Assessing PERRLA

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Hi, I'm a first semester student and we must do a complete physical assessment on all of our patients at every clinical. I find it very difficult to do PERRLA on my patients. Specifically, assessing concensual response and accommodation - I never see it and I know it's important! Any advice?

Thanks,

Laura

Specializes in Critical Care, Capacity/Bed Management.

When you assess for consensual response make sure you are looking at both eyes; for example when you shine the light in the left eye the right pupil should also constrict (it's a reflex) as for accommodation tell the patient to keep their eyes fixed on the pen light and then bring the pen light close to their nose; their eyes should converge on the object and slight constriction of the pupils should occur.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

make sure the patient isn't facing a light. Pull the shade if you have to. Have the patient look at the center of your forehead. Shine the penlight in one eye ® and look at that eye ®....then you look at the other eye (L) and shine the penlight in the eye you were just looking at ® while looking at the other eye (L). Repeat this with the other eye.

The opposite eye (the one without the light on it...will also constrict to the light stimuli on the other eye.

I have a question...don't they "teach you this" do they "show" you how it should be done?

ampela

10 Posts

I find it helpful to just close all the lights in the room including blinds and curtains. For consensual response: shine the light in one eye, look for constriction; then do it again (shine the light in the same eye) but this time watch for constriction in the other eye. For accommodation have the patient look at your pen light as you move it close to the patient. The eyes should converge equally on the pen light.

skyebones

4 Posts

Yes, of course they teach this... my post was about having difficulty with seeing the pupil constrict, not that I didn't know how to perform the assessment. Sorry for the trouble.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Please..... I meant no offense. It is difficult when on the internet and programs vary so much. I just remember YEARS ago my instructors being very specific about how we did things I was not trying to be offensive. Once you are here a while you will come to know that I am the last person to be critical or offensive. It just isn't my style. ;)

People cpome here ALL the time with different needs and levels of instruction. I always ask questions to know how best to help. I'm very sorry if you were offended.

skyebones

4 Posts

Thanks! Those pupils will be the death of me : ).

nurseprnRN, BSN, RN

1 Article; 5,114 Posts

Nah. Blown pupils are the death of somebody else. :)

(looking for the "I'm running away now!" icon)

NuGuyNurse2b

927 Posts

I have a question...don't they "teach you this" do they "show" you how it should be done?

In my program, they told us to buy all these nursing diagnostic tools, and among them was a flash pen. I have yet to use it in clinical, we never had formal lab on how to use it nor have ever had it demonstrated in any skills lab. About the only thing we were formally taught was the stethoscope.

Specializes in Emergency Department.
Nah. Blown pupils are the death of somebody else. :)

(looking for the "I'm running away now!" icon)

That or they just left the Ophthalmologist's office...

Specializes in Emergency Department.

Today I had a patient whose pupils were about 4mm bilaterally, equal, round and non-reactive. When assessing the pupils, I noticed a rather tell-tale flashing back there... the patient used to have cataracts. Key word, used to. When you're assessing pupils, don't just look for pupil reaction to light, actually look at those pupils because you might be surprised what you find behind the iris. It could very well be some replacement lenses. If you see that, don't be surprised if the pupils aren't actually round and are non-reactive to light. And there are a LOT of people that have had cataract surgery.

Guests

Guest

0 Posts

The first time you see blown pupils or unequal pupils or pinpoint pupils, you can't miss it...

If the pupils are already fairly constricted, it's tough to say whether they're brisk or sluggish.

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