Impaired Verbal Communication - Nursing Diagnosis for Stroke / CVA

Nursing Care Plan for Stroke / CVA


A stroke, sometimes referred to as a cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain.

Strokes are a medical emergency and prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.

Risk factors for stroke include old age, high blood pressure, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, tobacco smoking and atrial fibrillation.


There are two main causes of strokes:

• ischaemic (accounting for over 80% of all cases) – the blood supply is stopped due to a blood clot
• haemorrhagic – a weakened blood vessel supplying the brain bursts and causes brain damage

Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions such as speech and language therapy, physical therapy and occupational therapy.


Nursing Diagnosis for Stroke / CVA : Impaired Verbal Communication related to the decrease in cerebral blood circulation.

Goal: communication can function optimally.

Outcomes:

• The creation of a communication where the client's needs can be met.
• The client is able to respond to any communication verbal and gesture.

Interventions:

1. Assess the type / degree of dysfunction, such as patients do not seem to understand the word or have difficulty speaking or understanding their own making.
2. Distinguish between aphasia by dysarthria.
3. Notice errors in communication and provide feedback.
4. Ask the patient to follow simple commands (like "open eyes," "point to the door") repeat the word / phrase that simple.
5. Show the object and ask the patient to name the object.
6. Ask the patient to utter simple sounds. such as "you".
7. Ask the patient to write the name and / or short sentences. If you can not write, ask the patient to read short sentences.
8. Place a notice in the nurses' station and patient room on the speech disorder. Give special bell when necessary.
9. Provide alternative methods of communication, such as writing on the blackboard, drawing. Provide visual cues (hand gestures, drawings, list of requirements, demonstrations).
10. Anticipate and meet the needs of patients.
11. Tell directly with the patient, speak slowly and calmly. Use open-ended questions with a "Yes / No" further develop the more complex questions according to patient response.
12. Speak in a normal tone and avoid rapid conversation. Give the patient time to respond distance. Talk without pressure on a response.
13. Encourage visitors / people nearby retain his efforts to communicate with patients, such as reading, discussion about the things that happen to the family.
14. Talk about things that are known to the patient, such as work, family, and hobbies (pleasure).
15. Appreciate the ability of the patient before the disease; avoid "patronizing speech" at the patient or making things against the pride of the patient.
16. Consult with / refer to a speech therapist.

Rationale :

1. Help define the area and the degree of cerebral damage that occurred and the patient's difficulties in some or all stages of the communication process. Patients may have difficulty understanding spoken words (aphasia sensory / damage to the area Wernick); pronounce words correctly (expressive aphasia / damage to Broca's speech area) or suffered damage to both regions.
2. Interventions are chosen depending on the type of degradation. Aphasia is a disorder in use and interpret language and symbols may involve components of sensory and / or motor skills, such as the inability to understand the writing / speech or written word, making signs, talking. Someone with disantria can understand, read, and write the language but have difficulty forming / pronounce words with respect to weakness and paralysis of the muscles of the oral region.
3. Patients may lose the ability to monitor speech out and do not realize that real communication is not spoken. Feedback helps patients realize why caregivers do not understand / respond accordingly and provide an opportunity to clarify the content / meaning contained in the words.
4. Assessing the damage to the sensory (Sensory aphasia).
5. Assessing the damage to motor (motor aphasia, such patients may recognize it but can not mention).
6. Identify the presence of dysarthria appropriate motor component of speech (such as the tongue, lips, breath control) that may affect articulation and may also not accompanied by motor aphasia.
7. Assess the ability to write (agrafia) and correct deficiencies in reading (aleksia) are also part of aphasia sensory and motor aphasia.
8. Eliminate the anxiety of patients in connection with the inability to communicate and the fear that the patient's needs will not be met immediately. The use of the bell is activated with minimal pressure will be beneficial when the patient can not use regular bell system.
9. Provide communication about needs by state / underlying deficit.
10. Helpful in reducing frustration when dependent on others and can not communicate meaning.
11. Lowering the confusion / anxiety during the communication process and respond to information more at any given time. As the process of re-training to further develop communication more and more complex to stimulate memory and can improve the association of ideas / words.
12. Patients do not need to damage hearing, and raised his voice can lead to angry patients / cause pain. Focusing responses can result in frustration and may cause patients to come talk to "automatic," such as twisting the words, talking rough / dirty.
13. Reduce the social isolation of patients and enhance the creation of effective communication.
14. Increasing meaningful conversation and provide opportunities for practical skills.
15. The ability of the patient to feel self-esteem, because patients often remain intellectual abilities well.
16. Assessment of individual speech and sensory, motor and cognitive functions to identify gaps / needs therapy.

Tag : Impaired Verbal Communication, Nursing Diagnosis and Interventions, Stroke