A cerebrovascular accident (CVA), more commonly known as a stroke, occurs when blood flow to the brain is blocked.
In this article:
- Types of Stroke
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Ineffective Cerebral Tissue Perfusion
- Risk For Injury
- Self-Care Deficit
- Unilateral Neglect
Types of Stroke
There are two main types of stroke: ischemic and hemorrhagic.
Ischemic strokes are caused by a reduction or complete blockage of blood flow to an area of the brain. Without oxygen and nutrients, brain tissue begins to die within minutes. These blockages can be caused by fatty deposits, blood clots, or other debris that travel to the brain.
Hemorrhagic strokes are caused by a leaking or bursting blood vessel, leading to bleeding into the brain. Blood pooling in the brain tissue increases cerebral pressure and damages brain cells. Causes include a weak spot in a blood vessel (aneurysm), uncontrolled high blood pressure, head trauma, over-treatment with anticoagulants, protein deposits in blood vessels that cause weakening (cerebral amyloid angiopathy), or an ischemic stroke that leads to hemorrhage.
Transient ischemic attacks (TIA), which may be referred to as “mini-strokes,” are temporary blockages of blood flow to an area of the brain. These attacks typically resolve within 24 hours, most within the first hour and before lasting damage occurs. A history of TIAs can increase the risk of a stroke in the future, so it is important to modify risk factors to minimize the risk.
Nursing Process
Patients will have varying levels of disability following a stroke, depending on the severity of the stroke, length of time before treatment was started, and pre-existing conditions. Initial treatment is usually provided in higher-level care settings such as the ICU or step-down units. Nurses specially trained to monitor stroke patients hold an NIH Stroke Scale (NIHSS) certification. This is because stroke symptoms can change rapidly and subtly and require critical thinking and prompt intervention to prevent deterioration.
Severe strokes can leave the patient disabled, requiring total care in feeding, bathing, and turning. Long-term deficits can be debilitating and cause depression for the patient and their family. The nurse utilizes compassionate care to maintain patient safety and dignity while managing their physical and psychosocial needs.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to a stroke.
Review of Health History
1. Ask about the patient’s general symptoms.
Any of the following sudden onset symptoms are indications that a stroke may be occurring:
- Hemiparesis or hemiplegia: weakness of the face, arm, and leg on the same side
- Sensory deficits: numbness or tingling of extremities (paresthesias)
- Dysphagia: difficulty with swallowing
- Visual disturbances: loss of half of the visual field or loss of peripheral vision
- Difficulty speaking:
- Expressive aphasia: unable to speak words in ways others can understand
- Receptive aphasia: unable to understand words when spoken to
- Dysarthria: difficulty forming words
- Ataxia (unsteady gait)
- Alterations in balance and coordination
- Changes in mental status
2. Note the onset of symptoms.
Strokes manifest suddenly. Determine when symptoms first appear and the last known time the patient was considered at their normal level of functioning. This factor is crucial in determining the appropriateness of certain interventions.
3. Determine the patient’s risk factors.
The following risk factors increase the risk of stroke:
- Age 55 years or older
- African American or Hispanic ethnicity
- Male gender
- Prior stroke or TIA
4. Review the patient’s medical history.
Blockage of blood flow to the brain from blood clots, fatty deposits, or other debris is the most common cause of strokes (87% of strokes are ischemic). These may result from the following medical conditions:
- Hypertension
- Obesity
- Hypercholesterolemia
- Diabetes
- Obstructive sleep apnea
- Heart disease
- Atrial fibrillation
- COVID-19 infection
5. Review the patient’s family history.
There is a higher risk of stroke in patients with immediate family who had a stroke, especially before the age of 65. Genetic conditions like CADASIL (a rare vascular disease) can obstruct blood flow to the brain and lead to strokes.
6. Review the patient’s medication list.
Review the patient’s medication list, the rationale for the medication, and if they are being taken as prescribed.
- Birth control pills or hormone treatments containing estrogen increase the risk of stroke.
- Blood pressure medications that are not taken as prescribed may lead to uncontrolled hypertension and increased stroke risk.
- Aspirin or other anticoagulants (enoxaparin, heparin, warfarin) could indicate a patient at a higher risk of stroke due to clotting disorders or cardiac conditions.
7. Determine the use of illegal substances.
Stroke risk has been linked to the use of illegal and highly addictive substances, such as amphetamines, heroin, and cocaine.
8. Assess the patient’s lifestyle.
The risk of stroke may increase due to lifestyle choices such as:
- A diet high in cholesterol, trans fats, and saturated fats
- Insufficient physical exercise
- Excessive alcohol consumption
- Smoking
Physical Assessment
1. Recognize F.A.S.T.
Immediately recognize stroke symptoms. Remember the acronym F.A.S.T.
- Face: Check for facial drooping
- Arms: Observe for arm weakness
- Speech: Determine any difficulties with speech
- Time: Note the time of symptom onset
2. Assess the ABCs.
Conduct an initial assessment that includes airway, breathing, and circulation. Patients are susceptible to aspiration and asphyxiation. They may exhibit respiratory problems as a result of increased intracranial pressure.
3. Perform a stroke assessment.
Patients suspected of having had a stroke should receive a neurological examination. The most widely used tool for determining the severity of a stroke is the National Institutes of Health Stroke Scale (NIHSS), which consists of the following categories:
- Level of consciousness (LOC)
- Gaze
- Visual fields
- Facial palsy
- Motor arm
- Motor leg
- Limb ataxia
- Sensory
- Language
- Dysarthria
- Inattention
4. Assess vital signs.
Patients suffering from a stroke will commonly display hypertension. As the stroke is treated and cerebral blood flow improves, it is important not to decrease the blood pressure too quickly.
Diagnostic Procedures
1. Check blood glucose levels.
Immediately obtain a fingerstick glucose to rule out hypoglycemia as the cause of neurological changes. Symptoms of hypoglycemia can mimic signs of a stroke.
2. Prepare the patient for brain imaging.
In a patient with a suspected stroke, a non-contrast head CT is most commonly performed for rapid evaluation. Additional neuroimaging that may be used include:
- CT angiography and CT perfusion scanning
- Magnetic resonance imaging (MRI)
- Carotid duplex scanning
- Digital subtraction angiography
3. Obtain laboratory tests.
Lab tests can help the care team identify a stroke’s underlying cause, which aids in treatment and prevention. Laboratory tests may consist of the following:
- Complete blood count to determine underlying causes such as polycythemia or thrombocytopenia
- Cardiac biomarkers to evaluate underlying cerebrovascular disease or coronary artery disease
- Toxicology screen to rule out intoxication as the cause of stroke-like symptoms
- Fasting lipid profile to identify elevated cholesterol levels
- Coagulation studies before administering any antiplatelet or anticoagulation agents
4. Perform pregnancy tests for female patients.
Perform urine pregnancy tests for female patients within reproductive/childbearing age, as studies have not been conducted to evaluate the safety of fibrinolytic therapy in pregnancy.
5. Perform an electrocardiogram (ECG).
The source of the stroke may be an emboli resulting from a cardiac arrhythmia, particularly atrial fibrillation (Afib). This condition results in blood pooling in the atria of the heart, which then may travel to the brain as an emboli, causing a stroke. Identifying Afib and treating the patient with blood thinners will minimize further risk of stroke.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a stroke.
Restore Brain Perfusion
1. Perform an initial evaluation and prepare the patient for diagnostic imaging.
Within one hour of arrival to the emergency department, a patient presenting with stroke symptoms should have imaging of the brain with a STAT non-contrast head CT. This will determine if the patient is having a stroke and whether the stroke is ischemic or hemorrhagic.
2. Restore adequate blood flow to the brain.
Start alteplase as soon as possible when an ischemic stroke is confirmed. Alteplase is a tissue plasminogen activator (tPA) that dissolves clots. Alteplase is contraindicated for hemorrhagic strokes due to the risk of bleeding. Administer IV alteplase for patients who meet the inclusion criteria and have a symptom onset or last known baseline within three hours based on AHA/ASA recommendations.
3. Continually monitor the neurologic status of the patient.
Following a stroke, frequent neurologic assessments allow the nurse to observe for changes in a patient’s neurologic status and intervene promptly.
- Monitor and measure pupil size and reactivity
- Assess speech, memory, and cognition
- Observe for mood changes
- Assess bilateral strength and coordination
4. Administer medication as ordered.
Secondary events such as hypertensive crisis, re-bleeding in the brain, seizures, and constipation will be important for the nurse to prevent.
- Blood pressure medications will assist with maintaining blood pressure parameters.
- Seizure prevention may be initiated, especially if the stroke is hemorrhagic or located in the cerebral cortex of the brain. If a seizure occurs within two weeks of a stroke, a short-term course of anti-seizure medication is indicated.
- Stool softeners or laxatives will prevent straining with a bowel movement, as straining will increase ICP and should be avoided.
5. Manage the blood pressure.
The recommended blood pressure range for the first 24 hours following IV alteplase is less than 180/105 mm Hg. In patients who are not candidates for fibrinolytic therapy, current guidelines recommend maintaining moderate hypertension in most patients experiencing acute ischemic stroke. Blood pressure should never be lowered too quickly or aggressively.
- After an ischemic stroke, maintain the blood pressure at a slightly elevated level for the first 2-3 days to counter vasoconstriction. Following this, the blood pressure should be lowered gradually to treat any underlying hypertension.
- Hemorrhagic stroke events will need close monitoring with an immediate goal of a systolic blood pressure of 140 mmHg.
6. Prepare for a mechanical thrombectomy if indicated.
Some patients may undergo a mechanical thrombectomy using a catheter through the groin to dissolve or remove a clot that is occluding a major cerebral artery. Ensure the provider has spoken to the family about risks and benefits and that the informed consent is complete before the procedure.
7. Prepare for endovascular techniques.
If plaque buildup is identified in the carotid artery, a carotid endarterectomy may be performed to open the narrowed artery. Another option is angiography with stent placement to keep an artery open. Both procedures aid in reperfusion and reduce the risk of a stroke.
Stroke Recovery and Prevention
1. Refer the patient to stroke rehabilitation.
Assist the patient in their recovery or adaptation to changes. The patient may receive referrals to the following professionals or programs:
- Speech therapy
- Physical therapy
- Occupational therapy
- Cognitive therapy
2. Educate on strategies to manage speech deficits.
Speech therapy will be included in a patient’s stroke rehabilitation plan if aphasia is an effect of their stroke. Recommendations that can be encouraged between sessions include:
- Consistent use of “communication partner training” strategies
- Speech practice using flashcards, books, computer programs, and visual aids
- Utilizing communication boards, pen and paper, and apps as needed to communicate needs
3. Educate on prescribed medications.
Common medications prescribed at discharge may include:
- Anticoagulants
- Oral anticoagulation medication will be started following an acute stroke for a confirmed case of atrial fibrillation. Some examples include:
- Apixaban
- Dabigatran
- Rivaroxaban
- Nearly all patients will receive low-dose heparin or enoxaparin for deep vein thrombosis (DVT) prophylaxis to reduce the risk of blood clots forming in the legs.
- As a preventative treatment, aspirin may be prescribed to decrease the risk of a second stroke.
- Oral anticoagulation medication will be started following an acute stroke for a confirmed case of atrial fibrillation. Some examples include:
- Blood pressure medications will be used to control hypertension as a means to prevent additional strokes. Classes of these drugs include:
- Diuretics
- Beta-blockers
- Calcium channel blockers
- Ace inhibitors
4. Initiate safety strategies.
Strength and coordination deficits following a stroke will leave patients at increased risk for falls and injury. Always ensure the bed rails are up, the bed alarm is on, and the call light is within reach. Patients may require aids to assist with walking and completing ADLs safely.
5. Encourage attending a support group.
Refer the patient to local stroke support groups. Support groups for stroke victims and caregivers are important to recovery as they provide hope and encouragement in the form of new friends facing similar challenges.
6. Promote and educate about lifestyle modifications.
Educate the patient on how to minimize their risk of a second stroke. Important components of this education will include:
- Limiting processed foods and saturated fats
- Participating in daily exercise
- Quitting smoking
- Limiting alcohol
- Maintaining a healthy weight
7. Ensure adherence to treatment regimens.
Another vital aspect of preventing a future stroke is to adhere to treatment regimens surrounding other comorbidities such as hypertension, diabetes, and hypercholesterolemia. Ensure the patient takes medications as prescribed and completes follow-up tests and appointments.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for a stroke, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for a stroke.
Impaired Verbal Communication
Cerebrovascular accidents often result in deficits in communication. Patients may struggle with comprehending or expressing speech as well as a physical inability to produce meaningful speech.
Nursing Diagnosis: Impaired Verbal Communication
Related to:
- Prolonged cerebral occlusion
- Dysarthria (weakened muscles used for speech)
- Aphasia (impaired ability to comprehend or produce language)
As evidenced by:
- Slurred speech
- Nonverbal
- Difficulty forming words
- Difficulty expressing thoughts
- Slow to respond due to delayed comprehension
- Extremity weakness or paralysis resulting in an inability to write or type
Expected Outcomes:
- Patient will establish a form of communication to express their thoughts and needs
- Patient will participate in speech therapy to improve communication
- Patient will utilize resources and devices to support communication
Assessment:
1. Note type of aphasia.
Global aphasia is severe and affects the patient’s ability to produce and understand language. Wernicke’s aphasia may cause the patient to speak in nonsensical sentences. Broca’s aphasia means the patient may understand what is said to them and know what they want to say but have difficulty getting the words out.
2. Observe how the patient communicates.
Patients may have their own unique way of communicating such as in gestures, signals, or sounds. Family members can aid in teaching the nurse how the patient requests something.
Interventions:
1. Speak in short, direct sentences.
Always speak clearly, facing the patient so they can see your lips and expressions. Use direct sentences as they may not be able to comprehend abstract thoughts. Short “yes” or “no” questions may be easiest for the patient to comprehend.
2. Utilize alternative communication methods.
Use writing, drawing, and flashcards if these work for the patient. The nurse and patient may be able to work out a system to communicate needs such as a thumbs up or down, eye blinking, or smiling if they are nonverbal.
3. Encourage speech therapy.
Speech-language therapy is vital in improving communication. Aphasia can improve over time and speech therapy can help the patient restore language abilities as well as instruct on devices and technology to aid in communicating.
4. Encourage family participation.
Family involvement is crucial as both the patient and family learn to maneuver communication changes. Family members should also participate in therapy sessions and learn specific techniques that support clear communication.
Ineffective Cerebral Tissue Perfusion
When blood is blocked from the brain it does not receive necessary oxygen. If blood flow is not restored promptly this will result in tissue death.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Interruption of blood flow to the brain
- Thrombus formation
- Artery occlusion
- Cerebral edema
- Hemorrhage
As evidenced by:
- Altered mental status
- Blurred vision
- Slurred speech
- Extremity weakness
Expected Outcomes:
- Patient will recognize symptoms of a stroke and seek immediate medical attention
- Patient will display improved cerebral perfusion as evidenced by vital signs within ordered parameters
- Patient will display improvement in stroke deficits such as slurred speech, weakness, and swallowing ability by discharge
Assessment:
1. Determine baseline presentation.
When assessing for a possible stroke it is vital to know the last time the client was “well” or at their baseline level of functioning before exhibiting symptoms. Certain interventions (thrombolytics) can only be administered within a 4-hour timeframe of when symptoms started. The nurse can also use this information when performing follow-up assessments to determine improvement or deterioration.
2. Perform neurological assessments.
The nurse will perform stroke scale assessments as directed by their facility. These frequent assessments monitor LOC, visual changes, facial movement, motor coordination, sensory changes, and speech or language deficits.
3. Obtain a CT scan or MRI of the brain.
These are the most important diagnostic tests to confirm or rule out a stroke. They also show whether a stroke is hemorrhagic or ischemic which will further determine treatment.
Interventions:
1. Maintain blood pressure.
To maintain cerebral perfusion, blood pressure is kept elevated. For ischemic strokes, the blood pressure may be allowed as high as 220 systolic (unless receiving thrombolytic therapy) and no lower than 140 systolic for a hemorrhagic stroke. Specific parameters will be ordered by the provider.
2. Administer thrombolytics.
Thrombolytics are administered to dissolve clots in an ischemic stroke. They should never be administered for a hemorrhagic stroke as this will cause fatal bleeding. Also, thrombolytics must be administered within 4 hours of the development of stroke symptoms to be effective.
3. Educate on risk factors of strokes.
If the patient only experiences a TIA or does not suffer long-term deficits from a stroke, prevention of a future stroke should be communicated. Risk factors include hypertension, heart disease, diabetes, smoking, and stress. These are modifiable risk factors that the patient can work towards changing through diet, exercise, and lifestyle behaviors.
4. Instruct on symptoms of a stroke using FAST.
“Time is tissue” in the instance of a stroke. The sooner symptoms are recognized, the quicker the treatment, and less sustained damage to brain tissue. Patients and family members should be instructed on the acronym F.A.S.T which stands for Facial drooping, Arm weakness, Speech difficulty, and Time (call 911).
Risk For Injury
Depending on the area of the brain affected by the stroke, the patient may have spatial-perceptual issues and impaired judgment. Along with deficits in swallowing, motor coordination, and generalized weakness, safety is a priority.
Nursing Diagnosis: Risk For Injury
Related to:
- Impaired judgment
- Spatial-perceptual deficit
- Weakness
- Poor motor coordination
- Poor balance
- Poor concept of time
- Impaired sensory awareness
- Dysphagia
- Inability to communicate
- Hemiplegia
- Short attention span
- Impulsivity
Note: A risk for diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and nursing interventions are directed at prevention.
Expected Outcomes:
- Patient will remain free from falls
- Patient will maintain intact skin integrity
- Caregivers will support the patient and create a modified environment to keep the patient safe and free from injury
Assessment:
Determine deficits related to the area of brain injury.
Depending on the area of the brain that is damaged by the stroke the patient may display specific deficits. Right-brain strokes may result in difficulty in gauging the distance of an object making driving and walking dangerous. Left-brain strokes are more likely to have impaired swallowing and speech.
Assess sensory awareness.
An inability to recognize pain, heat, or sharp sensations places the patient at an increased risk of skin breakdown and injury.
Note neglect or visual disturbances.
A stroke on one side of the brain may cause a lack of awareness in the opposite side of the body. This can also affect the visual field. Hemianopia is a loss of half of the visual field which can be dangerous in certain situations.
Interventions:
1. Use bed and chair alarms.
When patients suffer a right-brain stroke specifically, they may be more impulsive and deny or minimize their deficits. This puts them at high risk for injury and falls. Keeping a bed alarm on at all times and a chair alarm if they are sitting up will increase safety.
2. Assist with eating.
Patients with dysphagia will require special meals and thickened liquids. Ensure they are chewing and swallowing adequately and are not displaying signs of possible aspiration such as pocketing food, drooling, or coughing.
3. Teach to scan the environment.
If the patient has left or right-sided neglect or visual disturbances teach them to scan from left to right. This can help them when moving in their environment but also assist with activities such as reading.
4. Turn and assess skin frequently.
If the patient is paralyzed on one side and lacks sensation it is the nurse’s responsibility to maintain their skin integrity. Turn every 2 hours, keep boney areas supported, maintain proper alignment of extremities and ensure lines and tubes are not digging into the patient’s skin.
Self-Care Deficit
After a stroke, patients may experience hemiparesis, which makes it difficult to perform activities of daily living and self-care activities.
Nursing Diagnosis: Self-Care Deficit
Related to:
- Neurobehavioral manifestations
- Weakness
- Musculoskeletal impairment
- Cognitive dysfunction
- Decreased motivation
- Impaired physical mobility
- Unilateral neglect
As evidenced by:
- Inability to independently complete cleansing activities
- Inability to independently put on or take off clothing
- Impaired ability to use eating utensils, prepare food, or self-feed
- Inability to access the bathroom or perform toileting
Expected outcomes:
- Patient will maintain intact skin and be free from body odor.
- Patient will verbalize the successful utilization of assistive methods and devices to bathe effectively.
- Patient will report dignity and satisfaction with bathing when requiring the assistance of a caregiver.
- Patient will be able to dress and perform ADLs to their optimal potential.
- Patient will display competence in utilizing assistive devices.
- Patient will be able to feed themselves safely and effectively.
- Patient will remain free from incontinent episodes, stool impaction, and urine or feces on the skin.
Assessment:
1. Assess the patient’s functional ability and limitations.
After a stroke, patients may experience impairment in physical mobility, sensation, cognition, and emotions. Determining the patient’s functional ability and limitations can help plan an appropriate treatment regimen to promote recovery and improve the patient’s quality of life. It will also help with planning for discharge and identifying needs once the patient is ready to go home or to a rehabilitation facility.
2. Assess the patient’s preferences.
Respecting the patient’s preferences and comfort level will allow the nurse to work with the patient to continue to build confidence. It is also important to honor cultural or other preferences in food, hygiene, and self-care to continue to work toward independence in all areas of self-care.
3. Perform risk assessments routinely.
The nurse can evaluate for complications that affect the patient’s self-care. These include:
- Fall risk assessment: Patients recovering from stroke are at a high risk for falls due to limitations in mobility. Utilize the Morse Fall Scale to identify risk factors.
- Skin assessment: The Braden Scale is a useful tool for pressure ulcer risk assessment.
- Swallowing assessment: Patients are at risk for aspiration if their swallowing ability is affected following a stroke. A bedside swallow study should be performed before any oral intake.
Interventions:
1. Establish a toileting schedule.
After a stroke, patients may have decreased mobility and are at an increased risk for constipation. Maintaining a toileting schedule, administering stool softeners as ordered, and ensuring a prompt response to requests to use the restroom are important to prevent this condition.
2. Encourage independence when possible.
Promote independence with ADLs to maximize the patient’s autonomy and rebuild self-esteem while maximizing recovery.
3. Ensure adequate time for meals.
Patients who have experienced a stroke and have difficulty with swallowing and other aspects of eating and drinking may require additional time to safely consume meals.
4. Assist with using adaptive equipment.
Patients recovering from strokes will often need to utilize devices to assist them with their ADLs. These devices may include button hooks or zipper pulls for dressing, shower benches or electric toothbrushes for bathing/grooming, and larger utensils, mobility aids, and other tools to support their independence.
5. Consult with physical and occupational therapy.
Physical and occupational rehabilitation assist in relearning skills that have become impaired due to damage to the brain. It may also help them learn new ways of performing tasks to compensate for disabilities.
Unilateral Neglect
Unilateral neglect is associated with brain damage from a stroke. It causes problems with responding to stimuli on one side of the body.
Nursing Diagnosis: Unilateral Neglect
Related to:
- Disease process
- Brain trauma or damage
- Ischemia of cerebral tissue
As evidenced by:
- Altered safety behavior on the neglected side
- Failure to move eyes in the neglected hemisphere
- Inability to move limbs in the neglected hemisphere
- Difficulty grooming neglected side
- Unawareness of the positioning of the neglected limb
Expected outcomes:
- Patient will demonstrate techniques that can minimize unilateral neglect.
- Patient will be able to care for both sides of the body appropriately and keep the affected side free from harm.
- Patient will return to the highest level of functioning possible based on individual goals and abilities.
Assessment:
1. Assess the patient for signs of unilateral neglect.
Signs of unilateral neglect include:
- Not performing self-care on one side of the body
- Leaning inappropriately on the affected arm or leg
- Eating food on only one side of a plate
- Failing to respond to stimuli contralateral to the side of the brain damage
2. Assess the level of awareness of unilateral neglect.
It will require practice for the patient to get used to paying more attention to their movements and activities to maintain their safety. Discuss strategies such as scanning their environment for hazards or practicing tasks such as dressing or grooming.
3. Assess the skin, especially on the neglected side.
When the patient is unaware of a part of their body, they are more likely to forget to move or reposition it or may not feel uncomfortable sensations. They may bump, scratch, or leave it resting on a hard surface for too long and develop an injury or skin breakdown.
Interventions
1. Initiate fall precautions.
Patients with unilateral neglect may experience one-sided weakness and are at risk for falls. Ensure the bed alarm is activated as appropriate, and the call light is within reach.
2. Encourage progressive and appropriate use of assistive devices.
The use of assistive devices will help patients cope with unilateral neglect. Assistive devices will also encourage paying attention to the neglected side and enhance patient safety.
3. Instruct the patient to maintain neutral body positioning.
Keeping the body position neutral with regular position changes will help prevent pain, joint subluxation, and contractures due to immobilization. Encourage the patient to monitor their position often to remain observant of their neglected side.
4. Position the patient’s belongings on the unaffected side.
Place objects in a location that is accessible to the patient. Approach the patient and encourage getting out of bed on the unaffected side to promote safety and awareness.
5. Coordinate the transfer of the patient to the appropriate rehabilitation program.
Rehabilitation should begin as soon as possible to improve health outcomes, patient confidence, and self-care abilities. Rehabilitation may involve physical, occupational, and speech therapies, depending on the patient’s needs.
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