Care plan for stroke patient

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I'm really at a loss here, any help is appreciated. My patient is a 57-year-old female with a history of diabetes, partial hysterectomy, hypertension, and hyperlipidemia. She was admitted 16 days ago with right-sided stroke and she now has a flaccid left side. She is a medium fall risk vital signs of been stable, has no known drug allergies, hearing is intact, but attends occupational therapy for one and a half hours a day for auditory speech and balance. Attends physical therapy from more than 35 minutes per day.

Labs:

Troponin-

Na-137 mEq/L

K-3.4 mEq/L

Chloride-100 mEq/L

HCO3-27 mEq/L

BUN-8 mg/dL

Creatinine-0.7 mg/dL

Glucose-87 mg/dL

Liver Function-Normal

AST-15 U/L

ALT-20 U/L

WBC-11.7 x 10^3µ/L

Hgb12.6 g/dL

Hct-36.5%

Platelets-338 x 10^3µL

My problem here in my opinion, is a lot of her diagnoses are risk for diagnoses. However my instructor does not want us to do at risk for in our care plans, she wants us to do our care plan on actual problems. While taking care of this woman the only thing I noticed was her left-sided weakness, her memory and speech seemed completely intact to me, she seemed to have very little complications r/t the stroke, she was sharp as a tack. I have to list all of the diagnoses that apply but i'm only doing a care plan on 2 of them and it has to be the TOP 2, i have impaired physical mobility, but thats all i have, she doesn't even want us doing anything like Bathing self care deficit (anything to do with ADLS), so i guess basically she wants us to make it up. If i'm leaving anything out let me know and i'll give you the information.

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Impaired swallowing, impaired verbal communication..

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Does that apply if shes on solid food? she wasn't being monitored while eating, and her communication seemed completely fine..

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Specializes in ortho, hospice volunteer, psych,.

Impaired swallowing so choking is a hazard. She may need to be reminded to chew thoroughly and to take frequent drinks.

She may need to be sent the meats that are ground then reassembled into what they had been. I can't think what they are called

right now. They lessen the choking hazard. Can she cut her food easily? Which hand was her dominant hand pre-stroke?

By virtue of the fact that she has had a stroke, she will unimaginably tired. She will probably have to have naps scheduled between therapies. Even if it doesn't seem to you that a sitting down-type of activity such as speech therapy might be tiring, believe me, it is!

Even if her vision wasn't affected by the stroke, it probably will be when she's tired, at least for awhile. It must be considered, if it's a factor.

She may be cold all the time and no comfort measure warms her up. Having a stroke can affect your internal thermostat!

When she gets sick, from now on, every stroke-related symptom will get worse for the duration of her illness. She should be told so it won't scare her later when it happens. For example, if (on a routine basis) she is no longer having balance problems, she might while she's ill. Or se might have to switch back to a hemiwalker from her cane.

Her fine motor coordination might need some fine tuning even after se has completed OT.

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Her dominant side is her right side and she has left sided weakness. about the food, i didn't know about that and the nurse never mentioned it me to so i had no clue that was a possibility. I would imagine that even though her dominant side is intact cutting her food with only one hand would prove difficult.

I'm trying little by little to research more about strokes because unfortunately we have not yet had a class on that, its still a few weeks away so i don't know much about them. thanks for the info

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Have you researched R sided CVA?

[h=1]Effects of right-sided stroke[/h] Stroke usually affects one side of the brain. Movement and sensation for one side of the body is controlled by the opposite side of the brain.

Some problems that happen after stroke are more common with stroke on one side of the brain that the other.

  • The right side of the brain controls the ability to pay attention, recognize things you see, hear or touch, and be aware of your own body.
  • In most people, the left side of the brain controls the ability to speak and understand language.

In some left-handed people, language is controlled by the right side of the brain and awareness by the left side of the brain.

If your stroke affected the right side of your brain, you will have problems with the left side of your body.

[h=2]Anomia[/h] You may not recognize faces or pictures of familiar people or objects.

[h=2]Attention span[/h] You may be unable to focus attention on a conversation or tasks for long periods of time.

[h=2]Denial[/h] You may deny that you had a stroke. Some people even deny that their paralyzed arm or leg belongs to them. They look at the paralyzed arm or leg and believe it belongs to someone else.

[h=2]Neglect[/h] You may ignore the left side of your body or your environment. This means you may not turn to look toward your left side or you may not recognize things that are on your left.

[h=2]Perseveration[/h] You may have difficulty following instructions or answering many questions asked one right after the other. You may repeat answers or movement even though a new instruction was given or a new question asked.

[h=2]Visual / spatial problems[/h] You may have problems judging distance, size, position and rate of movement and how parts relate to a whole.

Is your patient perhaps exhibiting the normal effects of the CVA? Are her sugars under control especially when she is out of the hospital? Is she on insulin? What knowledge deficit would she have that she needs to be taught to ensure her recovery at home? Is she in any meds for the CVA or clots?

Effects of right-sided stroke: Anomia, attention span, denial, neglect, perservation, visual / spacial problems

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It really, really annoys the hell out of me to hear students taught that "risk for" nursing diagnoses are not "actual problems." There's a whole big section in the NANDA-I 2012-2014 on safety (Domain 11, if you're following along in your hymnal) and almost all of those are "risk for" diagnoses. Surely your instructor does not intend to imply that safety is not a real consideration in nursing care. You can tell her I said so, and show her Domain 11 and see how many of those fit your patient's presentation. (Amazon, free 2-day delivery, $29, or instant delivery for your Kindle or iPad for $25. Do it now.)

When you're looking up the effects of right-brain/left-affected stroke, see what you find about executive function (look it up-- critical info) self-awareness and safety awareness. These can get very messed up, and people can look "sharp as a tack" but have some serious deficits there. Also look at role changes-- does she have a family, a job? If she can't do those, what's that going to do to her family role/relationships, her self-esteem?

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Specializes in Med/Surg, Academics.

I don't have any advice, but I have to ask if your instructor works bedside anymore. Good lord, no risk for nor ADL diagnoses on a stroke patient?! What planet does she live on?

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I don't have any advice, but I have to ask if your instructor works bedside anymore. Good lord, no risk for nor ADL diagnoses on a stroke patient?! What planet does she live on?

She is still a bed side nurse. I guess what she's trying to accomplish by keep us away from risk for diagnoses is to keep is from taking the "easy" way out of a care plan, she wants to see that we can come up with a.e.b and such is my best guess. I honestly have no clue, like I said we aren't actually carrying these out but when your patient seems otherwise intact it's harder to not do what fits.

Also now I'm doing my postpartum care plan on a c section mom...what would the better Dx; impaired physical mobility or activity intolerance? She says that it hurts to walk too much, changing positions frequently hurts as well.

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Something with body image should work

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Or knowledge deficit

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Specializes in SICU, trauma, neuro.

How is she doing emotionally, socially? She's pretty young and out on one side. That's a really raw deal.

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