[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Vital signs and assessment](https://durgical.com/en/nursing/areas/vitals/) › Neurological checks: level of consciousness, pupils and the Glasgow scale # Neurological checks: level of consciousness, pupils and the Glasgow scale - Assessment Neuro checks repeat the same assessment (consciousness, orientation, Glasgow, pupils) at set intervals to catch any deterioration early. Updated Nov 5, 2026 ## Key points - Glasgow with method: check for factors that prevent assessment, observe, stimulate and rate. - The Glasgow scale adds three areas: eye opening, verbal response and motor response; totals range from 3 to 15. - Normal pupils: 2 to 5 mm, equal, round and reactive to light and accommodation. - Pinpoint pupils with slow breathing and coma suggest opioid overdose; a pupil that becomes larger or slower than the other is an alarm. - New confusion or any drop in the Glasgow score: call at once; if unsure whether the confusion is new, assume it is. ## What it is A nursing neuro check is not looking for a diagnosis: it is looking for a change. It is repeated with the same technique at the ordered times: level of consciousness and orientation, the Glasgow Coma Scale, pupil size and reaction, and vital signs. The first assessment, on admission, is the baseline; each check is compared with the one before. New confusion or any acute drop in the Glasgow score is a sign of potentially serious deterioration and is escalated at once. ## Reference values - Glasgow: 4 eye responses, 5 verbal and 6 motor; total 3 to 15. - A Glasgow score below 8 is classed as coma. - Pupils: 2 to 5 mm, equal, with a brisk reaction to light. - Orientation is checked with name, place and day; normal is recorded as «alert and oriented ×3». ## What you need - Penlight and a pupil gauge (paper pupillometer). - The previous assessment (baseline) and the ordered frequency of checks. - Knowing what can distort the assessment: sedation, intubation, eyelid swelling, deafness, language, or missing glasses or hearing aids. ## How to measure it (and why) - Check what may prevent assessing each component (sedation, intubation, deafness, language) — it is recorded as «not testable» instead of being scored wrongly. - Observe without stimulating: do they open their eyes, move, speak on their own? — the spontaneous response is the best one. - If there is no response, speak to them, then apply a physical stimulus per protocol — the aim is the best response with the least stimulus needed. - Ask name, place and date; if the date is not known, ask the day of the week, month or season — orientation picks up subtle confusion. - Dim the lights, shine the light into each pupil from the side and compare size, shape and speed — new asymmetry is a warning sign. - Rate each response against the defined criteria of the scale — so different nurses score it the same way. - Record each response, the total, pupils, vital signs and time — this shows the trend and communicates it clearly. ## How to read it - NEWS2 adds new confusion to the level of consciousness: AVPU becomes ACVPU. - Delirium is acute, reversible confusion (from fever, infection or low oxygen); dementia is chronic, irreversible confusion and memory loss. - On NEWS2, new confusion scores 3 by itself and calls for urgent assessment. - Check glasses and hearing aids before testing orientation: poor sight or hearing can look like confusion. ## Next step: when to call for help - Call at once for any drop in the Glasgow score, new confusion, agitation or drowsiness that was not there before. - Call at once if a pupil enlarges, becomes sluggish or the pupils become unequal. - If the patient becomes unresponsive, call for emergency help per protocol. - Record the name of the person told, the time and the measures taken. ## Test yourself Think of the answer, then tap the question to see it. ## Which three responses does the Glasgow scale assess? Eye opening, verbal response and motor response; their scores are added for a total of 3 to 15. ## What pupil size is considered normal? Between 2 and 5 mm, with both pupils equal, round and reactive to light and accommodation. ## What steps does the structured Glasgow assessment follow? Check what prevents assessment, observe the spontaneous response, stimulate if there is none and rate against defined criteria. ## What do you do for new confusion in a patient who was oriented? Call at once. It is a sign of possibly serious deterioration, and if in doubt whether it is new, assume it is. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/neurological-checks-level-of-consciousness-pupils-and-the-glasgow-scale/) ## Elsewhere in DurgiPedia - [Level of consciousness and the Glasgow Coma Scale](https://durgical.com/en/clinical-exam/level-of-consciousness-and-the-glasgow-coma-scale/) ## Connections ## Related 2 - [Early warning scores (NEWS2) and when to escalate](https://durgical.com/en/nursing/early-warning-scores-and-when-to-escalate/) - [Vital signs in nursing: when, how often and how to record them](https://durgical.com/en/nursing/vital-signs-in-nursing-when-how-often-and-how-to-record-them/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills (Open RN), 6.4 Assessing Mental Status](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/06%3A_Neurological_Assessment/6.04%3A_Assessing_Mental_Status) (Open RN, Wisconsin Technical College System (LibreTexts), 2021); [Nursing Skills (Open RN), 6.5 Assessing Cranial Nerves](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/06%3A_Neurological_Assessment/6.05%3A_Assessing_Cranial_Nerves) (Open RN, Wisconsin Technical College System (LibreTexts), 2021); [Glasgow Coma Scale: structured approach](https://www.glasgowcomascale.org/) (Royal College of Physicians and Surgeons of Glasgow, 2014); [National Early Warning Score (NEWS) 2: executive summary and recommendations](https://www.rcp.ac.uk/media/ctulqqbn/news2-executive-summary_0.pdf) (Royal College of Physicians, 2017). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/neurological-checks-level-of-consciousness-pupils-and-the-glasgow-scale/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/neurological-checks-level-of-consciousness-pupils-and-the-glasgow-scale/