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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Impaired Physical Mobility

The goal of care for patients with impaired physical mobility is to maintain and improve the patient’s functional abilities through maintaining normal functioning and alignment, reducing spasticity, preventing edema of extremities, and preventing complications of immobility.

Nursing Diagnosis

  • Impaired Physical Mobility

Common related factors for this nursing diagnosis:

  • Neuromuscular involvement: weakness, paresthesia; flaccid/hypotonic paralysis (initially)
  • Perceptual/cognitive impairment
  • Loss of balance and coordination
  • Spasticity
  • Hemiparesis

May be evidenced by

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Inability to purposefully move within the physical environment; impaired coordination; limited range of motion; decreased muscle strength/control

Common goals and expected outcomes:

  • Patient will maintain/increase strength and function of affected or compensatory body part [specify].
  • Patient will maintain optimal position of function as evidenced by absence of contractures, foot drop.
  • Patient will demonstrate techniques/behaviors that enable resumption of activities.
  • Patient will maintain skin integrity.

Nursing Assessment and Rationales

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

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1. Assess the extent of impairment initially and functional ability. Classify according to a 0–4 scale.
Identifies strengths and deficiencies that may provide information regarding recovery. Assists in choice of interventions because different techniques are used for flaccid and spastic paralysis.

2. Monitor the lower extremities for symptoms of thrombophlebitis.
Bed rest puts patients at risk for the development of deep vein thrombosis.

3. Observe the affected side for color, edema, or other signs of compromised circulation.
Edematous tissue is more easily traumatized and heals more slowly.

Nursing Interventions and Rationales

Here are the nursing interventions for impaired physical mobility for stroke nursing care plan.

1. Inspect skin regularly, particularly over bony prominences. Gently massage any reddened areas and provide aids such as sheepskin pads as necessary.
Pressure points over bony prominences are most at risk for decreased perfusion. Circulatory stimulation and padding help prevent skin breakdown and decubitus development.

2. Change positions at least every 2 hr (supine, side-lying) and possibly more often if placed on the affected side.
Frequently changing the position of the patient can reduce the risk of tissue injury. Place a pillow between the legs of the patient before placing them in a side-lying position. The upper thigh should not be acutely flexed to promote venous return and prevent edema. The patient may be turned from side to side if tolerated unless sensation is impaired. The amount of time spent on the affected side should be limited because of poorer circulation, reduced sensation, and more predisposition to skin breakdown.

3. Position in prone position once or twice a day if the patient can tolerate.
For several 15 to 30 minutes times a day, the patient should be placed in a prone position with a pillow placed under the pelvis. This position helps in normal gait through hyperextension of the hip joints and helps in preventing knee and hip flexion contractures (Crawford & Harris, 2016; Dowswell & Young, 2000). Prone position can also help drain bronchial secretions and prevents contractural deformities of the shoulders and knees. Monitor the patient’s respiration during this position.

4. Prop extremities in functional position; use footboard during the period of flaccid paralysis. Maintain a neutral position of the head.
Prevents contractures and foot drop and facilitates use when the function returns. Flaccid paralysis may interfere with the ability to support the head, whereas spastic paralysis may lead to deviation of head to one side.

5. Use an arm sling when the patient is in an upright position, as indicated.
During flaccid paralysis, using a sling may reduce the risk of shoulder subluxation and shoulder-hand syndrome.

6. Evaluate the need for positional aids and splints during spastic paralysis.
Flexion contractures occur because flexor muscles are stronger than extensors.

7. Place a pillow under the axilla to abduct the arm.
Helps prevent adduction of the shoulder and flexion of the elbow. When the patient is in bed, place a pillow in the axilla when there is limited external rotation to keep the arm away from the chest. Place a pillow under the arm while it is in a neutral position, with the distal joints of the arm positioned higher than the more proximal joints.

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8. Elevate arm and hand
Promotes venous return and helps prevent edema formation.

9. Place hard hand-rolls in the palm with fingers and thumb as opposed.
Hard hand rolls decrease the stimulation of finger flexion, maintaining finger and thumb in a functional position. If the upper extremity is spastic, a hand-roll is not used because it stimulates grasp reflex. Alternatively, place the hand with the palm facing upward, and the fingers are placed that they are barely flexed. Every effort is made to prevent edema of the hand.

10. Place knee and hip in an extended position.
Maintains functional position.

11. Maintain leg in neutral position with a trochanter roll.
Prevents external hip rotation.

12. Discontinue use of the footboard when appropriate.
Continued use (after a change from flaccid to spastic paralysis) can cause excessive pressure on the ball of the foot, enhance spasticity, and increase plantar flexion.

13. Assist patient in developing sitting balance by raising the head of the bed, assisting in sitting on the edge of the bed, having the patient use the strong arm to support body weight, and moving using the strong leg. Assist in developing standing balance by putting on flat walking shoes. Support patient’s lower back with hands while positioning own knees outside patient’s knees, assist in using parallel bars.
Aids in retraining neuronal pathways, enhancing proprioception and motor response.

14. Get the patient up in a chair as soon as vital signs are stable, except following a cerebral hemorrhage.
Helps stabilize BP (by restoring vasomotor tone), promotes maintenance of extremities in a functional position, and emptying of the bladder, reducing the risk of urinary stones and infections from stasis. If a stroke is not completed, activity increases the risk of additional bleed.

15. Position the patient and align his extremities correctly. Use high-top sneakers to prevent foot drop, contracture, convoluted foam, flotation, or pulsating mattresses or sheepskin.
These are measures to prevent pressure ulcers.

16. Pad chair seat with foam or water-filled cushion, and assist patient shift weight at frequent intervals.
To prevent pressure on the coccyx and skin breakdown.

17. Provide egg-crate mattress, water bed, flotation device, or specialized beds, as indicated.
Promotes even weight distribution, decreasing pressure on bony points and helping to prevent skin breakdown and decubitus formation. Specialized beds help with positioning, enhance circulation, and reduce venous stasis to decrease the risk of tissue injury and complications such as orthostatic pneumonia.

18. Begin active or passive range-of-motion (ROM) exercises on admission to all extremities (including splinted). Encourage exercises such as quadriceps/gluteal exercise, squeezing a rubber ball, an extension of fingers and legs/feet.
Active ROM exercises maintain or improve muscle strength, minimizes muscle atrophy, promote circulation, and helps prevent contractures. Passive ROM exercises help maintain joint flexibility. Affected extremities are put through passive ROM exercises about five times a day to maintain joint mobility, flexibility, prevent contractures, prevent deterioration of the neuromuscular system, enhance circulation, and regain motor control. Exercises help prevent venous stasis and decrease the risk of venous thromboembolism.

19. Encourage patient to assist with movement and exercises using unaffected extremity to support and move weaker side.
May respond as if the affected side is no longer part of the body and needs encouragement and active training to “reincorporate” it as a part of its own body.

20. Assist the patient with exercise and perform ROM exercises for both the affected and unaffected sides. Teach and encourage the patient to use his unaffected side to exercise his affected side.
Frequent repetition of activity helps form new neural pathways in the central nervous system, encouraging new patterns of motion. Initially, extremities are usually flaccid and tight; in this case, ROM exercises should be performed more frequently.

21. Use the “start low and go slow” approach during exercise.
Frequent short periods of exercise are always encouraged compared to more extended periods at infrequent intervals. Improvement in muscle strength and maintenance of the patient’s range of motion and flexibility can only be achieved through daily exercise.

22. Monitor patient for signs and symptoms of pulmonary embolism or cardiac overload during exercise.
With exercise, shortness of breath, chest pain, cyanosis, and increased pulse rate may indicate pulmonary embolism or excessive cardiac workload.

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23. Set goals with patient and significant other (SO) for participation in activities and position changes.
Promotes a sense of expectation of improvement and provides some sense of control and independence.

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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.
  • Hi. Everything you have here is super helpful. But, I could figure out how to put this in in text citation. Can you help?

  • I love this site and it has helped me so much through school, but I need to address an intervention here: One should NEVER massage any reddened areas. Please fix this

  • This is better than all the books i am studying right now im nursing school. Im on my last year and i just realised they have never taught us this stuff. Bookmarking this page so i can read it after exams

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