings:

• A pupil that is bigger than what is considered normal: The pupil may be constricted or dilated and can be unresponsive to light or responsive to it. It is probable that a neurologic disorder, such as head trauma or illness affecting the brainstem, is the root of the problem (in which case there may also be other neurologic signs).
• A pupil that is smaller than what is considered normal: Anisocoria may be a sign of underlying illnesses such as Horner's syndrome, which is the source of miosis, or elevated intracranial pressure, which can be caused by bleeding into the subarachnoid space or tumors pushing on nearby tissues in the brainstem. In addition, it may result from a disturbance in the autonomic nervous system or damage to the oculomotor nerve.
• Uneven pupils: This is a sign of minor trauma with swelling around one eye but not both; it may also signal a thrombosis of the temporal cerebral artery if accompanied by a headache. If you detect this result when examining a patient who has sustained a major head injury along with altered consciousness states and seizures, you should believe that the patient is experiencing elevated intracranial pressure due to bleeding inside their skull cavity.
• Pupils that do not respond to light: If you notice that your patient's pupils do not constrict when they are exposed to plentiful sources of natural light, then you should explore the following possible causes: injury to the optic nerve as well as a rise in intracranial pressure brought on by bleeding within the skull cavity.

Altered pupillary structures may require additional evaluation.

If your patient's pupils differ in size, shape, or how they respond to light, you may need to do an additional pupillary test.

You may also determine whether a patient's pupils are symmetrical by shining light from one side of their face and observing both pupils simultaneously. Observing one pupil behaving differently than the other might indicate an issue with cranial nerve 2 or 3 (optic nerve).

Ocular Reflex Responses

When evaluating the pupils, many reflexes are examined, and some of them are:

Pupillary Light Reflex

The eye examination must always begin with the pupillary light reflex since it is both essential and vital.

Medical practitioners may use it to assess the robustness and integrity of the afferent route. The typical pupillary light reflex comprises the following components: accommodation, convergence, near-reflexes, and far-reflexes. The pupil contracts in reaction to light. The contraction of a patient's pupils in response to looking at an item (or anything else that is bright) is referred to as a "direct reaction" since it takes place as soon as the patient is exposed to light and under normal circumstances (measured in milliseconds).

Pupillary Dark Response

The pupillary dark response is an eye test that measures how the pupil of the eye reacts to darkness as opposed to light.

Because of the pupillary light reflex, the pupil becomes more constricted in reaction to the absence of light than it was in response to darkness. This will go without a hitch in a healthy patient's space of a quarter of an hour.

The Accommodation Response

The capacity to concentrate on either close-to-home or faraway items is known as the Accommodation Response.

When the patient is in a critical care scenario, it is crucial to evaluate their vision in all three distance ranges: close, middle, and distant. This is significant since an eye ailment is one of the most prevalent reasons patients lose their vision when critically unwell.

Doctors should use the Snellen chart or another visual aid to test a person's visual acuity at a distance of 6 meters, approximating 20/20 vision (or 6/6 vision).

Conclusion

Pupil evaluation is an integral part of the eye exam process, and there are several ways to test the pupil. A medical professional will use these tests to determine whether there is a problem with the pupil's ability to react in certain situations. This can help them decide whether a patient has suffered from an injury that affected their vision.