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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Self-Care Deficit

Nursing Diagnosis

Common related factors for this nursing diagnosis:

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  • Neuromuscular impairment, decreased strength and endurance, loss of muscle control/coordination
  • Perceptual/cognitive impairment
  • Pain/discomfort
  • Depression

May be evidenced by

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

  • Impaired ability to perform ADLs, e.g., inability to bring food from receptacle to mouth; inability to wash body part(s), regulate temperature of water; impaired ability to put on/take off clothing; difficulty completing toileting tasks

Desired goals and outcomes

Common goals and expected outcomes:

  • Patient will demonstrate techniques/lifestyle changes to meet self-care needs.
  • Patient will perform self-care activities within level of own ability.
  • Patient will identify personal/community resources that can provide assistance as needed.

Nursing Assessment and Rationales

Here is the nursing assessment for this cerebrovascular accident (stroke) nursing care plan.

1. Assess abilities and level of deficit (0–4 scale) for performing ADLs.
Aids in planning for meeting individual needs.

2. Assess the patient’s ability to communicate the need to void and the ability to use a urinal bedpan. Take the patient to the bathroom at periodic intervals for voiding if appropriate.
Patient may have a neurogenic bladder, be inattentive, or be unable to communicate needs in the acute recovery phase, but usually can regain independent control of this function as recovery progresses.

3. Identify previous bowel habits and reestablish a normal regimen. Increase bulk in diet, encourage fluid intake, increased activity.
Assists in developing a retraining program (independence) and aids in preventing constipation and impaction (long-term effects).

Nursing Interventions and Rationales

The following are the nursing interventions for this stroke nursing care plan.

1. Avoid doing things for the patient that patient can do for themself, but assist as necessary.
To maintain self-esteem and promote recovery, the patient needs to do as much as possible for themself. These patients may become fearful and dependent, although assistance helps prevent frustration.

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2. Be aware of impulsive actions suggestive of impaired judgment.
May indicate the need for additional interventions and supervision to promote patient safety.

3. Maintain a supportive, firm attitude. Allow the patient sufficient time to accomplish tasks. Don’t rush the patient.
Patients need empathy and to know caregivers will be consistent in their assistance.

4. Provide positive feedback for efforts and accomplishments.
Enhances sense of self-worth, promotes independence, and encourages the patient to continue endeavors.

5. Create a plan for visual deficits that are present: Place food and utensils on the tray related to patient’s unaffected side; Situate the bed, so that patient’s unaffected side is facing the room with the affected side to the wall; Position furniture against the wall/out of travel path.
The patient will be able to see to eat the food. Will be able to see when getting in/out of bed and observe anyone who comes into the room. Provides safety when the patient can move around the room, reducing the risk of tripping/falling over furniture.

6. Provide self-help devices: extensions with hooks for picking things up from the floor, toilet risers, long-handled brushes, drinking straw, leg bag for catheter, shower chair. Encourage good grooming and makeup habits.
To enable the patient to manage for self, enhancing independence and self-esteem, reduce reliance on others for meeting own needs, and enables the patient to be more socially active.

7. Encourage SO to allow the patient to do self-care as much as possible.
Reestablishes a sense of independence and fosters self-worth, and enhances the rehabilitation process. Note: This may be very difficult and frustrating for the caregiver, depending on the degree of disability and time required for the patient to complete an activity.

8. Teach the patient to comb hair, dress, and wash.
To promote a sense of independence and self-esteem.

9. Refer the patient to a physical and occupational therapist.
Rehabilitation helps to relearn skills that are lost when part of the brain is damaged. It also teaches new ways of performing tasks to circumvent or compensate for any residual disabilities.

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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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