Nursingcrib.com Nursing Care Plan Cerebrovascular Accident (cva)

ASESSMENT SUBJECTIVE: “ Nahihirapan ako magsalita”, as verbalized by the client.

DIANOSIS Impaired verbal communication related to loss of facial or oral muscle tone control.

PLANNING After 1 hr. of nursing intervention, the patient will establish method of communication in which needs can be expressed.

INTERVENTION •

•

OBJECTIVE: BP: 150/100 PR: 74 RR: 30 T: 36.4

• •

Difficulty producing speech. Facial paralysis. Muscle and facial tension.

•

•

•

•

Talk directly to patient. Speaking slowly and directly. Use yes or no question to begin with.

•

Speak in normal tones and avoid talking too fast. Give patient ample time to respond.

•

•

Encourage family members and visitors to persist efforts to communicate with the patient.

•

As manifested by: •

Provide alternative methods of communication, like pictures or visual cues, gestures or demonstration. Anticipate and provide for patient’s needs.

RATIONALE Provide communication needs or desires based on individual situation or underlying deficit. Helpful in decreasing frustration when dependent on others and unable to communicate desires. It reduces confusion or anxiety and having to process and respond to large amount of information at one time. Patient is not necessary hearing impaired and raising voice may irritate or anger the patient. It is important for family members to continue talking to the patient to reduce patients isolation, promote establishment of effective communication and maintain sense of connectedness or bonding with the family.

EVALUATION After 1 hr. of nursing intervention, the patient was able to establish method of communication in which needs can be expressed.