Cerebrovascular accident (stroke) refers to any functional or structural abnormality of the brain caused by a pathological condition of the cerebral vessels or of the entire cerebrovascular system. This pathology either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation by a partial or complete occlusion of the vessel lumen with transient or permanent effects.
Thrombosis, embolism, and hemorrhage are the primary causes for CVA, with thrombosis being the main cause of both CVAs and transient ischemic attacks (TIAs). The most common vessels involved are the carotid arteries and those of the vertebrobasilar system at the base of the brain. A thrombotic CVA causes a slow evolution of symptoms, usually over several hours, and is “completed” when the condition stabilizes. An embolic CVA occurs when a clot is carried into cerebral circulation and causes a localized cerebral infarct. Hemorrhagic CVA is caused by other conditions such as a ruptured aneurysm, hypertension, arteriovenous (AV) malformations, or other bleeding disorders.
8 Cerebrovascular Accident (Stroke) Nursing Care Plan (NCP)
- Ineffective Cerebral Tissue Perfusion — Stroke Nursing Care Plan (NCP)
- Impaired Physical Mobility — Stroke Nursing Care Plan (NCP)
- Impaired Verbal Communication — Stroke Nursing Care Plan (NCP)
- Disturbed Sensory Perception — Stroke Nursing Care Plan (NCP)
- Ineffective Coping — Stroke Nursing Care Plan (NCP)
- Self-Care Deficit — Stroke Nursing Care Plan (NCP)
- Risk for Impaired Swallowing — Stroke Nursing Care Plan (NCP)
- Knowledge Deficit — Stroke Nursing Care Plan (NCP)
Diagnostic Studies - Cerebrovascular Accident (Stroke)
- CT scan (with/without enhancement): Demonstrates structural abnormalities, edema, hematomas, ischemia, and infarctions. Note: May not immediately reveal all changes, e.g., ischemic infarcts are not evident on CT for 8–12 hr; however, intracerebral hemorrhage is immediately apparent; therefore, emergency CT is always done before administering tissue plasminogen activator (t-PA). In addition, patients with TIA commonly have a normal CT scan.
- PET scan: Provides data on cerebral metabolism and blood flow changes, especially in ischemic stroke.
- MRI: Shows areas of infarction, hemorrhage, AV malformations; and areas of ischemia.
- Cerebral angiography: Helps determine specific cause of stroke, e.g., hemorrhage or obstructed artery, pinpoints site of occlusion or rupture. Digital subtraction angiography evaluates patency of cerebral vessels, identifies their position in head and neck, and detects/evaluates lesions and vascular abnormalities.
- Lumbar puncture (LP): Pressure is usually normal and CSF is clear in cerebral thrombosis, embolism, and TIA. Pressure elevation and grossly bloody fluid suggest subarachnoid and intracerebral hemorrhage. CSF total protein level may be elevated in cases of thrombosis because of inflammatory process. LP should be performed if septic embolism from bacterial endocarditis is suspected.
- Transcranial Doppler ultrasonography: Evaluates the velocity of blood flow through major intracranial vessels; identifies AV disease, e.g., problems with carotid system (blood flow/presence of atherosclerotic plaques).
- EEG: Identifies problems based on reduced electrical activity in specific areas of infarction; and can differentiate seizure activity from CVA damage.
- X-rays (skull): May show shift of pineal gland to the opposite side from an expanding mass; calcifications of the internal carotid may be visible in cerebral thrombosis; partial calcification of walls of an aneurysm may be noted in subarachnoid hemorrhage.
- Laboratory studies to rule out systemic causes: CBC, platelet and clotting studies, VDRL/RPR, erythrocyte sedimentation rate (ESR), chemistries (glucose, sodium).
- ECG, chest x-ray, and echocardiography: To rule out cardiac origin as source of embolus (20% of strokes are the result of blood or vegetative emboli associated with valvular disease, dysrhythmias, or endocarditis).
Nursing Priorities - Cerebrovascular Accident (Stroke) Nursing Care Plan (NCP)
- Promote adequate cerebral perfusion and oxygenation.
- Prevent/minimize complications and permanent disabilities.
- Assist patient to gain independence in ADLs.
- Support coping process and integration of changes into self-concept.
- Provide information about disease process/prognosis and treatment/rehabilitation needs.
Discharge Goals - Cerebrovascular Accident (Stroke) Nursing Care Plan (NCP)
- Cerebral function improved, neurological deficits resolving/stabilized.
- Complications prevented or minimized.
- ADL needs met by self or with assistance of other(s).
- Coping with situation in positive manner, planning for the future.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Other Nursing Diagnoses for Stroke
- Injury, risk for—general weakness, visual deficits, balancing difficulties, reduced large/small muscle or hand-eye coordination, cognitive impairment.
- Nutrition: imbalanced, less than body requirements—inability to prepare/ingest food, cognitive limitations, limited financial resources.
- Self-care deficit—decreased strength/endurance, perceptual/cognitive impairment, neuromuscular impairment, muscular pain, depression.
- Home Maintenance, impaired—individual physical limitations, inadequate support systems, insufficient finances, unfamiliarity with neighborhood resources.
- Self-Esteem, situational low—cognitive/perceptual impairment, perceived loss of control in some aspect of life, loss of independent functioning.
- Caregiver Role Strain, risk for—severity of illness/deficits of care receiver, duration of caregiving required, complexity/ amount of caregiving task, caregiver isolation/lack of respite.