12 Stroke (Cerebrovascular Accident) Nursing Care Plans

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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: 

  1. Risk for Ineffective Cerebral Tissue Perfusion
  2. Impaired Physical Mobility
  3. Impaired Verbal Communication
  4. Acute Pain
  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

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.

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Deficient Knowledge

Nursing Diagnosis

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.

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  • 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.

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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.

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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to neurological disorders:

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:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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