NURSING DIAGNOSIS: Knowledge deficit, Ineffective management of therapeutic regimen, or Altered health maintenance*

*The nurse should select the diagnostic label that is most appropriate for the client's discharge teaching needs.

Desired Outcome
The client will communicate an awareness of ways to decrease the risk of a recurrent CVA.
Nursing Actions and Selected Purposes/Rationales
  1. Assist client to recognize factors that may have contributed to the CVA (e.g. hypertension, elevated serum lipids, diabetes, atrial fibrillation, use of oral contraceptives).
  2. Identify appropriate actions client can take to decrease risk of a recurrent CVA (e.g. take medications as prescribed, decrease stress, stop smoking, modify diet, adhere to medical treatment plan to control hypertension and/or diabetes, use another form of birth control if taking oral contraceptives).
  3. Provide information about resources that can help client to control risk factors (e.g. National Stroke Association, American Heart Association, smoking cessation and stress management programs). Initiate a referral if indicated.
Desired Outcome
The client will identify ways to manage sensory and speech impairments and altered thought processes.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce instructions regarding ways to adapt to visual impairments if present:
    1. utilize scanning techniques if visual field cut is present
    2. arrange home setting so that when in favorite chair or in bed, stimuli other than wall or furniture are within visual field
    3. wear eyepatch or opaque lens if double vision persists.
  2. Reinforce use of established communication techniques and continuation with speech therapy if indicated.
  3. If client is experiencing spatial-perceptual deficits and/or unilateral neglect, stress need for assistance with usual daily activities and strict adherence to safety measures to prevent injury.
  4. Reinforce methods of adapting to impaired memory and shortened attention span (e.g. make lists of planned activities, review taped or written instructions frequently).
  5. Instruct client to request assistance when problem solving and setting priorities and to seek validation of decisions if reasoning ability is impaired.
Desired Outcome
The client will identify ways to improve ability to swallow.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce instructions regarding appropriate swallowing techniques (e.g. sit upright for meals and snacks, tilt head and neck forward slightly when eating, place food in unaffected side of mouth, do not put a lot of food in mouth at one time).
  2. Reinforce information about selecting or preparing foods/fluids that will promote more effective swallowing (e.g. avoid sticky foods; use "Thick-it," gelatin, or baby cereal to thicken liquids that are thin; moisten dry foods with gravy or sauces).
  3. Allow time for questions and clarification of information provided.
Desired Outcome
The client will identify ways to manage urinary incontinence.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce instructions regarding client's bladder training program. Stress the importance of adhering to the program in order to reduce the risk of incontinence.
  2. Demonstrate procedures that are included in client's bladder training program (e.g. intermittent catheterization, application of an external catheter).
  3. Allow time for questions, clarification, and return demonstration.
Desired Outcome
The client will demonstrate measures to facilitate the performance of activities of daily living and increase physical mobility.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce measures that the client is using to improve his/her ability to perform activities of daily living and increase physical mobility (e.g. participation in exercise program; use of assistive devices and mobility aids; continued concentration on body positioning, balance, and movement).
  2. Allow time for questions, clarification, and return demonstration.
Desired Outcome
The client will communicate an awareness of signs and symptoms to report to the health care provider.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Care Plan on Immobility, Diagnosis 17, for signs and symptoms to report to health care provider.
  2. Instruct client to report these additional signs and symptoms:
    1. increased weakness or loss of sensation in extremities
    2. increase in or development of visual disturbances such as tunnel vision, blurred vision, or transient blindness
    3. increased lethargy, irritability, or confusion
    4. increased difficulty chewing or swallowing
    5. increased difficulty speaking or understanding verbal and nonverbal communication
    6. increased difficulty maintaining balance
    7. seizures (can develop months after the CVA as scar tissue forms in the ischemic area).
Desired Outcome
The client will communicate knowledge of community resources that can assist with home management and adjustment to changes resulting from the CVA.
Nursing Actions and Selected Purposes/Rationales
  1. Provide information about community resources that can assist client and significant others with home management and adjustment to impairments in motor and sensory function and altered thought processes resulting from the CVA (e.g. home health agencies, stroke support groups, Meals on Wheels, social and financial services, local chapter of the American Heart Association, local service groups that can help obtain assistive devices, individual and family counselors).
  2. Initiate a referral if indicated.
Desired Outcome
The client will communicate an understanding of and a plan for adhering to recommended follow-up care including future appointments with health care provider and therapists and medications prescribed.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce the importance of keeping follow-up appointments with health care provider and physical, occupational, and speech therapists.
  2. Teach client the rationale for, side effects of, and importance of taking prescribed medications (e.g. anticoagulants, antihypertensives). Inform client of pertinent food and drug interactions.
  3. Implement measures to improve client compliance:
    1. include significant others in teaching sessions if possible
    2. encourage questions and allow time for reinforcement and clarification of information provided
    3. provide written instructions on scheduled appointments with health care provider and occupational, physical, and speech therapists; medications prescribed; signs and symptoms to report; and exercise program.