Stroke Nursing Diagnosis & Care Plan: Assessment & Interventions – devshopsimplenursing

Nursing Care Plan for Stroke

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By Amanda Thomas
Updated On May 2025
Medically Reviewed by:
Angela Slater FNP, RN
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Jump to Sections

  1. What is a Stroke (CVA)?
  2. Pathophysiology
  3. Signs & Symptoms
  4. Nursing Assessment
  5. Nursing Diagnosis
  6. Nursing Interventions
  7. Care Plans
  8. NCLEX Questions

Stroke patients need quick, effective care, and nurses play a key role. 

Understanding the right nursing diagnosis for stroke and which interventions to apply can make a life-changing difference. This means recognizing stroke symptoms, acting fast, and preventing complications. 

What is a Stroke (CVA)? 

An accurate CVA nursing diagnosis starts with understanding what a stroke is and how it affects the brain.

Recognizing the type and severity of a stroke helps guide nursing care and improve patient outcomes.

Definition and Overview 

A stroke, also known as a cerebrovascular accident (CVA), occurs when blood flow to the brain is interrupted, leading to brain cell death and neurological deficits. 

Strokes can cause long-term disability or death, depending on the location and extent of brain tissue affected. 

Ischemic vs. Hemorrhagic Stroke 

Ischemic Stroke

  • Definition: Caused by an obstruction in a blood vessel supplying blood to the brain 

Types:

  • Thrombotic stroke: Blood clot forms in an artery supplying the brain, often due to atherosclerosis
  • Embolic stroke: Blood clot or debris travels from another part of the body (e.g., the heart) and lodges in a cerebral artery 
  • Common causes: Atherosclerosis, atrial fibrillation, carotid artery disease

Hemorrhagic Stroke 

  • Definition: Occurs when a blood vessel in the brain ruptures, leading to bleeding within or around the brain

Types: 

  • Intracerebral hemorrhage: Bleeding within the brain tissue, commonly caused by hypertension 
  • Subarachnoid hemorrhage: Bleeding in the space between the brain and the arachnoid membrane, often due to aneurysm rupture 
  • Common causes: Hypertension, aneurysms, arteriovenous malformations (AVMs), anticoagulant therapy 

Pathophysiology of Stroke 

Ischemic Stroke Pathophysiology: 

  • Obstruction in cerebral blood flow leads to ischemia and oxygen deprivation. 
  • Ischemic cascade triggers excitotoxicity, free radical formation, and cell death. 
  • The core infarct area is surrounded by the ischemic penumbra, which may be salvageable with early intervention. 

Hemorrhagic Stroke Pathophysiology: 

  • A ruptured blood vessel causes bleeding, increasing intracranial pressure. 
  • Blood accumulation disrupts brain tissue and reduces cerebral perfusion. 
  • Vasospasm and inflammation further impair blood flow, leading to ischemic injury. 

Causes & Risk Factors of Stroke (Related To) 

Recognizing the causes and risk factors of stroke helps guide prevention strategies and improve patient outcomes. 

By understanding these contributing factors, nurses can implement targeted interventions and provide effective patient education to reduce the risk of future strokes.

Hypertension and Cardiovascular Disease 

  • Hypertension: This is a major risk factor for ischemic and hemorrhagic strokes. 
  • Cardiovascular disease: Atherosclerosis, heart failure, and atrial fibrillation increase embolic stroke risk. 

Diabetes and Metabolic Disorders 

  • Diabetes mellitus: Hyperglycemia accelerates atherosclerosis, increasing thrombotic stroke risk. 
  • Metabolic syndrome: Dyslipidemia, obesity, and insulin resistance contribute to cardiovascular disease. 

Smoking, Alcohol Use, and Lifestyle Factors 

  • Smoking: Smoking increases blood viscosity, platelet aggregation, and atherosclerotic plaque formation. 
  • Alcohol use: Heavy alcohol consumption raises blood pressure and the risk of hemorrhagic stroke. 
  • Sedentary lifestyle and poor diet: This contributes to obesity, hypertension, and diabetes. 

Age-related and Genetic Risks 

  • Age: Stroke risk doubles with each decade after age 55. 
  • Genetic factors: Family history of stroke or cardiovascular disease increases risk. 
  • Gender and ethnicity: Men and African Americans have a higher stroke risk.  

Signs and Symptoms of Stroke (As Evidenced By) 

Recognizing stroke symptoms quickly can make a significant difference in outcomes. 

Acting fast and seeking medical attention can help save lives, aid recovery, and reduce the chances of long-term complications.

FAST Symptoms 

  • Facial drooping: Asymmetry, drooping on one side of the face 
  • Arm weakness: Inability to raise one or both arms 
  • Speech difficulty: Slurred speech, difficulty forming words or understanding speech
  • Time to call emergency services: Prompt medical attention improves outcomes 

Hemiparesis and Unilateral Neglect 

  • Hemiparesis: Weakness or paralysis on one side of the body 
  • Unilateral neglect: Inattention to one side of the body or environment 

Altered Mental Status and Cognitive Deficits 

  • Confusion, disorientation, or agitation 
  • Memory loss and difficulty concentrating 
  • Impaired judgment and problem-solving skills 

Nursing Assessment for Stroke (CVA) 

Accurate assessment is the foundation of effective CVA nursing care plans, helping to guide timely interventions and improve patient outcomes. 

A thorough evaluation includes:

  • Collecting subjective and objective data
  • Sssessing neurological status
  • Identifying key diagnostic findings

By understanding the patient’s history and recognizing stroke-related changes, nurses can develop personalized care plans that address each patient’s unique needs.

Subjective & Objective Data 

Patient History and Symptom Onset

  • Time of symptom onset for eligibility for thrombolytic therapy 
  • History of hypertension, diabetes, atrial fibrillation, or previous strokes 

Neurological Examination Findings

  • Level of consciousness (LOC): Use the Glasgow Coma Scale for consciousness and orientation. 
  • Cranial nerve assessment: Evaluate vision, pupil response, facial symmetry, and swallowing. 
  • Motor and sensory function: 
    • Assess muscle strength, coordination, and reflexes. 
    • Check for hemiparesis, hemiplegia, or sensory deficits. 
  • Speech and language: Evaluate for dysarthria (slurred speech) or aphasia (expressive or receptive).
  • Cognitive and behavioral changes: Monitor for confusion, memory loss, or emotional lability. 

Diagnostic Tests & Imaging 

CT scan, MRI, and Blood tests 

  • Computed tomography (CT) scan (non-contrast): Provides first-line imaging to differentiate between ischemic and hemorrhagic stroke. 
  • Magnetic resonance imaging (MRI): Provides detailed imaging of brain tissue and ischemic areas. 
  • Cerebral angiography: Evaluates blood vessel abnormalities (e.g., aneurysms, AVMs).
  • Carotid Doppler ultrasound: Assesses carotid artery stenosis.
  • Laboratory tests:
    • Coagulation profile: The coagulation profile includes prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) to evaluate clotting status.
    • Blood glucose: Rule out hypoglycemia mimicking stroke symptoms. 
    • Electrolytes and renal function: Monitor for imbalances and renal perfusion. 

Stroke severity scales (NIH Stroke Scale) 

National Institutes of Health Stroke Scale (NIHSS): 
  • Purpose: Assess neurological deficits and stroke severity. 
  • Scoring: 0-42; higher scores indicate greater severity
  • Components: LOC, gaze, visual fields, motor function, sensation, language, and attention 
  • Frequency: Baseline, every 15 minutes during thrombolytic therapy and every shift 

Nursing Diagnoses for Stroke (CVA) 

Identifying the right nursing diagnosis for CVA is key to improving outcomes and preventing complications.

Impaired Verbal Communication 

  • Related to: Neurological damage affecting speech centers 
  • As evidenced by: slurred speech, difficulty forming words 

Ineffective Cerebral Tissue Perfusion 

  • Related to: Decreased blood flow to brain tissue 
  • As evidenced by: Confusion, weakness, speech impairment 

Risk for Aspiration 

  • Related to: Impaired swallowing reflex 
  • As evidenced by: Coughing or choking when eating 

Risk for Injury 

Related to: Loss of balance, weakness, impaired cognition 

Self-Care Deficit 

Related to: Should there be a decreased motor function, cognitive impairment 

Expected Outcomes & Nursing Goals 

When managing a nursing diagnosis for CVA (stroke), setting clear, achievable goals is essential for guiding patient care and promoting recovery. 

Nurses monitor progress, address complications early, and support the patient’s journey toward an improved quality of life.

Expected outcomes and goals include:

  • Maintaining stable neurological function
  • Preventing complications such as aspiration pneumonia 
  • Improving mobility and independence in self-care 

Nursing Interventions for Stroke (CVA) 

When a stroke occurs, every second counts, and CVA nursing interventions play an important role in promoting recovery.

Restoring Brain Perfusion & Preventing Further Damage 

  • Administer anticoagulants or thrombolytic therapy (if indicated). 
  • Monitor neurological status and vital signs closely. 

Managing Swallowing & Preventing Aspiration 

  • Conduct swallowing assessments and modify diet as needed. 
  • Educate caregivers on safe feeding techniques. 

Stroke Rehabilitation & Mobility Support 

  • Encourage passive and active range-of-motion exercises. 
  • Assist with transfers and positioning to prevent pressure ulcers. 

Cognitive and Emotional Support 

  • Provide strategies for memory enhancement. 
  • Support patient and family through the recovery process. 

Stroke (CVA) Nursing Care Plan Examples 

Here are three examples of a nursing care plan for stroke with diagnoses, interventions, and outcomes to guide effective patient care.

Care Plan #1: Stroke with Impaired Communication 

Nursing Diagnosis 

Impaired Verbal Communication 
Related To: 
  • Neurological damage affecting speech centers (e.g., Broca’s or Wernicke’s area) 
  • Motor speech disorder (dysarthria) or apraxia of speech
  • Cognitive deficits affecting language processing and word retrieval 
As Evidenced By: 
  • Inability to form words or sentences (expressive aphasia)
  • Inability to comprehend spoken or written language (receptive aphasia)
  • Slurred or unintelligible speech (dysarthria)
  • Frustration or anxiety related to communication difficulties

Expected Outcomes 

Short-Term Goals 
  • Communicate basic needs effectively using verbal or non-verbal methods within one week. 
  • Demonstrate reduced frustration and anxiety related to communication difficulties. 
Long-Term Goals 
  • Improve verbal communication and language comprehension within the rehabilitation period. 
  • Participate in social interactions using alternative communication methods as needed. 
  • Demonstrate effective coping mechanisms for communication challenges. 

Assessment 

Speech and Language Evaluation 
  • Assess expressive and receptive language abilities. 
  • Evaluate speech articulation, fluency, and comprehension. 
  • Collaborate with a speech-language pathologist for a detailed assessment. 
Cognitive and Emotional Assessment
  • Assess for cognitive deficits affecting communication (e.g., memory or attention). 
  • Monitor for frustration, anxiety, or depression related to communication difficulties. 
Non-Verbal Communication
  • Observe for gestures, pointing, or facial expressions used to convey messages. 

Interventions 

1. Facilitate Effective Communication: 
  • Use short, clear sentences and allow extra time for responses. 
  • Ask one question at a time and verify understanding by repeating or rephrasing. 
  • Encourage the use of gestures, communication boards, or electronic devices. 
2. Speech and Language Therapy: 
  • Collaborate with a speech-language pathologist for individualized therapy. 
  • Practice speech articulation, fluency, and language comprehension exercises. 
  • Encourage repetition of common words, phrases, or commands. 
3. Promote Alternative Communication Methods: 
  • Use communication boards or picture cards for basic needs (e.g., food or pain). 
  • Incorporate electronic communication devices or speech-generating apps. 
4. Emotional Support and Coping Strategies: 
  • Provide reassurance and emotional support to reduce frustration and anxiety. 
  • Educate family and caregivers on effective communication strategies. 

Care Plan #2: Stroke with Mobility Deficits 

Nursing Diagnosis 

Impaired Physical Mobility 
Related To: 
  • Hemiparesis or hemiplegia due to neurological damage 
  • Decreased muscle strength and coordination 
  • Balance and gait disturbances 
As Evidenced By: 
  • Inability to move one side of the body (hemiparesis or hemiplegia) 
  • Difficulty with ambulation and transfers 
  • Unsteady gait and high risk of falls 

Expected Outcomes 

Short-Term Goals 
  • Maintain joint mobility and muscle strength through passive and active range of motion (ROM) exercises. 
  • Transfer safely with minimal assistance within one week. 
Long-Term Goals 
  • Achieve the highest level of independent mobility possible. 
  • Prevent complications such as contractures, muscle atrophy, and pressure ulcers. 
  • Develop adaptive strategies to perform activities of daily living (ADLs). 

Assessment 

Neurological and Musculoskeletal Assessment 
  • Assess muscle strength, tone, and coordination on both sides of the body. 
  • Evaluate joint ROM and spasticity. 
  • Assess gait, balance, and the need for assistive devices. 
Functional Mobility Assessment
  • Evaluate the patient’s ability to perform ADLs (e.g., transferring or walking). 
  • Assess the need for mobility aids (e.g., walker, cane, or wheelchair). 
Fall Risk Assessment
  • Assess the patient’s risk of falls using a standardized tool (e.g., Morse Fall Scale). 

Interventions 

1. ROM Exercises 
  • Perform passive and active ROM exercises two to three times daily to maintain joint mobility. 
  • Focus on affected extremities to prevent contractures and muscle atrophy. 
2. Positioning and Transfers
  • Position the patient to promote circulation and prevent pressure ulcers. 
  • Use pillows or wedges to support the affected side and prevent shoulder subluxation. 
  • Assist with transfers using transfer belts or sliding boards for safety. 
3. Mobility Training and Rehabilitation
  • Collaborate with physical and occupational therapists for rehabilitation. 
  • Encourage the use of mobility aids (e.g., walker or cane) to enhance balance and safety. 
  • Implement gait training exercises to improve ambulation and balance. 
4. Fall Prevention and Safety Precautions
  • Maintain a clutter-free environment and adequate lighting. 
  • Use non-skid footwear and secure handrails in the bathroom and hallway. 
  • Educate the patient and family on fall prevention strategies. 

Care Plan #3: Stroke with Risk for Aspiration 

Nursing Diagnosis 

Risk for Aspiration 
Related To: 
  • Impaired swallowing reflex (dysphagia) due to cranial nerve damage 
  • Decreased level of consciousness and impaired gag reflex 
  • Weak or absent cough reflex 
As Evidenced By: 
  • Coughing, choking, or drooling during feeding 
  • Wet or gurgling voice after swallowing 
  • Food pocketing in the cheeks 

Expected Outcomes 

Short-Term Goals 
  • Swallow safely without coughing or choking during meals. 
  • Maintain clear lung sounds and oxygen saturation > 95% during feeding. 
Long-Term Goals
  • Achieve safe oral intake of food and fluids without aspiration. 
  • Prevent complications such as aspiration pneumonia. 

Assessment 

Swallowing Assessment
  • Evaluate swallowing ability using a bedside swallowing assessment. 
  • Collaborate with a speech-language pathologist for a modified barium swallow test. 
Respiratory Assessment
  • Monitor respiratory rate, effort, and oxygen saturation. 
  • Auscultate lung sounds for crackles, indicating aspiration. 
Nutritional Assessment 
  • Assess nutritional status and risk of malnutrition. 
  • Monitor weight, hydration status, and lab values (albumin and electrolytes). 

Interventions 

1. Swallowing Precautions and Safe Feeding Techniques
  • Position the patient upright (90 degrees) during and 30 minutes after meals. 
  • Provide small bites and sips, allowing adequate time to swallow. 
  • Use thickened liquids or pureed foods if recommended by the speech therapist. 
2. Aspiration Precautions 
  • Keep suction equipment at the bedside for emergency airway clearance. 
  • Monitor for signs of aspiration (e.g., coughing, choking, wet voice). 
  • Maintain oral hygiene to reduce the risk of aspiration pneumonia. 
3. Nutritional Support 
  • Collaborate with a dietitian for an individualized nutrition plan. 
  • Consider enteral feeding (e.g., nasogastric/NG tube or PEG tube) if oral intake is unsafe. 
4. Patient and Family Education: 
  • Educate caregivers on safe feeding techniques and aspiration precautions. 
  • Instruct on recognizing signs of aspiration and when to seek medical help. 

Patient Education & Discharge Planning 

When creating a stroke nursing diagnosis and care plan, it’s important to educate patients and their families about preventing future strokes, which includes recognizing early warning signs. 

A solid discharge plan empowers patients to manage their condition effectively at home and take action if stroke symptoms return.

Stroke prevention strategies 

1. Recognizing Early Warning Signs of Stroke 

FAST Symptoms
  • F – Facial drooping: One side of the face droops or feels numb. 
  • A – Arm weakness: Inability to raise one or both arms. 
  • S – Speech difficulty: Slurred speech or difficulty speaking or understanding speech. 
  • T – Time to call emergency services: Call 911 immediately if any symptoms present. 
Additional Warning Signs
  • Sudden severe headache with no known cause 
  • Sudden dizziness, loss of balance, or difficulty walking 
  • Sudden confusion or trouble understanding speech 
  • Sudden vision changes in one or both eyes 

2. Primary Prevention Strategies 

Blood Pressure Control
  • Maintain blood pressure < 130/80 millimeters of mercury (mmHg). 
  • Encourage regular home blood pressure monitoring. 
Cholesterol Management 
  • Promote a heart-healthy diet low in saturated fats and cholesterol. 
  • Educate on the importance of statin therapy for cholesterol control. 
Diabetes Management 
  • Maintain fasting blood glucose between 80 and 130 milligrams per deciliter (mg/dL). 
  • Encourage regular HbA1c checks and medication adherence. 
Smoking Cessation and Alcohol Moderation 

Provide resources for smoking cessation programs and counseling. 

Limit alcohol intake to no more than: 

  • 1 drink/day for women 
  • 2 drinks/day for men 

Medication Adherence and Lifestyle Changes 

1. Medication Adherence 

Importance of Medication Compliance 
  • Prevents recurrent strokes and manages risk factors (e.g., hypertension, diabetes). 
  • Reduces complications such as bleeding with anticoagulant therapy. 
Patient Education
  • Educate the patient on the purpose, dosage, and potential side effects of each medication. 
  • Instruct the patient on the importance of taking medications consistently and on time. 
  • Emphasize the need for regular follow-ups and laboratory monitoring. 
Strategies to Improve Adherence
  • Use pill organizers or medication reminder apps. 
  • Encourage setting alarms or linking medication intake with daily routines. 
  • Educate caregivers on assisting with medication administration if needed. 

2. Lifestyle Changes and Risk Factor Modification 

Healthy Diet and Nutrition 
  • Dietary approaches to stop hypertension (DASH) diet: 
    • High in fruits, vegetables, whole grains, lean protein, and low-fat dairy 
    • Low in saturated fats, cholesterol, and sodium 
    • Recommended sodium intake: < 2,300 mg/day 
  • Mediterranean diet: Emphasizes healthy fats (e.g., olive oil, nuts), fish, and plant-based foods. 
Physical Activity and Exercise
  • Aerobic exercise: At least 150 minutes of moderate-intensity exercise per week 
  • Strength training: 2 days per week to improve muscle strength and balance 
  • Balance and coordination exercises: Tai chi or balance training to reduce fall risk 
Weight Management and Obesity Prevention: 
  • Maintain a healthy BMI (18.5–24.9). 
  • Encourage gradual weight loss (1-2 lbs/week) for overweight or obese patients. 
Mental Health and Emotional Support: 
  • Screen for depression and anxiety using tools like patient health questionnaire-9 (PHQ-9) or general anxiety disorder-7 (GAD-7). 
  • Refer to counseling, support groups, or mental health professionals if needed. 

Home modifications for mobility support 

1. Fall Prevention and Safety Enhancements 

Environmental Safety 
  • Remove tripping hazards such as rugs, cords, and clutter. 
  • Install non-slip mats in the bathroom and kitchen. 
  • Ensure adequate lighting in hallways, staircases, and entrances. 
Assistive Devices

2. Adaptive Equipment and Accessibility Modifications 

  • Mobility aids: Cane, walker, or wheelchair for safe ambulation 
  • Grab bars and handrails: Install in bathrooms, showers, and stairways 
  • Raised toilet seats and shower chairs: For ease and safety during toileting and bathing 
Adaptive Equipment for Activities of Daily Living (ADLs) 
  • Long-handled reachers, dressing sticks, and shoehorns for getting dressed
  • Adaptive utensils, plate guards, and non-slip mats for feeding
Home Accessibility Modifications
  • Ramps: For wheelchair access to entrances and exits 
  • Widened doorways: To accommodate wheelchairs or walkers 
  • Stair lifts: For safe mobility between floors 

Recommended Resources for Stroke Recovery 

Access to reliable information is key for implementing effective stroke nursing interventions and supporting patient recovery. 

The following resources provide valuable guidelines, educational materials, and support tools to help nurses stay informed and deliver high-quality care to stroke patients.

Check out our NCLEX review page for more in-depth Stroke practice questions.

Nursing Care Plan Resources

Enhancing Stroke Recovery Through Nursing Care

Nursing interventions for stroke patients are vital for optimizing stroke recovery and preventing complications. Through evidence-based practices, nurses play a pivotal role in improving patient outcomes.

Key interventions include:

  • Monitoring neurological status to detect early signs of deterioration
  • Managing blood pressure to minimize the risk of further events
  • Preventing aspiration to protect airway integrity
  • Promoting mobility to prevent contractures and support functional recovery

These targeted actions ensure high-quality care, guiding stroke patients toward a safer and more effective recovery.

References & Sources 

  1. American Stroke Association. Stroke Recovery and Support. Accessed February 24, 2025.
  1. National Institute of Neurological Disorders and Stroke. Stroke Information Page. Accessed February 24, 2025.
  1. Centers for Disease Control and Prevention (CDC). Stroke: Risk Factors and Prevention. Accessed February 24, 2025.
  1. American Heart Association. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Stroke (2022). 
  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 15th ed., Wolters Kluwer, 2022. 

Additional Sources

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589849/ 

https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke

https://www.cdc.gov/stroke/signs-symptoms/index.html

https://www.stroke.org/en/about-stroke/stroke-symptoms