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Impaired Verbal Communication | Nursing Care Plan for Cerebrovascular Accident

Nursing diagnosis: impaired verbal [and/or written] Communication related to impaired cerebral circulation; neuromuscular impairment, loss of facial or oral muscle tone and control; generalized weakness and fatigue

Possibly evidenced by
Impaired articulation; soft speech or does not or cannot speak
Inability to modulate speech, find and name words, identify objects; inability to comprehend written or spoken language, global aphasia
Inability to produce written communication, expressive aphasia

Desired Outcomes/Evaluation Criteria—Client Will
Indicate understanding of the communication problems.
Establish method of communication in which needs can be expressed.
Use resources appropriately.

Nursing intervention with rationale:
1. Assess type and degree of dysfunction, such as receptive aphasia—client does not seem to understand words, or expressive aphasia—client has trouble speaking or making self understood:
Rationale: Helps determine area and degree of brain involvement and difficulty client has with any or all steps of the communication process. Client may have trouble understanding spoken
words (damage to Wernicke’s speech area), speaking words correctly (damage to Broca’s speech areas), or may experience damage to both areas.

2. Differentiate aphasia from dysarthria.
Rationale: Choice of interventions depends on type of impairment. Aphasia is a defect in using and interpreting symbols of language and may involve sensory and/or motor components, such as inability to comprehend written or spoken words or to write, make signs, and speak. A dysarthric person can understand, read, and write language, but has difficulty forming or pronouncing words because of weakness and paralysis of oral musculature, resulting in softly
spoken speech.

3. Listen for errors in conversation and provide feedback.
Rationale: Client may lose ability to monitor verbal output and be unaware that communication is not sensible. Feedback helps client realize why caregivers are not understanding
and responding appropriately and provides opportunity to clarify content and meaning.

4. Ask client to follow simple commands, such as “Shut your eyes,” “Point to the door”; repeat simple words or sentences.
Rationale: Tests for receptive aphasia.

5. Point to objects and ask client to name them.
Rationale: Tests for expressive aphasia—client may recognize item but not be able to name it.

6. Have client produce simple sounds, such as “sh,” “cat.”
Rationale: Identifies dysarthria because motor components of speech (tongue, lip movement, breath control) can affect articulation and may or may not be accompanied by expressive

7. Post notice at nurses’ station and client’s room about speech impairment. Provide special call bell if necessary.
Rationale: Allays anxiety related to inability to communicate and fear that needs will not be met promptly. Call bell that is activated by minimal pressure is useful when client is unable to use
regular call system.

8. Provide alternative methods of communication, such as writing or felt board and pictures. Provide visual clues—gestures, pictures, “needs” list, and demonstration.
Rationale: Provides for communication of needs or desires based on individual situation or underlying deficit.

9. Anticipate and provide for client’s needs.
Rationale: Helpful in decreasing frustration when dependent on others
and unable to communicate desires.

10. Talk directly to client, speaking slowly and distinctly. Use yes/no questions to start, progressing in complexity as client responds.
Rationale: Reduces confusion and anxiety at having to process and respond to large amount of information at one time. As retraining progresses, advancing complexity of communication
stimulates memory and further enhances word and idea association.
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