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.
Risk for Injury
- Risk for Injury
Risk factors may include
The following are the common risk factors:
- Altered sensory reception, transmission, and/or integration
Desired goals and outcomes
Below is the common expected outcome for stroke nursing care plan:
- Patient will interact appropriately with his or her environment and does not exhibit evidence of injury caused by sensory/perceptual deficit.
Nursing Assessment and Rationale
Below is a nursing assessment for this stroke nursing care plan.
1. Assess the type and degree of hemisphere injury the patient exhibits.
Describe right and left hemisphere injuries.
2. Evaluate for visual deficits. Note the loss of visual field, changes in in-depth perception (horizontal and/or vertical planes), presence of diplopia (double vision).
The presence of visual disorders can negatively affect a patient’s ability to perceive the environment and relearn motor skills and increases the risk of accident and injury.
3. Assess sensory awareness: dull from sharp, hot from a cold, position of body parts, joint sense.
Diminished sensory awareness and impairment of kinesthetic sense negatively affect balance and positioning and appropriateness of movement, which interferes with ambulation, increasing the risk of trauma.
4. Note inattention to body parts, segments of environment, lack of recognition of familiar objects/persons.
Agnosia, the loss of comprehension of auditory, visual, or other sensations, may lead result to unilateral neglect, inability to recognize environmental cues, considerable self-care deficits, and disorientation or bizarre behavior.
Nursing Interventions and Rationales
Here are the nursing interventions for this stroke nursing care plan.
1. Encourage patients with non-dominant (right) hemisphere injury to slow down and check each step or task as it is completed.
Patients with non-dominant (right) hemisphere injury may also have decreased pain sensation and sense of and visual field deficit but are typically unconcerned or unaware of or deny deficits or lost abilities. They tend to be impulsive and too quick with movements. Typically, they have impaired judgment about what they can and cannot do and often overestimate their abilities. These individuals are at risk for burns, bruises, cuts, and falls and may need to be restrained from attempting unsafe activities. They also are more likely to have unilateral neglect than individuals with dominant (left) hemisphere injury.
2. Remind patients who have a dominant (left) hemisphere injury to scan their environment.
These patients may lack or have decreased pain sensation and position sense and have visual field deficits on the right side of the body. They may need reminders to scan their environment but usually do not exhibit unilateral neglect.
3. Encourage making a conscious effort to scan the rest of the environment by turning head from side to side.
Patients may have visual field deficits in which they can physically see only a portion (usually left or right side) of the normal visual field (homonymous hemianopsia).
4. Give short, simple messages or questions and step-by-step directions. Keep the conversation on a concrete level (e.g., say “water,” not “fluid”; “leg,” not “limb”).
These individuals may have poor abstract thinking skills. They tend to be slow, cautious, and disorganized when approaching an unfamiliar problem and benefit from frequent, accurate, and immediate feedback on performance. They may respond well to nonverbal
encouragement, such as a pat on the back.
5. Have patients with apraxia return your demonstration of the task or see if they are able to be talked through a task or may be able to talk themselves through a task step-by-step.
Have patients with apraxia return your demonstration of the task or see if they are able to be talked through a task or may be able to talk themselves through a task step-by-step.
6. Intervene as follows for patients with nondominant (right) hemisphere injury:
Patients may have the following sensory perceptual alterations:
7. Keep the patient’s environment simple to reduce sensory overload and enable concentration on visual cues. Remove distracting stimuli.
Impaired ability to recognize objects using senses of hearing, vibration, or touch: These patients rely more on visual cues.
8. Assist patients with eating. Monitor the environment for safety hazards, and remove hazardous objects such as scissors from the bedside.
Difficulty recognizing and associating familiar objects: Patients may not know the purpose of silverware. These patients may not recognize hazardous objects because they do not know the purpose of the object or may not recognize subtle distinctions between objects (e.g., the difference between a fork and spoon may become too subtle to detect).
9. Teach the patient to concentrate on body parts, for example, by watching the swaying of hands or movement of the feet while walking. Using a mirror can also help them adjust.
The misconception of own body and body parts: These patients may not perceive their foot or arm as part of their body.
10. Provide these patients with restraint or wheelchair belt for support.
Inability to orient self in space: They may not know if they are standing, sitting, or leaning.
11. Provide a structured, consistent environment. Mark outer aspects of the patient’s shoes or tag inside the sleeve of a sweater or pair of pants with “L” and “R.”
Visual-spatial misconception: The patient may have trouble judging distance, size, position, rate of movement, form, and how parts relate to the whole. For example, the patient may underestimate distances and bump into doors or confuse inside and outside of an object, such as an article of clothing. These patients may lose their
place when reading or adding up numbers and therefore never complete the task.
12. Direct the patient’s attention to a particular sound (e.g., playing different musical instruments and associating its sound to its name.)
Impaired ability to recognize, associate, or interpret sounds.
13. Protect from temperature extremes; assess the environment for hazards. Recommend testing warm water with unaffected hand.
Promotes patient safety, reducing the risk of injury.
Recommended nursing diagnosis and nursing care plan books and resources.
- 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.
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.