Stroke Care Plan Assistance

[Mommy_RN1211]

Hello all,

I am currently in my adult (3rd) semester of school and am writing my care plan. This is my first time on a Tele floor. We have always pretty much stayed on med surg so this is unfamiliar territory. My patient was a 64 yr old male who had a hemorrhage of the brain (stroke). This was his 2nd stroke so he has had left side paralysis and inability to speak since the first stroke. His stoke condition was considered stable he was really only still in the hospital due to conflicts in insurance and a rehab facility.

With all that being said our insturctor requires 3 nursing diagnosis. I am going to do a psychosocial for sure maybe two. I will for sure use risk of impaired skin integerity due to poor mobility. I am struggling with what seems to be obvious. Impaired physical mobility r/t stroke. I am not sure what kind of goal is appropriate given he has had the paralysis for years. Everything I think of seems to be unrealistic. Any suggestions?

[Sandra2015]

He had a stoke... I think the big one you're missing is impaired tissue perfusion :)) so you want to check is vitals, specifically in terms of vitals --since he had a hemorrhagic stroke and not ischemic -- focus in BP and neuro checks. The main goal with this diagnosis is that you want to allow his state to progress, not deteriorate via your interventions.

Another good one I always include as a student is risk for aspiration. Check your gag reflex! Monitor their eating and have the hob elevated--- which would benefit your pt twice as much since he had a hemorrhagic stroke...that blood needs to drain.

All your others sound great!

And when thinking about goals...definitely a big thing is to promote independence--even if he has had the paralysis for years-- encourage use of his strong side.

[Esme12, ASN, BSN, RN]

Remember care pans are all about the patient assessment not the diagnosis. Tell me about your assessment of this patient. How is his swallowing? If he is going to rehab then there are things that he needs. People who suffer l sided paralysis have particular needs. They ignore that side of the body and don't always recognize that they are disabled...safety is key.

[h=4]Right Brain[/h] The effects of a stroke depend on several factors, including the location of the obstruction and how much brain tissue is affected. However, because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the side of the body it affects.

• Paralysis on the left side of the body
  
• Vision problems
  
• Quick, inquisitive behavioral style
  
• Memory loss
  

They believe they can walk. Their vision is affected and have something called

Hemianopia, or hemianopsia, is a decreased vision or blindness (anopsia) in half the visual field of one or both eyes,

and may think they have eaten everything when in reality they have only eaten half of the plate...but if you move the food they think they have another meal.