What is Stroke? Nursing Diagnosis, Interventions & Care Plan

Stroke is a primary health concern affecting millions of people worldwide. It can impair physical abilities, induce long-term cognitive deficits and cause emotional distress to those affected. The nursing diagnosis for stroke goes beyond assessing physical symptoms and evaluating test results; it involves utilizing an interdisciplinary approach to determine how best to care for those affected by stroke, regardless of the severity and type. 

As healthcare professionals, we must be aware of all available resources to accurately identify the individual’s needs on an assessment basis before developing care plans specific to their situation. 

In this blog post, we will explore different types of nursing diagnoses related to stroke and their common elements to gain insight into appropriate treatment strategies for patients with this life-altering condition.

What is Stroke?

To appropriately diagnose and treat those affected by stroke, it is essential first to understand what a stroke is. A stroke occurs when there is a sudden interruption of the blood supply to part of the brain, resulting in an inability for that area to receive oxygen and nutrients. 

This can often lead to paralysis, seizures, death, or permanent disability. Knowing a stroke’s vital signs and symptoms is essential for early intervention and minimizing potentially long-term disability.

A Stroke, called Cerebrovascular Accident (CVA) / Brain Attack, is divided into two main categories: Ischemic and Hemorrhagic. 

1. Ischemic strokes occur when there is a blockage of the artery that supplies blood to the brain. 
2. Hemorrhagic stroke arises when a weakened blood vessel ruptures, leading to bleeding inside or around the brain.

Pathophysiology Of Stroke

Stroke can be caused by various factors and is categorized into two types: 

1. Ischemic Stroke and Hemorrhagic Stroke. Ischemic strokes occur when there is an obstruction to the blood vessels that deliver oxygen and nutrients to the brain, resulting in cell death due to lacking these essential elements.
2. Hemorrhagic stroke arises when a weakened blood vessel ruptures, bleeding within or around the brain. The type of stroke will determine which nursing diagnosis is used when assessing a patient with this condition.

Causes of Stroke

• high blood pressure
• obesity
• diabetes
• smoking
• other vascular diseases.

Risk Factors for Stroke

It is necessary to identify the risk factors that may lead to an individual having a stroke to take preventive measures.

• Hypertension
• Cardiovascular diseases such as atrial fibrillation
• History of transient ischemic attack
• Hyperlipidemia
• Cigarette Smoking
• Heavy alcohol use,
• Cocaine use
• Obesity

In addition, a family history of stroke or cardiac disease can put someone at higher risk for this condition. Managing these risks through lifestyle changes such as quitting smoking and increasing physical activity

Signs and Symptoms of Stroke

The signs and symptoms of stroke vary depending on the severity, but some common indications are:

• paralysis or numbness on one side of the body,
• slurred speech or difficulty with language comprehension,
• loss of vision in one eye,
• confusion or disorientation.

Diagnosis

An imaging scan may be ordered for stroke diagnosis to provide visual evidence to help identify the stroke type. It could include a CT scan or MRI for more detailed information. Further tests may be necessary to gain deeper insight into the condition, depending on the results.

Medical Management

Once a stroke diagnosis is made, it is essential to provide appropriate medical management to reduce the risk of further damage or complications. This could include medications such as blood thinners, anticoagulants, antiplatelet drugs, lifestyle modifications, and diet and exercise. 

Also, physical and occupational therapy may be recommended for those affected by stroke to help promote improved physical functioning over time. 

Finally, psychological support may be necessary depending on individual needs during this challenging journey.

Nursing Stroke Care plan

Assessment

The assessment for stroke must include not only the physical symptoms but also an evaluation of all available resources to develop a comprehensive care plan. This includes examining factors such as age, lifestyle, medical history, and family history to gain insight into the individual’s needs.

Common CVA Nursing Diagnoses For Stroke

Each type of stroke requires unique nursing diagnoses, but some common diagnoses are seen across both classes. Some of the most commonly used nursing diagnoses for stroke include:

• Activity Intolerance: Inability to perform activities of daily living due to physical or cognitive limitations caused by the stroke.
• Disturbed Sensory Perception: Change in a person’s ability to interpret sensory information, such as vision, hearing, and touch.
• Risk For Injury: Increased vulnerability to injury due to physical and cognitive impairment from the stroke.
• Impaired Mobility: Decrease in coordination or range of motion resulting from the stroke.
• Risk For Infection: Possibility of infection due to a compromised immune system caused by the stroke.
• Anxiety/Fear/Distress: Emotional response associated with fear or uneasiness related to the diagnosis and prognosis of stroke.
• Impaired Memory: Loss of memory or ability to recall past events due to cognitive impairment caused by the stroke.
• Risk For Social Isolation: Increase in vulnerability to isolation due to physical, emotional, and cognitive limitations from the stroke.
• Ineffective Coping: Difficulty managing stressors related to changes in lifestyle and abilities caused by the stroke.
• Pain: Discomfort associated with physical limitation and complications resulting from the stroke.
• Activity Intolerance Related To Fatigue: Decrease in energy levels due to physical strain associated with activity after a stroke.
• Disturbed Sleep Pattern: Change in sleeping patterns due to discomfort or limited mobility resulting from the stroke.
• Impaired Verbal Communication: Inability to communicate verbally due to physical or cognitive effects of the stroke.
• Risk For Reduced Cardiac Output: Increased vulnerability for reduced heart function due to decreased oxygenation associated with a stroke.
• Readiness For Enhanced Knowledge Related To Stroke Management: Desire to learn more about managing post-stroke life changes and precautions.

These are just some of the typical stroke nursing diagnoses used when assessing a patient who has suffered from a stroke. Still, there can be many more depending on the individual’s situation and the type of stroke they experienced. Healthcare professionals must assess each patient individually to identify their needs and accurately provide the most appropriate care.

Nursing Interventions and Rationales

Intervention: Use ambulatory assistive devices if limb weakness present

• Rationale: Facilitates ambulation/transfers safely and reduces the risk of injury.

Intervention: Provide a safe environment to prevent injury

• Rationale: To reduce the risk of falls secondary to weakness or altered mobility.

Intervention: Monitor vital signs/neuro checks

• Rationale: To assess for any neurological or cardiovascular status changes that may indicate further complications from a stroke.

Intervention: Reorient patient frequently

• Rationale: To reduce the risk of disorientation or confusion caused by stroke.

Intervention: Provide a calm and supportive environment

• Rationales: To help decrease anxiety and fear associated with post-stroke changes in lifestyle and abilities.

Intervention: Provide patient/family education on prevention strategies for stroke

• Rationale: To increase awareness of risk factors that can be modified to prevent further complications due to stroke.

Intervention: Monitor for any signs or symptoms of infection due to immunosuppression from stroke

• Rationale: Infections can occur secondary to immunosuppression caused by the stroke, so early detection is critical in preventing further complications.

Intervention: Encourage physical activity as tolerated

• Rationale: To promote improved mobility and increase muscle strength while reducing the risk of complications from inactivity.

Intervention: Monitor for any signs or symptoms of depression/anxiety

• Rationales: To recognize any emotional changes that may be linked to post-stroke life changes.

Intervention: Assess for pain when the patient can communicate their needs

• Rationale: Pain can develop due to complications caused by stroke, and it is essential to identify these early to provide appropriate management.

Discharge and Home Care Guidelines

Before a patient can be discharged following a stroke, they must meet specific criteria. These include:

• Demonstrate the ability to perform activities of daily living independently or with assistance when needed.
• Demonstrate adequate mobility and strength as assessed by physical therapy.
• Follow any diet and medication instructions given by healthcare professionals.
• Be aware of any changes in health or symptoms and report them to their healthcare team.
• Schedule follow-up appointments with their doctor.

Once discharged, patients should follow all instructions their healthcare team provides and take precautions to reduce the risk of another stroke. This includes eating a healthy diet, exercising regularly, not smoking, and managing chronic medical conditions such as diabetes or high blood pressure.

Patients should also be aware of any signs or symptoms that may indicate the need for immediate medical attention (e.g., sudden numbness or weakness on one side of the body). Lastly, family members must be supportive and help monitor any changes in health.

Documentation Guidelines

The focus of documentation should involve the following:

• The patient’s response to nursing interventions and treatments.
• Any changes in physical/emotional status, such as mobility, confusion, or pain.
• Patient teaching regarding prevention strategies for stroke and appropriate home care.
• Follow-up appointment information was provided to the patient.
• Any additional resources or support systems available to the patient post-discharge.

Progress toward meeting discharge criteria and lifestyle modifications that must be made for continued recovery from stroke.

These are just some of the guidelines that should be followed when documenting a patient’s progress following a stroke diagnosis. Healthcare professionals need to complete detailed and accurate documentation to properly track the patient’s recovery and identify any additional areas of improvement that may be required.

Final Words

The nursing diagnoses listed above are just a starting point for developing a comprehensive plan of care tailored to each patient’s situation. By utilizing an interdisciplinary approach, healthcare professionals can ensure that all available resources are used to maximize the individual’s recovery after a stroke.

Nursing interventions for stroke should focus on providing support, education, and tools necessary to help patients manage any residual effects. 

Healthcare professionals need to remain up-to-date on advances in treatments and changes in standards and guidelines related to stroke management so they can best serve their patients with this life-altering condition.

References:

• https://en.wikipedia.org/wiki/Stroke
• https://www.ncbi.nlm.nih.gov/books/NBK568693/