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.
Impaired Verbal Communication
- Impaired Verbal Communication
May be related to
Common related factors for this nursing diagnosis:
- Impaired cerebral circulation; neuromuscular impairment, loss of facial/oral muscle tone/control; generalized weakness/fatigue
May be evidenced by
The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.
- Impaired articulation; does not/cannot speak (dysarthria)
- Inability to modulate speech, find and name words, identify objects; inability to comprehend written/spoken language
- Inability to produce written communication
Desired goals and outcomes
Common goals and expected outcomes:
- Patient will indicate an understanding of the communication problems.
- Patient will establish method of communication in which needs can be expressed.
- Patient will use resources appropriately.
Nursing Assessment and Rationales
The following are the nursing assessment for this stroke nursing care plan.
1. Differentiate aphasia from dysarthria.
Helps determine the area and degree of brain involvement and difficulty the patient has with any or all communication process steps.
2. Assess the patient for aphasia.
Aphasia is the loss of the ability to understand or express speech. The patient may have receptive aphasia or damage to Wernicke’s speech area, characterized by difficulty understanding spoken words. The patient may also have expressive aphasia or injury to Broca’s speech areas, which is difficulty to speak correctly, or may experience both. Choice of interventions depends on the type of impairment. Aphasia is a defect in using and interpreting language symbols and may involve sensory and motor components (inability to comprehend written or spoken words or to write, make signs, speak). The Boston Diagnostic Aphasia Examination (BDAE) is a tool you can use to help diagnose aphasia.
3. Assess the patient for dysarthria.
Dysarthria is a motor speech disorder in which the muscles used to produce speech are damaged, paralyzed, or weak. A dysarthric person can comprehend, read, and write language but has difficulty pronouncing words. The patient may lose the ability to monitor verbal output and be unaware that communication is not sensible.
4. Ask the patient to follow simple commands (“Close and open your eyes,” “Raise your hand”); repeat simple words or sentences.
Tests for Wernicke’s aphasia or receptive aphasia. In Wernicke’s aphasia, language output is fluent with a normal rate and intonation. However, the content is often difficult to understand because of paraphrastic errors (Acharya & Wroten, 2017).
5. Point to objects and ask the patient to name them.
Tests for Broca’s aphasia or expressive aphasia. Broca’s aphasia is non-fluent aphasia in which the output of spontaneous speech is markedly diminished, and there is a loss of normal grammatical structure (Acharya & Wroten, 2017). The patient may recognize an item but not be able to name it.
6. Have the patient produce simple sounds (“dog,” “meow,” “Shh”).
Identifies dysarthria because motor components of speech (tongue, lip movement, breath control) can affect articulation and may or may not be accompanied by expressive aphasia.
7. Assess the patient for signs of depression.
A patient with aphasia may become depressed. The inability to talk, communicate, and participate in a conversation can often cause frustrations, anger, and hopelessness. Make the atmosphere conducive for communication and be sensitive to the patient’s reactions and needs. The nurse can provide vital emotional support and understanding to allay anxiety and frustration.
Nursing Interventions and Rationales
Below are the nursing interventions for this stroke nursing care plan.
1. Listen for errors in conversation and provide feedback.
Feedback helps patients realize why caregivers are not understanding or responding appropriately and provides an opportunity to clarify meaning.
2. Ask the patient to write their name and a short sentence. If unable to write, have the patient read a short sentence.
Tests for writing disability (agraphia) and deficits in reading comprehension (alexia) are also part of receptive and expressive aphasia.
3. Write a notice at the nurses’ station and patient’s room about speech impairment. Provide a special call bell that can be activated by minimal pressure if necessary. Anticipate and provide for the patient’s needs.
Allays anxiety related to the inability to communicate and fear that needs will not be met promptly.
4. Provide alternative methods of communication.
A communication board that has pictures of common needs and phrases may help the patient. This provides a method of communicating needs based on the individual situation and underlying deficit.
5. Talk directly to the patient, speaking slowly and distinctly. Gain the patient’s attention when speaking. Phrase questions to be answered simply by yes or no. Progress in complexity as the patient responds.
Reduces confusion and allays anxiety at having to process and respond to a large amount of information at one time. Keep the language of instruction consistent and speak slowly. As speech retraining progresses, advancing the complexity of communication stimulates the memory and further enhances word and idea association. Avoid completing the thoughts or sentences of the patient because it can make the patient more frustrated by not being able to speak and may deter efforts to practice putting thoughts together and completing sentences.
6. Speak in normal tones and avoid talking too fast. Give the patient ample time to respond. Avoid pressing for a response. Use gestures to enhance comprehension. Respect the patient’s pre-injury capabilities; avoid “speaking down” to the patient or making patronizing remarks.
The patient is not necessarily hearing impaired, and raising a voice may irritate or anger the patient causing frustration. Forcing responses can result in frustration and may cause patients to resort to “automatic” speech (garbled speech, obscenities). Allow the patient ample time to process instructions and provide an environment for the patient to feel esteemed because intellectual abilities often remain intact. Be patient with the patient.
7. Discuss familiar topics (e.g., weather, family, hobbies, jobs).
Promotes meaningful conversation and provides an opportunity to practice skills. Communicating during nursing care activities can also provide a form of social therapy to the patient.
8. Encourage significant others (SO) to continue communicating with the patient: reading mail and discussing family happenings even if the patient cannot respond appropriately.
Family members need to continue talking to patients to reduce the patient’s isolation, promote effective communication, and maintain a sense of connectedness with the family.
9. Eliminate extraneous noise and stimuli as necessary.
Reduces anxiety and exaggerated emotional responses and confusion associated with sensory overload.
10. Consult and refer the patient to a speech therapist.
A speech therapist can help assess the communication needs of the patient, identify specific deficits, and recommend an overall method of communication. Encourage the patient to play an active part in establishing goals so that language intervention strategy are individualized to their needs.
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.