Hello? Is anybody there? Okay we're not actually looking to see
if anybody's there, like down the hall or in a room hiding.
We're today talking about pupil assessment known as PERRLA
and the reason I want to talk about that today is because as an educator
I am finding that I have to reteach this one
a lot, like probably nine times out of ten
I am revisiting this particular topic and it's one of our basic assessments
that for me I think you should be doing on
every patient if you work in acute care. Why? Because it gives us information,
vital information. So we're going to talk about what PERRLA
is, how to do it, and why you want to know how to do it - right after this.
Welcome back. My name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below
so that you get the next video when it's released. So a quick
non-invasive check up of your eyes health,
function and appearance is known as PERRLA. This stands for pupils
are equal, round and reactive to light and accommodation. So let's go
first of all through the pieces. P stands for pupils. Pupils are the dark
color part of your eye, the iris, the colored part in your eye
I don't know if you can see it here but
oh yeah there it is look right there the middle part - you knew that though
right? I'm just playing with you. So pupils are the dark colored spots in
the middle of your iris. We want to make sure that they're equal
in size and in shape. Now most people
have equal pupils. When we see different sized pupils
we have a term for that called anasecoria
Anasecoria means greater than one millimeter, one millimeter difference
between pupils. So our pupils control the light that enters into our eye and
we want to be looking to see that they are equal in size so both
eyes we're looking at, to make sure that the pupils are of the same
size in each side; both with a light shining and
when there isn't a light shining. So we're going to get into that in a minute.
Now aside from being equal they should also be round.
Our pupils should be perfect round little circles inside of our eyes;
when they are not then we want to begin investigating to make sure there isn't
any pathology that's causing that difference. Round and
reactive so reactive is really just a key word to remember that we need to
test it to light and accommodation. So our pupils do respond to the amount of light
in our environment and whether we're looking near or far at
objects. Now the equipment you're going to need
for this is a pen light. A pen light is the only tool you're going to need
because we can use this both to check for
our reaction to light and accommodation. So first reaction to light.
Now in your textbooks it will say to dim the lights and make a
lower lit room you can also do that just by putting a piece of paper, because in a
healthcare facility you don't always have the option
to turn off the lights but sometimes just getting rid of the reflection from
the ceiling with a piece of paper you know your
nursing notes will help to see those eyes better. Before you shine a
light in your patient's eyes you want to just be looking at both of those pupils
and looking to see what size they are and
kind of getting a measurement pre-test.
The first thing we're going to do is take our pen light and we're going to
shine it in one eye and we're going to look at this eye's response and then
we'll move the pen light away and then we're going to shine that light
in the same eye but we're going to look at the pupil reaction in the other
opposite eye to make sure it is also reacting to the
same degree. So let's start that. So when assessing the pupils of your
patient take your pen light and when you turn it on you want to come
from the side of the eye not directly in front because that's a
bright light we're shining in there, and the pupil will constrict
either way but it's a little kinder and gentler to come from the sides. You'd
want to come this way or angle it a little bit
forward so it's not a direct on light in the eye.
Okay so we're going to start looking in this eye first,
letting that eye reset and now we're going to focus on this pupil
and we're going to switch eyes again so let that kind of reset for a second
we're going to be looking in the eye which I shine first
and then take a look at this eye and this is known as a consensual reflex.
So when it comes to accommodation I'm going to be looking at the objects
beyond this camera and then I'm going to be focusing my attention
back on my finger right in front of my nose. So what you should see
are two things: there should be a change in pupil size, which may be quite subtle
considering my room here is not that big but the
second thing you should see is that when I come into focus on the object
right in front of me is that my eyes should come in that's called convergence.
So we're going to start with looking far away and note the pupil size
and we'll be looking for a subtle change as I focus on my finger in front of my
nose. You will have noticed that my eyes have
come together as they focus on the nose and the pupil
should have gotten smaller. And far away ...
close up...
and that would be accommodation. Okay so looking back at the accommodation bit it
really was a challenge to demonstrate that subtle change with the pupil size
and the convergence, so practice it on your own for sure.
Have somebody else you can look at that will make it so much easier -
some of the limitations of doing home videos
solo. So that is PERRLA. Now when you go to document it how you want to document
your pupil size is the initial size so for example mine
were three millimeters going down to two millimeters so you go
three slash two both eyes if that was the case.
Have fun practicing your assessment of the pupils and don't forget to do it!
It's such an important assessment. Remember it tells you information about
the nerve system, the blood supply and the brain; all good
things to know about especially when you're taking care of
patients. Until next time make it a great day! Hey I know you're
probably not ready to get off your phone or go back to work just yet or maybe
even turn the lights off to go to sleep so
why don't you spend a little bit more time here watching another video :)