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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Acute Pain

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).

Nursing Diagnosis

  • Hemiplegia
  • Disuse

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.

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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.
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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.
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