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.
Other Nursing Diagnoses
You can also make a care plan with these nursing diagnoses:
- Disturbed Sensory Perception: This nursing diagnostic label is now retired.
- Imbalanced Nutrition: Less Than Body Requirements: inability to prepare/ingest food, cognitive limitations, limited financial resources.
- Impaired Home Maintenance: individual physical limitations, inadequate support systems, insufficient finances, unfamiliarity with neighborhood resources.
- Situational Low Self-Esteem: cognitive/perceptual impairment, perceived loss of control in some aspect of life, loss of independent functioning.
- Risk for Caregiver Role Strain: severity of illness/deficits of care receiver, duration of caregiving required, complexity/ amount of caregiving task, caregiver isolation/lack of respite.
- Risk for Aspiration: This is due to depressed or absent cough reflex due to infarction of a brain area.
- Hyperthermia: This may be due to bleeding or edema of the hypothalamus which can lead to ischemia and thus changes in the thermoregulatory center of the brain.
- Impaired Skin Integrity: This is due to the loss of protective sensation and decreased ability to move away from injury.
- Ineffective Coping: Management of stroke requires a strong need for healthy lifestyle or change, this may be difficult for the patient.
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.