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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Risk for Unilateral Neglect

Nursing Diagnosis

Risk factors may include

Common related factors for this nursing diagnosis:

  • Disturbed perception from neurological damage
  • Cerebrovascular impairment
  • Neurological illness
  • Head trauma
  • Tumor

Desired goals and outcomes

Common goals and expected outcomes:

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  • Patient will demonstrate and use techniques that can be used to minimize unilateral neglect
  • Patient will care for both sides of the body appropriately and keep affected side free from harm
  • Patient will return to optimized functioning level possible
  • Patient will be free from injury

Nursing Assessment and Rationales

The following is a nursing assessment guide. Here are the nursing assessment cues for the stroke nursing care plan.

1. Assess the client for signs of unilateral neglect. Signs and symptoms include:

  • Neglecting to wash, shave, or dress one side of the body
  • Sitting or lying inappropriately on affected arm or leg
  • Failing to response to environmental stimuli contralateral to the side of lesion
  • Eating food on only one side of the plate
  • Failing to look to one side of the body
  • Alteration in safety behavior on neglected side
  • Disturbance of sound lateralization
  • Failure to dress neglected side
  • Failure to eat food from portion of plate on neglected side
  • Failure to groom neglected side
  • Failure to move body parts (eyes, head, limbs, trunk) in the neglected hemisphere
  • Failure to notice people approaching from neglected side
  • Hemianopsia

Nursing Interventions and Rationales

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

1. Progressively increase the client’s ability to cope with unilateral neglect by using assistive devices, feedback, and support during rehabilitation.
Recovery from unilateral neglect generally occurs in the first four weeks after stroke, with a much more gradual recovery after that.

2. Initiate fall prevention interventions.
Patients with CVA are twice as likely to fall. See Risk for Falls and Risk for Injury.

3. Set up the environment so that essential activity is on the unaffected side.
These help in focusing attention and aids in the maintenance of safety. Place the client’s personal items within view and the unaffected side. Position the bed so that the client is approached from the unaffected side.

4. Educate the patient to turn the head in the direction of the defective visual field.
To compensate for the loss in visual acuity.

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5. Teach the client to be aware of the problem and modify behavior and environment.
Awareness of the environment decreases the risk of injury.

6. Direct client or significant other (SO) to position bed at home so that the client gets out of bed on the unaffected side.
Increases safety.

7. Encourage family participation in care and exercise.
Improvement is seen in clients who participated in exercise training with their family members.

8. Teach the client how to scan regularly to check body parts’ position and to periodically turn head from side to side when ambulating or doing ADLs.
Reinforcement of this technique helps increase patient safety.

9. Speak in a calm, comforting, quiet voice, using short sentences. Maintain eye contact.
The patient may have limited attention span or problems with comprehension. These measures can help patients attend to communication.

10. Ascertain patient’s perceptions. Reorient patient frequently to environment, staff, procedures.
Assists patient to identify inconsistencies in reception and integration of stimuli and may reduce perceptual distortion of reality.

11. Approach the patient from the visually intact side. Leave the light on; position objects to take advantage of intact visual fields. Patch affected eye if indicated.
Helps the patient to recognize the presence of persons or objects and may help with depth perception problems. This also prevents patients from being startled. Patching the eye may decrease sensory confusion of double vision.

12. Stimulate a sense of touch. Give patient objects to touch, and hold. Have patient practice touching walls boundaries.
Aids in retraining sensory pathways to integrate reception and interpretation of stimuli. Helps patient orient self spatially and strengthens the use of affected side.

13. Encourage the patient to watch feet when appropriate and consciously position body parts. Make the patient aware of all neglected body parts: sensory stimulation to the affected side, exercises that bring the affected side across the midline, reminding the person to dress/care for the affected (“blind”) side.
The use of visual and tactile stimuli assists in the reintegration of the affected side and allows the patient to experience forgotten sensations of normal movement patterns.

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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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