silly questions (just wanna clarify)

Nursing Students Student Assist

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well, first of all, i've been confused with this stuff. i mean, when recording the pupil size of the patient, which one do you record:

the size before or after illumination?

and in patients with tracheostomy, where do they exactly exhale: through the nares or the trach tube? how do you check the nasal patency?

well, that's about it. any inputs and answers are definitely welcome. thanks!:imbar

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Specializes in med/surg, telemetry, IV therapy, mgmt.

You record the pupil size after illumination.

If the cuff of the tracheostomy tube is inflated, the patient will exhale through the tracheostomy tube. If the cuff is deflated, some air will be exhaled through the nasal cavity, but most air will be exhaled through the trach. There is no reason to check the nasal patency. The reason the trach is in place is because the patient is, for some reason, having problems getting air into the trachea due to an obstruction anywhere in the upper respiratory track. All you can do is provide nasal care as best you can for the patient. Because the patient will have no air coming in or out their nares, it will not be possible for them to blow their nose. You can only gently clean the nares with water moistened Q-tips or a washcloth to loosen and remove the dried crusts of mucus that form.

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thanks! um, another silly question... um... in stroke patients or comatose, are the pupils still PERRLA or something else? what are the usual findings regarding the pupils?

thanks again!

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