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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Risk for Disuse Syndrome

Nursing Diagnosis

  • Risk for Disuse Syndrome

Risk factors may include

The following are the common risk factors:

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  • Neuromuscular impairment with limited use of upper and/or lower limbs

Desired goals and outcomes

Common goals and expected outcomes:

  • The patient and significant other will display methods that improve ambulating and transferring.
  • The patient will not manifest evidence of shoulder subluxation or shoulder-hand syndrome.

Nursing Assessment and Rationales

Here is the nursing assessment for this stroke nursing care plan.

1. Assess for subluxation of the shoulder, such as severe pain and swelling, tingling sensation, inability to move the joint, altered appearance of bony prominences.
Shoulder subluxation happens when the muscles around the shoulder become weak, resulting in the separation of the shoulder joint.

Nursing Interventions and Rationales

The following are the nursing interventions for this stroke nursing care plan.

1. Instruct the patient to inspect their extremities first, then check the position before ambulating.
These are safety precautions to avoid falling. For instance, alert the patient to make a conscious effort to raise and extend the foot when ambulating.

2. Provide a pillow or lapboard to be used as a support in positioning the patient in the correct alignment. Encourage active/passive ROM to enhance muscle tone.
These interventions aids in maintaining the anatomic position.

3. Instruct the client with balance problems to adjust by leaning toward the stronger side to ensure correct upright posture.
Stroke patients tend to lean heavily to their weak side.

4. Encourage the use of an arm sling.
The sling supports and protects the arm and shoulder while the client is standing or ambulating.

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5. Avoid pulling the affected arm. Place a hand behind the scapula when moving the upper extremity instead of pulling from the arm; Utilize a lift sheet during bed repositioning. When the patient is sitting, provide the arm with a firm support surface
These are interventions that help prevent subluxation and deformity. When in bed, the shoulder should be placed a bit forward to counteract shoulder rotation. The affected arm should be placed in external rotation as the patient is lying on the affected side.

6. Provide instructions on transfer techniques utilizing the stronger extremity to move the weaker extremity.
For example, to move the affected leg in bed or when changing from a lying to a sitting position, slide the unaffected foot under the
affected ankle to lift, support, and bring the affected leg along in the desired movement.

7. Instruct the patient to use proper footwear. Avoid the use of slippers.
Well-fitting footwear helps improve balance. Using slippers may put the patient at risk of falls.

8. Provide a light joint range of motion exercises and proper arm positioning to avoid shoulder-hand syndrome. Position the arm on the abdomen or rest it in a pillow when the patient is in bed. Do not place the arm under the body. Maintain the arm above heart level. Encourage repeated shoulder movement and regular fist clenching and unclenching.
Shoulder-hand syndrome is a neurovascular condition characterized by pain, edema, and skin and muscle atrophy due to impairment of the circulatory pumping action of the upper extremity.

9. Instruct and apply the following transfer principles:

  • 9.1. Encourage weight bearing on the patient’s stronger side.
  • 9.2. Teach the patient to focus on the stronger side and utilize the stronger arm as a way for support.
  • 9.3. Instruct the patient that the simplest and safest way to transfer is to go on the unaffected side.
  • 9.4. Teach the patient to put the unaffected side closest to bed or chair to which he or she wishes to transfer.
  • 9.5. Instruct the patient to place the affected leg under with the foot flat on the ground during transferring.
  • 9.6. Place a locked wheelchair or braced chair near to the patient’s stronger side.

These are methods to follow when moving patients with impaired physical mobility. These transfer principles emphasize using the stronger or unaffected side to help support patients for safe transfers to reduce the risk of falling.

10. If the client needs assistance from a health care staff, refrain the client from pulling on or putting hands around the assistant’s neck as a means to support.
Staff members should utilize their knees and feet to brace the feet and knees of weak clients.

11. Secure referral to physical therapy and occupational therapy if needed. Reinforce special mobilization techniques such as proprioceptive neuromuscular rehabilitation, neurodevelopmental treatment, motor relearning program, and constraint-induced movement therapy per the client’s individualized rehabilitation program.
These techniques may vary from the general principles mentioned. For example, Bobath focuses on using the affected side in mobility training so that patients try to bear weight on their affected side and move toward their affected side to relearn normal movement patterns and positions. Movement therapy involves restraining the functioning arm to induce “rewiring of the brain,” thereby improving functional movement.

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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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