I am a new nurse and recently started my first job in a psychiatric hospital.
In all of our units, pts might be on detox protocols. Part of the assessment is to note it their pupils are pinpoint, larger than normal, much larger than normal, etc. This seems straightforward when I type it, but it is something I am really struggling with! In school, we of course assessed for PERRLA and noted the width of pupils in millimeters, but we never covered this. At this point, I still have a preceptor with me, so I always run my assessment by him/ her, and I'm usually wrong. Does anyone have a good resource for learning this assessment- preferably with pictures :-). I am fine with discriminating pinpoint versus extremely dilated, but everything in between looks normal to me.
Jul 20, '12
It would be good for you to be able to tell how many millimeters a person's pupils are, without having to look at any sort of gadget. When I first began, I drew the measurement on my index finger, so I could look at it as I looked at a person's pupils.
What's important about the detox eye-pupil measurement is to determine if the diameter of the pupil is consistent with how much light is in the room...much larger or smaller than the amount of light would indicate.. For instance, if there's little light, the pupils should be wide. If there's lots of light, the pupils should be smaller. Different drugs alter the pupils' diameters, so measuring them determines drug-effects. Of course, they should match and follow all the other PERRLA things too.
Sep 2, '12
I used a pen light that was super cheap & disposable with the measurements on it...I was the only person I knew of in my school that actually wrote down what I determined the size to be. I used that pen until it ran out and realized that I could do without and still be accurate. You can buy these for about $3 and buy the reusable ones for about $6 check out allheart.com they are pretty great. Things come with practice... spend some time reading about neurological assessments, sensory system, and then look to see how that connects with your particular assessments I feel that will help a lot.
Sep 2, '12
When someone is heavily in the throes of intoxication or detox, a measurement guide is not always necessary--their pupils are usually dilated/pinpoint enough under any conditions that there's no question they are not normal.
It's not always that cut-and-dry though...so I agree with Whispera and MySonIsAdorable's suggestions. And yes, practice is key.
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