To assess a patient's pupillary reaction to light, the nurse should have the patient look straight ahead and then bring a penlight beam in from the side to shine on each pupil. The nurse observes for direct constriction of the illuminated pupil and consensual constriction of the opposite pupil, noting the speed and equality of the reaction.

The assessment involves shining a penlight into one pupil while the patient looks straight ahead. The direct response is the constriction of the illuminated pupil, while the consensual response is the constriction of the opposite pupil. The nurse should evaluate the speed of the reaction; a brisk response is immediate, while a sluggish response takes longer than one second. Both pupils should be assessed for reactivity and documented for any differences.

Key points

Have the patient look straight ahead during the assessment.
Shine a penlight from the side to observe direct and consensual responses.
Normal reaction includes immediate constriction of both pupils.
Document any differences in reactivity between the pupils.

How should a nurse assess a patient's pupillary reaction to light according to the chapter?