Unilateral Neglect | Nursing Care Plan for Cerebrovascular Accident

Nursing Diagnosis: unilateral Neglect related to left hemiplegia from CVA of right hemisphere

Possibly evidenced by

Failure to move eyes, head, limbs, trunk in the neglected hemisphere despite being aware of a stimulus in that space

Appears unaware of positioning of neglected limbs

Lack of safety precautions with regard to the neglected side

Failure to eat food from left side of plate and dress or groom neglected side

Failure to notice people approaching from neglected side

Desired Outcomes/Evaluation Criteria—Client Will

Adaptation to Physical Disability

Acknowledge presence of impairment.

Client/Caregiver Will

Identify adaptive or protective measures for individual situation.

Demonstrate behaviors, lifestyle changes necessary to promote physical safety.

Nursing intervention with rationale:

1. Reinforce to client the reality of the dysfunction and need to compensate, avoiding participation in client’s use of denial.

Rationale: Enhances dealing with reality of situation, thus avoiding scenarios (denial) that can limit progress and attainment of goals.

2. Instruct client and SO/caregiver in treatment strategies focused on training attention on the neglected side: Approach client from unaffected side.

Rationale: Promotes involvement of all individuals in addressing problem, which may enhance recovery.

3. Encourage client to turn head and eyes to “scan” the environment.

Rationale: Helps client compensate for visual field loss, increasing awareness of environment.

4. Discuss affected side while touching, manipulating, and stroking affected side; provide items of varied size, weight, and texture for client to hold.

Rationale: Focuses client’s attention on left side, and limb activation treatment provides tactile stimuli to promote use of affected limb in neglected hemisphere.

5. Have client look at and handle affected side, bring across midline during care activities.

Rationale: Encourages client to accept affected limb or side as part of self even though it does not feel like it belongs.

6. Assist client to position affected extremity carefully and to routinely visualize placement or use a mirror to adjust placement.

Rationale: Promotes safety awareness, reducing risk of injury.

7. Instruct SO/caregiver to monitor alignment of limbs and to inspect skin regularly.

Rationale: Decreased sensation and positional awareness may result in pressure injuries.

8. Discuss environmental safety concerns and assist in developing plan to correct risk factors.

Rationale: Client may continue to have some ongoing degree of functional impairment, including difficulty with navigating in familiar environments (Barrett & John, 2007).

9. Reinforce continuation of prescribed rehabilitation activities and neuropsychological therapies, as indicated.

Rationale: Maximizes recovery and enhances independence. Note:

Research indicates that most clients with neglect show early recovery, particularly within the first month, and marked improvement within 3 months (Barrett & John, 2007).