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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Ineffective Coping

Nursing Diagnosis

  • Ineffective Coping

Common related factors for this nursing diagnosis:

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  • Situational crises, vulnerability, cognitive perceptual changes

May be evidenced by

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

  • Inappropriate use of defense mechanisms
  • Inability to cope/difficulty asking for help
  • Change in usual communication patterns
  • Inability to meet basic needs/role expectations
  • Difficulty problem solving

Desired goals and outcomes

Common goals and expected outcomes:

  • Patient will verbalize acceptance of self in situation.
  • Patient will talk/communicate with SO about situation and changes that have occurred.
  • Patient will verbalize awareness of own coping abilities.
  • Patient will meet psychological needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.

Nursing Assessment and Rationales

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

1. Assess the extent of altered perception and related degree of disability. Determine Functional Independence Measure score.
Determination of individual factors aids in developing a plan of care/choice of interventions and discharge expectations.

2. Identify the meaning of the dysfunction and change to the patient. Note the ability to understand events, provide a realistic appraisal of the situation.
Independence is highly valued in American culture but is not as significant in some cultures. Some patients accept and manage altered function effectively with some adjustment, whereas others may have considerable difficulty recognizing and adjusting to deficits. To provide meaningful support and appropriate problem-solving, healthcare providers need to understand the meaning of the stroke/limitations to patients.

3. Determine outside stressors: family, work, future healthcare needs.
Help identify specific needs, provides an opportunity to offer information, and begin problem-solving. Consideration of social factors and functional status is vital in determining an appropriate discharge destination.

4. Identify previous methods of dealing with life problems. Determine the presence of support systems.
Provides an opportunity to use behaviors previously effective, build on past successes, and mobilize resources.

5. Monitor for sleep disturbance, increased difficulty concentrating, statements of inability to cope, lethargy, withdrawal.
May indicate the onset of depression (a common after-effect of stroke), which may require further evaluation and intervention.

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Nursing Interventions and Rationales

Below are the nursing interventions for this stroke nursing care plan.

1. Note whether the patient refers to the affected side as “it” or denies the affected side and says it is “dead.”
Suggests rejection of body parts and negative feelings about body image and abilities, indicating the need for intervention and emotional support.

2. Provide psychological support and set realistic short-term goals. Involve the patient’s SO in the plan of care when possible and explain his deficits and strengths.
To increase the patient’s sense of confidence and can help in compliance to the therapeutic regimen.

3. Encourage the patient to express feelings, including hostility or anger, denial, depression, sense of disconnectedness.
Demonstrates acceptance of patient in recognizing and beginning to deal with these feelings.

4. Acknowledge statement of feelings about the betrayal of the body; remain matter-of-fact about the reality that patient can still use unaffected side and learn to control affected side. Use words (weak, affected, right-left) that incorporate that side as part of the whole body.
Helps the patient see that the nurse accepts both sides as part of the whole individual. Allows the patient to feel hopeful and begin to accept the current situation.

5. Emphasize small gains either in the recovery of function or independence.
Consolidates gains, helps reduce feelings of anger and helplessness, and conveys a sense of progress.

6. Support behaviors and efforts such as increased interest/participation in rehabilitation activities.
Suggest possible adaptation to changes and understanding about own role in future lifestyle.

7. Refer for neuropsychological evaluation and counseling if indicated.
May facilitate adaptation to role changes necessary for a sense of feeling/being a productive person. Note: Depression is common in stroke survivors and may directly result from brain damage and an emotional reaction to sudden-onset disability.

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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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