Brisk vs Sluggish pupillary response

all517 · Dec 27, 2012

Subjective means the person (pt) is describing it. If something is subjective, you personally are feeling it. Objective is what you are actually seeing. When you assess pupils, the light should elicit a quick (brisk) response by shrinking. Sluggish reaction is just what it sounds like... Slow to react. Fixed pupils shows no reaction= no bueno. Be sure to look up what pupillary response actually means in the brain, it's fascinating! (Neuro nurse here, kind of biased!)

ktliz · Dec 30, 2012

Sorry, I don't have an answer to your question, but I get what you mean about it being subjective. Kind of like rating edema--one nurse may say it's +1 and another will think it's +2. I am a new nurse and have found assessing pupils to be more difficult than one would think, but the more pupils you look at, the easier it gets.

Rhi007 · Dec 30, 2012

Subjective means the person (pt) is describing it. If something is subjective you personally are feeling it. Objective is what you are actually seeing. When you assess pupils, the light should elicit a quick (brisk) response by shrinking. Sluggish reaction is just what it sounds like... Slow to react. Fixed pupils shows no reaction= no bueno. Be sure to look up what pupillary response actually means in the brain, it's fascinating! (Neuro nurse here, kind of biased!)[/quote']
^^^ this is perfect. As a St. John volunteer, this is something I have to deal with when doing neuro obs and I always check twice to make sure as well as get a second opinion.

all517 · Dec 31, 2012

It is objective... you (the RN) are assessing it and making a judgement by what you (the RN) sees. Those are specifics... what you really need to know is if there is a change and is it abnormal :-)

edmia, BSN, RN · Dec 31, 2012

Great question! Sometimes the seemingly easiest things are the hardest to assess.

I find assessments of pupil reaction and grade of edema vary greatly between practitioners and is a little frustrating to see that not everyone assessing knows what the scales mean.

For pupils, I realized that with the bright lighting of an ICU, pupils were often marked as sluggish when in reality it just wasn't a good assessment. I turn the overhead light off while I'm auscultating and then shine my light on the pupils once they've had a chance to adjust to the dim lighting. You will really see a good response then.

Sluggish is really slow. The word itself describes it best. Like molasses.

Sent from my iPhone using allnurses.com

futureRNwine2survive · Nov 10, 2017

I know this is an old post, but I have a question re: one of the comments :) I'm in school currently and just want clarification :)

"For pupils, I realized that with the bright lighting of an ICU, pupils were often marked as sluggish when in reality it just wasn't a good assessment. I turn the overhead light off while I'm auscultating and then shine my light on the pupils once they've had a chance to adjust to the dim lighting. You will really see a good response then."

When saying you "auscultate" the pupils... I thought auscultate simply meant listening (i.e. auscultating the lungs, heart, bowel sounds, etc.-- utilizing your STETHOSCOPE) Can it be used in this instance as well, or would that be considered more "assessment" or any other term!? Just curious so I don't sound/look silly when giving report at clinical :) THX!!

smf0903 · Nov 10, 2017

I know this is an old post, but I have a question re: one of the comments :) I'm in school currently and just want clarification :)
"For pupils, I realized that with the bright lighting of an ICU, pupils were often marked as sluggish when in reality it just wasn't a good assessment. I turn the overhead light off while I'm auscultating and then shine my light on the pupils once they've had a chance to adjust to the dim lighting. You will really see a good response then."
When saying you "auscultate" the pupils... I thought auscultate simply meant listening (i.e. auscultating the lungs, heart, bowel sounds, etc.-- utilizing your STETHOSCOPE) Can it be used in this instance as well, or would that be considered more "assessment" or any other term!? Just curious so I don't sound/look silly when giving report at clinical :) THX!!

They probably meant they turn off overhead lights and then auscultate the lungs/heart/abdomen and then go back and assess pupils. The time while they are auscultating allows time for the pupils to adjust to the lower light level before they actually do the pupil assessment :)