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    NCP Ischemic Stroke

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    LP Benoza
    The nursing care plan is for a 63-year-old patient named C.G. who suffered a cerebrovascular accident (CVA or stroke) and is experiencing ineffective tissue perfusion. The goal is for the patient to demonstrate increased perfusion after nursing interventions. The plan includes monitoring vital signs, encouraging fluid intake, administering oxygen, instructing on preventing shoulder adduction, changing hand and finger positions frequently, providing exercises and range of motion, teaching relaxation techniques, maintaining proper body alignment, exercising the affected limb, and instructing the patient to place food on their unaffected side when eating.

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    NCP Ischemic Stroke

    Uploaded by

    LP Benoza
    9K views3 pages
    The nursing care plan is for a 63-year-old patient named C.G. who suffered a cerebrovascular accident (CVA or stroke) and is experiencing ineffective tissue perfusion. The goal is for the patient to demonstrate increased perfusion after nursing interventions. The plan includes monitoring vital signs, encouraging fluid intake, administering oxygen, instructing on preventing shoulder adduction, changing hand and finger positions frequently, providing exercises and range of motion, teaching relaxation techniques, maintaining proper body alignment, exercising the affected limb, and instructing the patient to place food on their unaffected side when eating.

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    NCP

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    The nursing care plan is for a 63-year-old patient named C.G. who suffered a cerebrovascular accident (CVA or stroke) and is experiencing ineffective tissue perfusion. The goal is for the patient to demonstrate increased perfusion after nursing interventions. The plan includes monitoring vital signs, encouraging fluid intake, administering oxygen, instructing on preventing shoulder adduction, changing hand and finger positions frequently, providing exercises and range of motion, teaching relaxation techniques, maintaining proper body alignment, exercising the affected limb, and instructing the patient to place food on their unaffected side when eating.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    9K views3 pages

    NCP Ischemic Stroke

    Uploaded by

    LP Benoza
    The nursing care plan is for a 63-year-old patient named C.G. who suffered a cerebrovascular accident (CVA or stroke) and is experiencing ineffective tissue perfusion. The goal is for the patient to demonstrate increased perfusion after nursing interventions. The plan includes monitoring vital signs, encouraging fluid intake, administering oxygen, instructing on preventing shoulder adduction, changing hand and finger positions frequently, providing exercises and range of motion, teaching relaxation techniques, maintaining proper body alignment, exercising the affected limb, and instructing the patient to place food on their unaffected side when eating.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    DIVINE WORD COLLEGE OF SAN JOSE

    NURSING DEPARTMENT
    NURSING CARE PLAN
    Name: C.G.
    Age: 63
    Address: Caminawit, San Jose
    NURSING
    DIAGNOSIS
    Ineffective tissue
    perfusion related to
    impaired transport
    of oxygen secondary
    to cerebro vascular
    accident

    ANALYSIS
    Decrease in oxygen
    resulting in the
    failure to nourish
    the tissues at the
    capillary level.

    Medical Diagnosis:CVA
    Attending Physician: DR. Francisco
    Chief Complaint: Chest Pain
    GOAL &
    OBJECTIVES
    GOAL
    After series of nursing
    interventions, the patient
    will demonstrate increased
    perfusion.

    INTERVENTION

    RATIONALE

    Goal unmet.
    Patient needs more seek
    from doctors and more
    advanced technologies in
    determining her condition.

    NANDA
    I= kadalasan
    sumasakit ang dibdib
    ko
    O= pale & weak
    Dyspnea
    Left hemiparesis
    Difficulty of
    swallowing
    M= T=37.1
    P=72
    R=18
    BP= 150/90

    OBJECTIVES:
    After 8 hours of nursing
    interventions the patient
    will:
    Demonstrate
    behaviors/lifest
    yles changes to
    improve
    circulation

    EVALUATION

    Establish rapport to the


    client and significant
    others
    Monitor and record vital
    signs
    Monitor and record I &
    O

    To have their full


    cooperation
    To have baseline data
    To determine fluid
    volume relative to
    oxygen transportation
    and circulation

    Elevate head of bed

    maximize
    tissue perfusion

    Encourage quiet and


    restful atmoshphere
    Encourage increase
    fluid intake
    Administer oxygen to
    the client

    To promote circulation
    Conserves energy
    lowers tissue oxygen
    demands.
    To prevent from
    dehydratrion
    To compensate the
    demand of oxygen
    needed by the body

    Instruct patient on
    preventing shoulder
    adduction

    promote
    wellnes

    Encouraged patient to
    frequently change
    position of hands and
    fingers

    To promote circulation

    Advised client to
    exercise and provide
    ROM

    To decrease tension
    level

    Demonstrate use of
    relaxation techniques
    Maintain body
    alignment in functional

    position
    Exercise affected limb
    Assist and provide
    comfort measures to the
    patient
    Instruct patient to place
    food on the unaffected
    side of the mouth

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