Managing care

of a client after CVA

Victoria Grigorita

Introduction of the
patient
76 yo African American
female
Lives alone in apartment
complex
FAST

Introduction of the focus

of presentation
CVA: Subdural hematoma

Past Pertained Health History

CVA x3 HTN
DM

Chief Reason for Rehab

Right hemiparesis of UE
and LE
Right visual field deficit
Expressive aphasia
Short-term memory
issues

Physical Assessment
Dependence

Transfers
Walking
LE dressing
Balance
Coordination
Activity
intolerance
1-person assist

Capabilities

Bathing
Grooming
UE dressing
Feeding
Toileting (Continent)
Compensation
with left side
Required set up

Psychosocial History
Divorced
Two daughters
Live in GA, TX
Do not help

Lives alone in apartment complex

1st floor/ no stairs

Aid comes daily 0900-1300

Helps with IADLs
Covered by Medicare

Enjoys being independent

Scared of becoming a burden

CONCEPT MAP

Unexpected Situation
Pain
Changes in a plan of care?
What could the nurse do
differently?

Goals
Short-term goals (by discharge)
Use adaptive techniques/devices that
promote ambulation and transferring
Use safety measures to minimize
potential for injury

Long-term goals (after

discharge)
Perform ADLs independently or w/the
use of adaptive devices

Remain free from injury

Interventions

Physiatrists
Physical Therapists
Occupational Therapists
Speech and Language
Therapists
Case Manager
Rehabilitation Nurses

Nursing Interventions

VS check
Glucose control
Medication administration
DVT/PE prevention
Teaching
Therapeutic
communication

Psychosocial well-being in persons with aphasia

participating in a nursing intervention after stroke

Authors: B. A. Bronken, M. Kirkevold, R.

Martinsen, T.B. Wyller, & K. Kvigne
Sample: 7 participants with moderate-tosevere aphasia, 33 to 72 years old
Method of data collection: 10 to 16
individual dialog-based encounters
between stroke survivors and a trained
nurse lasting 40 minutes to two hours.
Findings: participation in intervention
was experienced as a significant source of
support, method of gaining new
knowledge, and contribution to

Alternative Interventions

Virtual Reality/ Video

Gaming
CAM:
Yoga
Aromatherapy

Progress Made
Right hemiparesis of UE and LE
Walking: 30 ft 100 ft
Balancing: difficulty standing
climbed stairs
Transfers: 1 person assist stand by assist

Expressive aphasia
Slurred speech difficulty w/complex
words

Short-term memory issues

Inability to recall words remembering 2
words

Post Discharge Plan

PT
OT
SLT
Aid 0900-1300
Follow-up
Neurologist
Optometrist

References
Laver, K., George, S., Thomas, S., Deutsch, J. E., &
Crotty, M. (2012). Virtual reality for stroke
rehabilitation. Stroke, 43(2), e20-e21.
Bronken, B. A., Kirkevold, M., Martinsen, R., Wyller, T.
B., & Kvigne, K. (2012). Psychosocial well-being in
persons with aphasia participating in a nursing
intervention after stroke. Nursing Research &
Practice, 1-14.
Healthline. Alternative Stroke Treatments. Retreived
on 02/10/2015 from
http://www.healthline.com/health/stroke/alternativetreatments#Overview1

Thank you for your attention!