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.
Post-stroke pain is common and can affect the rehabilitation and quality of life of stroke survivors. In a study, patients report newly developed pain six months after stroke (Hansen et al., 2012).
May be evidenced by
- Reports of shoulder pain
- Reports of shoulder stiffness
- Spasticity and contractures
Desired goals and outcomes
- Patient report decrease in pain [specify with pain scale assessment].
- Patient performs activities for recovery and rehabilitation
- Patient demonstrate absence of side effects from analgesics
Nursing Assessment and Rationales
1. Assess the patient for shoulder stiffness, pain.
Hemiplegic shoulder pain (HSP) is a common and distressing complication related to stroke and occurs in the paralytic side of the patient. Incidence of this complication varies from 12% to 58% and the most common period of occurrence is at 8-10 weeks poststroke (Li & Alexander, 2015). Shoulder pain may prevent patients from learning new skills and affect their rehabilitation and quality of life poststroke.
2. Assess the patient for central poststroke pain (CPSP) syndrome.
HSP is linked to central poststroke pain, which is defined as pain and sensory abnormalities in the body parts that correspond to the brain territory that has been injured by the cerebrovascular lesion.
For more pain assessment cues, please visit Acute Pain.
Nursing Interventions and Rationales
1. Recognize the need for a properly worn sling.
Strapping of the hemiplegic shoulder prevents it from dangling without support by inhibiting the musculature surrounding the scapula and promote normal alignment of the scapula in relation to the thorax, humerus, and clavicle. Though there is little evidence to confirm the benefit of strapping the shoulder in treating HSP, these techniques are used for subluxation and shoulder pain.
2. Assist the patient when changing position.
Never lift the patient by the flaccid shoulder or pull on the affected arm or shoulder as this will cause pain. Using an appropriate force when turning or changing the patient’s position will prevent it from overstretching the affected shoulder joint. Strenuous arm and shoulder movement should also be avoided.
3. Position the shoulder of the patient appropriately.
Many shoulder problems can be prevented by proper patient movement and positioning. The position of the shoulder should be checked when the patient is assisted in moving in bed, and it should be ensured that the scapula glides forward, particularly when lying on the hemiplegic side (Li & Alexander, 2015). See interventions for Impaired Physical Mobility in this nursing care plan.
4. When lifting the arm, it should be moved slowly and be rotated outward.
Avoid impingement. If the arm is paralyzed, incomplete dislocation (subluxation) at the shoulder can occur due to overstretching of the joint capsule and musculature by the force of gravity when the patient sits or stands in the early stages after a stroke. Elevate the arm and hand to prevent dependent edema.
5. Avoid the use of overhead pulleys.
The use of overhead pulley has the highest risk of developing shoulder pain and should be avoided during rehabilitation (Lankhorst et al., 2002; Kumar et al., 1990).
6. Perform therapeutic technique of range of movement by holding the humerus under the axilla and maintaining external rotation.
Lifting the hemiplegic arm by holding the humerus under the axilla and maintaining external rotation produces a greater range of flexion at the hemiplegic shoulder than a distal hold (Tyson & Chissim, 2002). Incorrect handling of patients can cause improper dynamic motor control and rotator cuff tearing.
7. Assist the patient in performing range-of-motion exercises.
ROM exercises are essential in preventing shoulder stiffness, thus preventing pain. Some activities the patient can do include:
- Interlacing the fingers, place the palms together, and push the clasp hands slowly forward to bring the scapulae forward, then raise both hands above the head.
- Flex the affected wrist at intervals and move all joints of the affected fingers.
- Push the heel of the hand firmly down on a flat surface.
8. Other interventions for hemiplegic shoulder pain include:
- Administration of botulinum toxin A (BTX-A). Studies have shown that administration of BTX-A provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroids (Xie et al., 2021).
- Acupuncture. Studies concluded that acupuncture combined with exercises was effective for HSP (Li & Alexander, 2015).
- Soft tissue massage. Slow-stroke back massage was found to be effective nursing intervention for reducing the patients’ level of shoulder pain perception and anxiety in elderly patients with stroke (Li & Alexander, 2015).
- Pain medications. Medications helpful in management of poststroke pain include: amitriptyline, gabapentin, pregabalin, and lamotrigine.
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.