Nursing Diagnose

Nursing Outcomes

Nursing Interventions

Evaluation

• Verbalize or indicate an understanding of the communication difficulty and plans for ways of handling.

• Establish method of communication in which needs can be expressed.

• Participate in therapeutic communication (e.g., using silence, acceptance, restating reflecting, Active-listening).

• Demonstrate congruent verbal and nonverbal communication.

• Use resources appropriately.

• Review history for neurological conditions that could affect speech, such as CVA, tumor, multiple sclerosis, hearing loss.

• Note results of neurological testing such as electroencephalogram (EEG), computed tomography (CT) scan.

• Note whether aphasia is motor (expressive: loss of images for articulated speech), sensory (receptive: unable to understand words and does not recognize the defect), conduction (slow comprehension, uses words inappropriately but knows the error), and/or global (total loss of ability to comprehend and speak). Evaluate the degree of impairment.

• Evaluate mental status, note presence of psychotic conditions (e.g., manic-depressive, schizoid/affective behavior). Assess psychological response to communication impairment, willingness to find alternate  of communication.

• Note presence of ET tube/tracheotomy or other physical blocks to speech (e.g., cleft palate, jaws wired). Determine ability to read/write. Evaluate musculoskeletal states, including manual dexterity (e.g., ability to hold a pen and write).

• Obtain a translator/written translation or picture chart when writing is not possible.

• Facilitate hearing and vision examinations/obtaining necessary aids when needed/desired for improving communication. Assist client to learn to use and adjust to aids.

• Establish relationship with the client, listening carefully and attending to client’s verbal/nonverbal expressions.

• Keep communication simple, using all modes for accessing information: visual, auditory, and kinesthetic

• Determine meaning of words used by the client and congruency of communication and nonverbal messages.

• Validate meaning of nonverbal communication; do not make assumptions, because they may be wrong. Be honest; if you do not understand, seek assistance from others.

• Individualize techniques using breathing for relaxation of the vocal cords, rote tasks (such as counting), and singing or melodic intonation to assist aphasic clients in relearning speech.

• Anticipate needs until effective communication is reestablished.

• Plan for alternative methods of communication (e.g., slate board, letter/picture board, hand/eye signals, typewriter/computer) incorporating information about type of disability present.

• Provide environmental stimuli as needed to maintain contact with reality; or reduce stimuli to lessen anxiety that may worsen problem.

• Use confrontation skills, when appropriate, within an established nurse-client relationship to clarify discrepancies between verbal and nonverbal cues.

• Involve family/SO(s) in plan of care as much as possible. Enhances participation and commitment to plan.

• Response to interventions/teaching and actions performed.

• Response to interventions/teaching and actions performed.

• Attainment / progress toward desired outcome(s).

• Modifications to plan of care.