Underestimation of Pupil Size by Critical Care and Neurosurgical Nurses

Author(s): Robert G. Kerr, MD, PhD, Andrea M. Bacon, RN, BSN, Laura L. Baker, MS, ARNP, FNP-BC, Janelle S. Gehrke, RN, BSN, CCRC, K. Danielle Hahn, BS, Cheryl L. Lillegraven, MSN, ARNP, ACNS-BC, Catherine Hackett Renner, PhD, and Sarah K. Spilman, MA

Contact Hours 1.00

CERP A 1.00

Expires May 01, 2019

Topics: Neurology

Population: Adult

Role: Staff

Member: Free
NonMember: $10.00

Added to Collection

Activity Summary

Early detection of pupillary changes in patients with head injuries can alert the care team to increasing intracranial pressure. Previous research has shown inconsistencies in pupil measurement that are most likely due to the subjective nature of measuring pupils without the assistance of technology.


  • Identify the association between pupil diameter and nurses’ accuracy of assessment, specifically noting whether nurses are prone to underestimation or overestimation as the true diameter increases.
  • Describe the patterns of inconsistency in nurses’ assessments of duplicated images and how this could impact bedside assessments.
  • Explain why inaccurate assessment and inability to detect subtle pupillary changes could negatively impact patient care.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. Approval of a continuing education activity does not imply endorsement by AACN or ANCC of any commercial products displayed or discussed in conjunction with the activity.


The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC's) Commission on Accreditation, ANCC Provider Number 0012 (60 min contact hour). AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing, California Provider number CEP01036 for 1.2 contact hours (50 min contact hour).

AACN programming meets the standards for most states that require mandatory continuing education contact hours for license and/or certification renewal. AACN recommends consulting with your state board of nursing or credentialing organization before submitting CE to fulfill continuing education requirements.