Assessment of light reaction of pupil

[tkyeung]

In a normal situation, when a torch shines light on the pupil, the pupil constricts. If the torch is not moved away and continues to shine the pupil, what will happen to the pupil size?

[akulahawkRN, ADN, RN, EMT-P]

As CodeteamB has stated, if you're only given 2 options, reactive or non-reactive, you should chart "reactive" and write a descriptive note about the dilation response because it is abnormal. If I'm doing paper-based charting or any other form of narrative charting, I'd chart the pupil response as "Pupils dilated in response to light" along with all the other usual descriptors I'd use. If there's a flag that indicates that the exam component is abnormal, I would set that status as well, in a computerized system. I would certainly NOT flag that as "WNL" status because it clearly isn't!

Edit: Since your hospital's system only has those three options, you go with the above. This is where you should be doing some critical thinking about this.

Is there a particular reason why you're asking for clarification?

[CodeteamB]

In my hospital the assessment only allows me to chart "reactive" (+ sign) or "non-reactive". (- sign) or eyelid swollen. I assume that it wants me to chart "reactive" as long as there is reaction from pupil from the shining of light (regardless of constrict or enlarge). Am I right?[/quote']

Is there no note function, or freehand charting section? If so this us an extremely flawed system.

Also, I doubt that anyone intends for you to chart something that is not true, regardless of the limitations of your system.

The problem is, "reactive" implies a normal exam and paradoxical dilatation is not normal. So a plus sign with no elaboration is charting in error. This is an important finding and needs to be charted accurately.

Do you understand?

[tkyeung]

Yes. If a pupil ever changes size it is "reactive". It is only nonreactive or "fixed" if it stays the same size no matter what amount of light it is exposed to.

A non reactive pupil will not change with any light source...ever. It does not dilate in darkness nor will it constrict in light. It stays the same.

Once the pupil changes at all to a light source it is reactive.

As said above, if the pupil changes upon the shining of light, then it is reactive?

[CodeteamB]

As said above if the pupil changes upon the shining of light, then it is reactive?[/quote']

Asked and answered.

Life (nursing) is not that simple. Charting a paradoxical dilatation as "reactive" is simply, flat-out, incorrect and no one on this thread has advised that you do so.

I'm not sure I can explain any better.

If you are still confused I advise you do some independent research. If you have made up your mind to chart only by tickbox despite your actual findings I advise you invest in malpractice insurance.

[tkyeung]

but the pupil dilates in response to light is also a reaction of the pupil to light, right? reactive to light does not necessarily mean the the pupil constricts with light, it only means pupil has reaction towards light?

[IrishErin]

but the pupil dilates in response to light is also a reaction of the pupil to light, right? reactive to light does not necessarily mean the the pupil constricts with light, it only means pupil has reaction towards light?

You've been given several great answers to this repetitive question a few times already.

[tkyeung]

To sum up, is the following statement correct?When light is shone on the pupil, if the pupil remains the same, no response occurs, then it is non-reactive; If light is shone on the pupil, it changes in size to the light source (constricts or enlarges) , it is reactive.

[Esme12, ASN, BSN, RN]

normal reaction is when the pupil constricts. If it dilated that is an abnormal reaction. note it in your narrative.

In an afferent pupillary defect there is a decreased direct response caused by decreased visual function in one eye. This can be demonstrated with the swinging flashlight test, in which the light is moved back and forth between the eyes every two to three seconds. The afferent pupillary defect becomes obvious when the flashlight is moved from the normal to the affected eye, and the affected pupil dilates in response to light. Under normal conditions, the pupil constricts in response to light.

Afferent Pupillary Defects

An afferent pupillary defect test is an important physical sign in an evaluation for neurologic disease. A relative afferent pupillary defect (RAPD) is an objective sign of unilateral or asymmetric disease of the optic nerve head or retina. The visual acuity does not necessarily correlate with an RAPD. If there is an RAPD with good central vision, you are likely dealing with optic nerve diseases and not retinal diseases. Usually retinal disease has to be quite severe for an RAPD to be clinically evident. In addition, there are many conditions with a severe vision loss, but without an RAPD, such conditions are a complete vitreous hemorrhage and hyphema.

http://www.pacificu.edu/optometry/ce/courses/19433/pupilanompg2.cfm

[sapphire18]

You are most likely never going to see a pupil dilate in response to light. Don't worry about that possibility- just cross that bridge if/when you come to it.

[tkyeung]

so is my statement correct? when there is a change in pupil size with the light source, it is reactive.Even when it dilates, it is reactive though it is an abnormal reaction.

[Mn nurse 22]

No your statement is not correct.

This has been explained to you over and over.

I have read through your other posts where you were just as argumentative as you continue to be on this issue.

It is very frustrating that you keep trying to twist people's words around.

[Esme12, ASN, BSN, RN]

What is this for? It is NOT plain nor simple

In a way, technically yes the pupil moves to light means it reacts but the term reactive indicates normalcy which dilation to light is not.