Included in this guide are 12 nursing diagnoses for stroke (cerebrovascular accident) nursing care plans. Know about the nursing interventions for stroke, assessment, goals, and related factors of each nursing diagnosis and care plan.
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 a pathological condition of the cerebral vessels of the entire cerebrovascular system. It is the sudden impairment of cerebral circulation in one or more blood vessels supplying the brain. This pathology either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation by 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 a full 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 of stroke, with thrombosis being the leading 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 primary nursing care plan goals for patients with stroke depend on the phase of CVA the client is in. During the acute phase of CVA, efforts should focus on survival needs and prevent further complications. Care revolves around efficient continuing neurologic assessment, support of respiration, continuous monitoring of vital signs, careful positioning to avoid aspiration and contractures, management of GI problems, and monitoring of electrolyte and nutritional status. Nursing care should also include measures to prevent complications.
Listed below are 12 nursing diagnoses for stroke (cerebrovascular accident) nursing care plans:
- Risk for Ineffective Cerebral Tissue Perfusion
- Impaired Physical Mobility
- Impaired Verbal Communication
- Acute Pain
- Ineffective Coping
- Self-Care Deficit
- Risk for Impaired Swallowing
- Activity Intolerance
- Risk for Unilateral Neglect
- Deficient Knowledge
- Risk for Disuse Syndrome
- Risk for Injury
- Other Nursing Diagnosis
NOTE: This nursing care plan is recently updated with new content and a change in formatting. Nursing assessment and nursing interventions are listed in bold and followed by their specific rationale in the following line. Still, when writing nursing care plans, follow the format here.
Deficient Knowledge
Nursing Diagnosis
May be related to
Common related factors for this nursing diagnosis:
- Lack of exposure; unfamiliarity with information resources
- Cognitive limitation, information misinterpretation, lack of recall
May be evidenced by
The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Request for information
- Statement of misconception
- Inaccurate follow-through of instructions
- Development of preventable complications
Desired goals and outcomes
Common goals and expected outcomes:
- Patient will participate in learning process.
- Patient will verbalize understanding of condition/prognosis and potential complications.
- Patient will verbalize understanding of therapeutic regimen and rationale for actions.
- Patient will initiate necessary lifestyle changes.
Nursing Assessent and Rationales
Here is the nursing assessment for this stroke nursing care plan.
1. Assess the type and degree of sensory-perceptual involvement.
This will affect the choice of teaching methods and content complexity of instruction.
2. Identify signs and symptoms requiring further follow-up: changes or decline in visual, motor, sensory functions; alteration in mentation or behavioral responses; severe headache.
Prompt evaluation and intervention reduce the risk of complications and further loss of function.
3. Identify individual risk factors (e.g., hypertension, cardiac dysrhythmias, obesity, smoking, heavy alcohol use, atherosclerosis, poor control of diabetes, use of oral contraceptives) and discuss necessary lifestyle changes.
Promotes general well-being and may reduce the risk of recurrence. Note: Obesity in women has been found to have a high correlation with ischemic stroke.
Nursing Interventions and Rationales
Below are the nursing interventions for this stroke nursing care plan.
1. Include SO and the family in discussions and teaching.
These people will be providing support and care, thus having a significant impact on the patient’s quality of life and home health care.
2. Discuss specific pathology and individual potentials.
Aids in establishing realistic expectations and promotes understanding of current situation and needs.
3. Review current restrictions and discuss potential resumption of activities (including sexual relations).
Promotes understanding, provides hope for the future, and creates the expectation of resumption of a more “normal” life.
4. Reinforce the current therapeutic regimen, including using medications to control hypertension, hypercholesterolemia, diabetes, as indicated; aspirin or similar-acting drugs, for example, ticlopidine (Ticlid), warfarin sodium (Coumadin). Identify ways of continuing the program after discharge.
Recommended activities, limitations, and medication and therapy needs are established based on a coordinated interdisciplinary approach. Follow-through is essential to the progression of recovery and prevention of complications. Long-term anticoagulation may be beneficial for patients older than 45 who are prone to clot formation; however, using these drugs is not practical for CVA resulting from vascular aneurysms or vessel rupture.
5. Provide written instructions and schedules for activity, medication, essential facts.
Provides visual reinforcement and reference source after discharge.
6. Encourage the patient to refer to written communications or notes instead of depending on memory.
Provides aids to support memory and promotes improvement in cognitive skills.
7. Discuss plans for meeting self-care needs.
Varying levels of assistance may need to be planned for based on the individual situations.
8. Suggest patients reduce environmental stimuli, especially during cognitive activities.
Multiple stimuli may aggravate confusion, overwhelm the patient, and impair mental abilities.
9. Recommend patients seek assistance in the problem-solving process and validate decisions, as indicated.
Some patients (especially those with right CVA) may display impaired judgment and impulsive behavior, compromising their ability to make sound decisions.
10. Review the importance of a balanced diet, low in cholesterol and sodium if indicated. Discuss the role of vitamins and other supplements.
Improves general health and well-being and provides energy for life activities.
11. Reinforce the importance of follow-up care by rehabilitation teams: physical and occupational therapists, vocational therapists, speech therapists, and dieticians.
Consistent work may eventually lead to minimized or overcoming residual deficits.
12. Refer to a home care supervisor or a visiting nurse.
The home environment may require evaluation and modifications to meet individual needs.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to neurological disorders:
- Alzheimer’s Disease | 15 Care Plans
- Brain Tumor | 3 Care Plans
- Cerebral Palsy | 7 Care Plans
- Cerebrovascular Accident | 12 Care Plans
- Guillain-Barre Syndrome | 6 Care Plans
- Meningitis | 7 Care Plans
- Multiple Sclerosis | 9 Care Plans
- Parkinson’s Disease | 9 Care Plans
- Seizure Disorder | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
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:
- Acharya, A. B., & Wroten, M. (2017). Wernicke Aphasia.
- Amarenco, P., Lavallée, P. C., Monteiro Tavares, L., Labreuche, J., Albers, G. W., Abboud, H., … & Wong, L. K. (2018). Five-year risk of stroke after TIA or minor ischemic stroke. New England Journal of Medicine, 378(23), 2182-2190.
- Crawford, A., & Harris, H. (2016). Caring for adults with impaired physical mobility. Nursing2020, 46(12), 36-41.
- Cumbler, E., & Glasheen, J. (2007). Management of blood pressure after acute ischemic stroke: An evidence‐based guide for the hospitalist. Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine, 2(4), 261-267.
- Dowswell, G., Dowswell, T., & Young, J. (2000). Adjusting stroke patients’ poor position: an observational study. Journal of Advanced Nursing, 32(2), 286-291.
- Gorelick, P. B., Farooq, M. U., & Min, J. (2015). Population-based approaches for reducing stroke risk. Expert review of cardiovascular therapy, 13(1), 49-56.
- Hansen, A. P., Marcussen, N. S., Klit, H., Andersen, G., Finnerup, N. B., & Jensen, T. S. (2012). Pain following stroke: a prospective study. European journal of pain, 16(8), 1128-1136.
- Kazemzadeh, Z., Manzari, Z. S., & Pouresmail, Z. (2017). Nursing interventions for smoking cessation in hospitalized patients: a systematic review. International nursing review, 64(2), 263-275.
- Kumar, R., Metter, E. J., Mehta, A. J., & Chew, T. (1990). Shoulder pain in hemiplegia. The role of exercise. American journal of physical medicine & rehabilitation, 69(4), 205-208.
- Lankhorst, G. J., & Bouter, L. M. (2002). Risk factors for hemiplegic shoulder pain: A systematic review. Critical Reviews’ in Physical and Rehabilitation. Medicine, 14(3&4), 223-233.
- Li, J., Yuan, M., Liu, Y., Zhao, Y., Wang, J., & Guo, W. (2017). Incidence of constipation in stroke patients: a systematic review and meta-analysis. Medicine, 96(25).
- Li, Z., & Alexander, S. A. (2015). Current evidence in the management of poststroke hemiplegic shoulder pain: a review. Journal Of Neuroscience Nursing, 47(1), 10-19.
- Marler, J. R., Tilley, B. C., Lu, M., Brott, T. G., Lyden, P. C., Grotta, J. C., … & NINDS rt-PA Stroke Study Group. (2000). Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology, 55(11), 1649-1655.
- Menon, B. K., & Demchuk, A. M. (2011). Computed tomography angiography in the assessment of patients with stroke/TIA. The Neurohospitalist, 1(4), 187-199.
- Ovbiagele, B., Kidwell, C. S., Starkman, S., & Saver, J. L. (2003). Neuroprotective agents for the treatment of acute ischemic stroke. Current neurology and neuroscience reports, 3(1), 9-20.
- Purnawinadi, I. G. (2019). The Characteristics Of Impaired Physical Mobility Among Patients With Stroke. Klabat Journal of Nursing, 1(1), 1-8.
- Sacco, R. L. (2004). Risk factors for TIA and TIA as a risk factor for stroke. Neurology, 62(8 suppl 6), S7-S11.
- Shah, R. S., & Cole, J. W. (2010). Smoking and stroke: the more you smoke the more you stroke. Expert review of cardiovascular
- Tyson, S. F., & Chissim, C. (2002). The immediate effect of handling technique on range of movement in the hemiplegic shoulder. Clinical rehabilitation, 16(2), 137-140.
- Xie, H. M., Guo, T. T., Sun, X., Ge, H. X., Chen, X. D., Zhao, K. J., & Zhang, L. N. (2021). Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation.
there is a lot of good information but I don’t know how to cite the website and the author in the APA format
I agree with the comment above! How can we cite this awesome website?!
Vera, M. (2013, August 2). Nursing care plans: 8 cerebrovascular accident (stroke) nursing care plans. Retrieved October 24, 2013, from Nurses labs: https://nurseslabs.com/8-cerebrovascular-accident-stroke-nursing-care-plans/#Impaired_Verbal_Communication
APA 6th Edition
Make sure to italicize: Nursing care plans: 8 cerebrovascular accident (stroke) nursing care plans.
Slight correction on what was posted:
Vera, M. (2013). 8+ Cerebrovascular Accident (Stroke) Nursing Care Plans. Retrieved from https://nurseslabs.com/8-cerebrovascular-accident-stroke-nursing-care-plans/11/
And, as stated, make sure to italicize the title.
Very educational, learnt a lot how to provide care with a client who has had a CVA.
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Hi. Everything you have here is super helpful. But, I could figure out how to put this in in text citation. Can you help?
Hello Vikki. Sure. You can use a tool like bibme.org to make citations. Just enter the link and fill up the details. Here, I went ahead and made you the APA citation for this study guide:
Vera, M., RN. (2019, February 12). 8 Cerebrovascular Accident (Stroke) Nursing Care Plans.
Retrieved from https://nurseslabs.com/8-cerebrovascular-accident-stroke-nursing-care-plans/
Comment: the information was precise and helpful. thank you
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