STROKE CARE PLAN: COGNITION

All interventions must be monitored, evaluated and documented as per Home policy.

Any changes (improvements or deterioration) must be reported to the RN/RPN.

FOCUS / GOAL(S) / TIMELINES / INTERVENTIONS / ACCOUNTABILITY
Attention
Resident easily distracted and therefore unable to independently complete tasks due to impaired cognition related to stroke / Resident will be able to focus on one task (option to insert a specific task (e.g. brushing teeth, getting dressed, reading) at a time
Resident will be able to complete one task at a time with or without cues
Resident ADL short or long score will improve by ____ / Decrease distractions during care tasks (e.g. turn off the television, radio and limit other conversations).
Provide slow, short, simple, step-by-step instructions.
Make direct eye contact with the resident when giving instructions.
Ask the resident to repeat task instructions back to you to confirm understanding.
Allow the resident time to think and process the information you have provided.
Performcare tasks at a pace which supports resident participation.
Educate resident/family on interventions to assist with attention. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Orientation
Resident not fully aware of time, place and/or person due to impaired orientation related to stroke. / Resident will be aware of their name, where they are and the date.
Resident will be able to locate his or her room on a regular basis.
CPS score will be maintained or improved. / Greet the resident each morning, including the date in the greeting
Give gentle reminders and the correct
Use a calendar to help the resident keep track of the day and date.
Post personal information on a bulletin board in the resident’s room and refer the resident to the bulletin board as needed.
Limit changes to the resident’s schedule-maintain a consistent routine.
Praise accomplishments.
Educate resident/family on interventions to support orientation. / HCA/PSW/PCA/ Restorative Care/Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Memory
Impaired short and long term memory related to stroke as evidenced by a score of __ on CPS. / Resident‘sCPS score will be maintained or improved. / Assist the resident in using memory aids such as a daily planner, calendar, clock, white boards or sticky notes.
Repeat information to help the resident remember it.
Store items in the same place.
Label drawers and cupboards with the contents.
Provide simple, clear instructions / information.
Provide only the key information.
Present new information one step at a time.
Use signs and pictures as memory cues.
Educate resident/family on interventions to support memory retention. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Insight
Resident has limited insight into his/her abilities and limitations and safety due to impaired cognition related to a stroke. / Resident will be safe when moving around his/her environment (specify which environment(s)) through the next quarter. / Make the environment as safe as possible and ensure the environment is free of hazards (e.g. hallways and room free from clutter, ensure good lighting throughout the LTC home).
Ensure assistive devices and walking aids (specify what assistive devices and/or walking aids) are close at hand for residents with impaired mobility.
Gently remind the resident about his/her stroke and his/her resulting limitations.
Provide the necessary amount of supervision (specify amount of supervision) to ensure the resident’s safety. mobility
Educate resident/family on interventions to support insight. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Judgment
Resident making poor choices and decisions while being aware of his/her own capabilities due to impaired cognition related to a stroke. / Resident will make safe choices and decisions during day to day tasks (specify a specific task (s)). / Do not place the resident in difficult or challenging situations (specify situation (s)) as he/she may have difficulty deciding what actions are safe.
Make the environment as safe as possible (e.g. hallways and room free from clutter, ensure good lighting throughout the LTC home).
Place assistive devices and walking aids (specify what assistive devices and / or walking aids) are close at hand for residents with impaired mobility.
Gently remind the resident/family about his/her stroke and his/her resulting limitations.
Provide the necessary amount of supervision to ensure the resident’s safety.
Educate resident/family on interventions to support decision-making. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Impulsivity
Resident acting quickly (impulsively) without thinking things through putting him/her in an unsafe situation (specify the unsafe situation (s)) due to impaired cognition related to a stroke. / Resident will make safe choices and decisions during day to day tasks (specify which day to day tasks). / Educate resident to slow down and to think of actions/consequences.
Give clear and specific instructions.
Divide tasks into small steps in order for the resident to focus on one part of the task at a time.
Educate resident to perform one task before moving on to the next (e.g. swallow that mouthful of food first, and then take another bite).
Make the environment as safe as possible (e.g. ensure that walking aids or assistive devices are close by).
Educate resident/family on interventions to reduce impulsivity and promote safety. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Sequencing
Resident is unable to arrange things or perform actions in the proper order (sequencing) (specify the task(s) that the resident is having difficulty sequencing) due impaired cognition related to a stroke. / Resident will properly sequence the steps of a task (specify the task (s)) with or without cues. / Give clear step-by-step instructions to help the resident understand and plan the task (specify the task(s).
Explain the next step of a task to the resident (if needed) (specify the task(s)).
Give the resident time to practice the task (specify the task(s)).
Complete the task the same way each time (specify the task(s)).
Educate resident/family on interventions to support sequencing. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
Problem-solving
Resident having difficulty recognizing a problem and finding a safe/effective solution due to impaired cognition related to a stroke. / Resident will be able to identify a problem and appropriately find a solution (specify the problem (s)) with or without cuing. / Break tasks into small steps for the resident.
Focus the resident on one step at a time with gentle, verbal or physical cues.
Help the resident identify different ways of solving the problem.
Educate resident/family on interventions to support problem-solving. / PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff
PSW/HCA/
Restorative Care/ Therapy Assistants/Registered Staff

December 2011

Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:

Tips and Tools for Everyday Living (Heart and Stroke Foundation of Ontario, 2010)

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