Nursing Care Plan For Stoke Case Study

PN 0004C Weekly Clinical Planning Sheet Student Name: S.H Care plan #5
Patient Initials: t.l
Age/Sex: 73/f
Allergies: Potassium
Nurse on Duty: Regin
Admission Date: 06/29/2013
Admitting Physician: Dr. Cole
Consulting physician:
Code status: Hospice, dnr
Activity Level: As tolerated
Diet: nectar thick/puree
Patient History and Diagnoses: primary dx: cva.

Patient admitted to coral bay 06/29/2013 with a primary diagnosis of CVA. Patient’s HX includes uti, bipolar,
The secondary manifestations in the brain are the result of one or more of these underlying diseases or risk factors. The primary pathologies include hypertension, atherosclerosis leading to coronary artery disease, dyslipidemia, heart disease, and hyperlipidemia. The two types of stroke that result from these disease states are ischemic and hemorrhagic strokes. A stroke is the sudden onset of weakness, numbness, paralysis, slurred speech, aphasia, problems with vision and other manifestations of a sudden interruption of blood flow to a particular area of the brain. The ischemic area involved determines the type of focal deficit that is seen in the
NIHSS is a standardized assessment of conscious, vision, sensory and motor responses, speech and language function.
Pt will remain free of neurological deficits and maintain and stable BP.
2.Risk for ineffective airway clearance related to a stoke as evidenced by dysphagia

Patient will maintain clear, open airway as evidenced by normal breath sounds normal rate and depth of respirations, and ability to cough secretions after treatment during her stay at coral bay.
Assess for dysphagia
Impaired swallowing may occur with stroke. The use of a formal dysphagia screening protocol significantly decreases the risk for aspiration pneumonia.
Patient will maintain airway patency
3. Impaired physical mobility related to a stroke evidenced by decreased muscle strength, control or