12 Stroke (Cerebrovascular Accident) Nursing Care Plans

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Included in this guide are 12 nursing diagnosis for stroke (cerebrovascular accident) nursing care plans. Know about the nursing interventions for stroke, its assessment, goals, and related factors of each nursing diagnosis and care plan for stroke.

What is Cerebrovascular Accident (CVA) or Stroke? 

Cerebrovascular accident (CVA), also known as stroke, cerebral infarction, brain attack, is any functional or structural abnormality of the brain caused by pathological condition of the cerebral vessels of the entire cerebrovascular system. It is the sudden impairment of cerebral circulation in one or more of the blood vessels supplying the brain. 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. The sooner the circulation returns to normal after a stroke, the better the chances are for complete recovery. However, about half of those who survived a stroke remain disabled permanently and experience the recurrence within weeks, months, or years.

Thrombosis, embolism, and hemorrhage are the primary causes for stroke, 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.

Nursing Care Plans

The major nursing care plan goals for patients with stroke depends on the phase of CVA the client is into. During the acute phase of CVA, efforts should focus on survival needs and prevention of further complications. Care revolves around efficient continuing neurologic assessment, support of respiration, continuous monitoring of vital signs, careful positioning to prevent aspiration and contractures, management of GI problems, and careful monitoring of electrolyte, and nutritional status. Nursing care should also include measures to prevent complications.

Listed below are 12 nursing diagnosis for stroke (cerebrovascular accident) nursing care plans: 

  1. Ineffective Cerebral Tissue Perfusion
  2. Impaired Physical Mobility
  3. Impaired Verbal Communication
  4. Disturbed Sensory Perception
  5. Ineffective Coping
  6. Self-Care Deficit
  7. Risk for Impaired Swallowing
  8. Activity Intolerance
  9. Risk for Unilateral Neglect
  10. Deficient Knowledge
  11. Risk for Disuse Syndrome
  12. Risk for Injury
  13. Other Nursing Diagnosis
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Unilateral Neglect

Nursing Diagnosis

  • Unilateral Neglect

Related Factors

  • Disturbed perception from neurological damage
  • Cerebrovascular impairment
  • Neurological illness
  • Head trauma
  • Tumor

Defining Characteristics

  • Alteration in safety behavior on neglected side
  • Disturbance of sound lateralization
  • Failure to dress neglected side
  • Failure to eat food from portion of plate on neglected side
  • Failure to groom neglected side
  • Failure to move body parts (eyes, head, limbs, trunk) in the neglected hemisphere
  • Failure to notice people approaching from neglected side
  • Hemianopsia
  • Impaired performance on line cancellation, line bisection, and target cancellation tests
  • Omission of drawing on the neglected side.

Desired Outcomes

  • Patient will demonstrate and use techniques that can be used to minimize unilateral neglect
  • Patient will care for both sides of the body appropriately and keep affected side free from harm
  • Patient will return to optimized functioning level possible
  • Patient will be free from injury

Nursing Interventions

Nursing Interventions Rationale
Nursing Assessment
Assess the client for signs of unilateral neglect. Signs include:

  • Neglecting to wash, shave, or dress one side of the body
  • Sitting or lying inappropriately on affected arm or leg
  • Failing to response to environmental stimuli contralateral to the side of lesion
  • Eating food on only one side of the plate
  • Failing to look to one side of the body
Therapeutic Interventions
Progressively increase the client’s ability to cope for unilateral neglect by using assistive devices, feedback, and support during rehabilitation. Recovery from unilateral neglect generally occur in first 4 weeks after stroke with much more gradual recovery after that.
Initiate fall prevention interventions. (See Risk for Falls) Patients with CVA are twice as likely to fall.
Set up the environment so that essential activity is on the unaffected side. For example:

  • Placing the client’s personal items within view and within the unaffected side.
  • Position the bed so that the client is approached from the unaffected side.
Helps in focusing attention and aids in maintenance of safety.
Teach the client to be aware of the problem and modify behavior and environment. Awareness of the environment decreases risk of injury.
Direct client or SO to position bed at home so that the client gets out of bed on the unaffected side. Increases safety.
Encourage family participation in care and exercise. Improvement is seen in clients who participated in exercise training with their family members.
Teach client on how to scan regularly to check the position of body parts and to regularly turn head from side to side when ambulating or doing ADLs. Reinforcement of this technique helps increase patient safety.
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References and Sources

The following are the references and recommended sources for stroke nursing care plans and nursing diagnosis including interesting resources to further your reading about the topic:

  • Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby. [Link]
  • Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
  • Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. [Link]
  • Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
  • Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
  • Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2017). Medical-surgical nursing: Assessment and management of clinical problems.
  • Urden, L. D., Stacy, K. M., & Lough, M. E. (2006). Thelan’s critical care nursing: diagnosis and management (pp. 918-966). Maryland Heights, MO: Mosby.

See Also

You may also like the following posts and care plans:

Neurological Care Plans

Nursing care plans for related to nervous system disorders:

16 COMMENTS

  1. I love this site and it has helped me so much through school, but I need to address an intervention here: One should NEVER massage any reddened areas. Please fix this

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