Nursing Care Plan

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Medical Diagnoses: Impaired Verbal Communication, Recent stroke, alteration of central nervous and decrease in circulation to brain

Assessment

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders and Rationale

*I

Evaluation

Goals

Interventions

Subjective

She appears frustrated after questioning as evidenced by her facial expression and body language.

Client’s daughter, who is staying with her, reports that her mother doesn’t seem to be “herself” since the stroke, and that she sometimes had mood swings and periods of confusion.

On the morning of her admission, her daughter stated that she was cooking breakfast when she collapsed onto the floor. She had complained for the past 2 days of a headache with visual changes, difficulty speaking, and progressive right-sided weakness

         

         

         

         

Objective

Client is alert and oriented at present, but has a difficult time speaking, client has paralysis on her right side with decreased grips and reflexes on the left side.

difficulties in expressing her needs and thoughts, which caused her much frustration

  

Problem

  

Impaired Verbal Communication

     

Long Term:

Client will use effective communication techniques by the time of discharge and continue using effective communication techniques through rehab and speech therapy.

Involve a familiar person when attempting to communicate with a client who has difficulty with communication, if accepted by the client. EB: Conversation partners of individuals with aphasia, including healthcare professionals, families, and others, play a role that is important for communication for individuals with aphasia (Roth, 2004).

Listen carefully. Validate verbal and nonverbal expressions particularly when dealing with pain. EBN: Listening to a client was identified as a caring behavior of nurses (Gregg, 2004). EBN: Nonverbal indicators of pain observed by nurses of clients with intellectual disabilities: moaning, crying, painful facial expression, swelling and screaming during manipulation, not using (affected) body part, and moving the body in a specific way of behaving (Zwakhalen et al, 2004).

Using an individualized approach, establish an alternative method of communication such as writing or pointing to letters, word phrases, picture cards, or simple drawings of basic needs. EB: Alternative methods of communication are necessary when the client is unable to speak verbally (Happ, Roesch & Kagan, 2005).

Teach the client and family techniques to increase communication, including the use of communication devices. Alternative methods of communication are necessary when the client is unable to use verbal communication.

      

 

         

R/T

Recent stroke, alteration of central nervous and decrease in circulation to brain

 

Short Term:

Client will demonstrate understanding  of daily treatment even if not able to speak  by end of shift on 1300 on [date].

Use presence. Spend time with the client, allow time for responses, and make the call light readily available. EBN: Attentive presence makes explicit that the other is cherished; it is a universal lived experience that is important to health and quality of life (Carroll, 2002). EBN: Time with the nurse had a positive effect on the healing process and recovery (Rudolfsson et al, 2003).

Explain all healthcare procedures. EBN: Clients who were nonvocal and ventilated were attuned to everything occurring around them, and they appreciated explanations from the nurse (Carroll, 2004).

Teach the client and family techniques to increase communication, including the use of communication devices. Alternative methods of communication are necessary when the client is unable to use verbal communication.

      

      

      

AEB

Her facial expression and body language and difficult time speaking

      

 

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*I = Implementation.  Check those interventions/actions/orders that were implemented.

 



References:

Carroll KA: Attentive presence: a lived experience of human becoming. Loyola University of Chicago doctoral dissertation (136 p). UMI Order AAI3056410, 2002.

Carroll SM: Silent, slow lifeworld: a phenomenological study of the communication experience of nonvocal ventilated patients. Boston Collegedoctoral dissertation (173p). CINAHL AN: 2009027345, 2004.

 

Gregg MF: Values in clinical nursing practice and caring, Japan J Nurs Sci 1(1):1118, 2004.

 

Happ MB , Roesch TK, Garrett K: Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study, Heart Lung 33(2):92101, 2004.

         

Roth EJ: Grand rounds. A set of observational measures for rating support and participation in conversation between adults with aphasia and their conversation partners, Top Stroke Rehabil 11(1):6783, 2004.

         

Rudolfsson G, Hallberg LRM, Ringsberg KC et al: The nurse has time for me: the perioperative dialogue from the perspective of patients, J Adv Perioperative Care 1(3):7784, 2003.

Zwakhalen SMG, van Dongen KAJ, Hamers JPH et al: Pain assessment in intellectually disabled people: non-verbal indicators, J Adv Nurs 45(3):236245, 2004.


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