Transient Ischemic Attack Nursing Diagnosis and Nursing Care Plan

Last updated on April 30th, 2023 at 12:38 am

Transient Ischemic Attack Nursing Care Plans Diagnosis and Interventions

Transient Ischemic Attack TIA NCLEX Review and Nursing Care Plans

A transient ischemic attack often referred to as TIA is considered a mini cerebrovascular accident or stroke that happens when a part of the brain or spinal cord becomes ischemic or loses adequate blood supply.

Unlike with a full-blown stroke, however, the ischemic episode is temporary, leaving no lasting damage, and any symptoms incurred is usually temporary.

While not life threatening, having a transient ischemic attack is a sign that a patient is at high risk for stroke, and thus should be managed to prevent further ischemic episodes that may have longer lasting or even permanent, debilitating effects.

Causes of Transient Ischemic Attack

The brain and its supporting structures are very dependent on oxygen to continue functioning. While there are collateral circulations in place to ensure continued blood and oxygen supply to the brain, any prolonged disruption of cerebral circulation can cause the brain to eventually deteriorate. 

As with a full-blown ischemic stroke, a transient ischemic attack occurs when there is a blockage in an artery supplying blood to the brain or spinal cord, typically a blood clot. When blood supply is blocked, the cells become deprived of oxygen.

However, unlike with a stroke, the blockage is quickly broken down while the brain’s collateral structure is still able to adequately supply the brain with blood, which is why there is no lasting brain damage and any neurological symptoms experienced are temporary, or transient.

Risk Factors to Transient Ischemic Attack

Transient ischemic attacks can happen in any age group, although some patients are at higher risk than most. Patients most at risk for developing transient ischemic attacks include the following:

  • Genetic predisposition to stroke, or other pre-morbid conditions that increase risk for stroke
  • Patients with blood clotting or blood disorders
  • Hypertension
  • Diabetes mellitus
  • Patients with high cholesterol (Hyperlipidemia) and atherosclerosis
  • Tobacco and marijuana smoking
  • Excessive alcohol intake
  • Obesity
  • Physical inactivity or immobility
  • Advancing age – the risk for transient ischemic attack doubles each year once past 55 years old
  • Gender – males are more likely to have a transient ischemic attack than females, and African-Americans and Hispanics are at higher risk for experiencing an ischemic episode.
  • History of stroke – previous stroke patients are at a higher risk for both transient ischemic attacks and a second stroke.

Signs and Symptoms of Transient Ischemic Attack

The signs and symptoms of a transient ischemic attack are similar to that of a stroke. A common mnemonic used to identify these symptoms is the F.A.S.T:

  1. Facial asymmetry: a droop or uneven smile in one side of the face
  2. Arm numbness or dropping: any sign of numbness or weakness in one or both arms; if both patient’s arms are raised, the affected limb either remains unsteady or steadily drops.
  3. Speech difficulty: Slurring of speech or any sudden onset of speech impairment.
  4. Time:  Note the time when the patient showed signs of a transient ischemic attack or stroke. Effectiveness of treatment regimen is largely dependent on prompt identification and treatment within the golden time (2 hours).

Other symptoms commonly associated with a transient ischemic attack are:

  • Severe headache
  • Numbness in the face
  • Difficulty walking
  • Poor limb coordination and balancing
  • Vision problems in one or both eyes
  • Difficulty in thinking or in comprehension

Even if a patient’s transient ischemic attack symptoms will fade within an hour, emergency consultation and treatment are still highly recommended, as the risk for a stroke remains very high shortly after an episode.

Diagnosis of Transient Ischemic Attack

While generally not considered life-threatening, a transient ischemic attack is still considered a medical emergency.

In order to diagnose a transient ischemic attack, healthcare providers will run a series of laboratory and diagnostic exams to rule out other neurological conditions, including the episode being an actual stroke. Personal history will also be taken to identify any risk factors in developing an attack.

  • Physical exam: A physical exam will consist of neurological tests that will determine the patient’s visual acuity, eye movements and responsiveness, speech, limb tone and strength, and any other sensory deficit. The patient will also be assessed for other signs of premorbid conditions that can increase the risk for stroke, such as pathologic heart sounds indicative of atherosclerosis, elevated blood pressure, or blood sugar levels.
  • Laboratory tests. Usually done to help determine the cause of a transient ischemic attack, rule out other diseases, as well as any other causative co-morbid conditions. Typical blood works ordered include complete blood count, PT/PTT, lipid profile, and blood sugar tests.
  • CT or CTA scans. CT scans are one of the golden standards in confirming the diagnosis of most neurological disorders, including transient ischemic attacks. A CT Scan uses multiple X-Ray images to create a set of 3D composite images of the scanned area, and for transient ischemic attacks, it provides a visual to determine the presence and extensiveness of brain or artery damage. A CTA scan is a type of CT scan but makes use of infused dye to better visualize blood flow in affected blood vessels in the head and neck.
  • MRI and MRA. Another diagnostic test can confirm the presence of stroke or transient ischemic attack. MRIs make use of a magnetic field to generate a 3D image of the targeted area. MRA also makes use of magnetic fields to assess blood vessels, and like CTA scans, may include the introduction of an injectable dye for better visualization. While MRIs and MRAs generally produce higher quality images, they are more expensive and less accessible than CT scans.
  • Ultrasound. A healthcare provider may conduct a carotid ultrasound to determine if a clot or plaque build-up in the carotid artery is the cause of the transient ischemic attack. It uses sound waves to produce diagnostic images and is helpful in identifying blocks or narrowing arteries.
  • Echocardiography (ECG). Evaluating cardiac function is often done to further evaluate heart and blood vessel conditions that may predispose a patient to a transient ischemic attack. Echocardiography makes use of sound waves to create an image, much like ultrasound. Other more extensive forms of echocardiography, such as TEE, allow better visualization of the heart and blood clots that may not be visible in traditional echocardiogram exams.
  • Arteriography. An invasive radiological test that gives better visualization of major arteries through the insertion of a catheter in the femoral artery and injection of a dye to provide X-ray images of the cerebral circulatory system. However, the necessity of this diagnostic test is limited.

Treatment for Transient Ischemic Attack

The goal of treating a transient ischemic attack begins with properly identifying the cause of the attack. It is followed by treating any underlying diseases that could predispose the patient to a repeat attack and preventing further episodes from occurring in the future. Treatment, therefore, primarily depends on the cause of the transient ischemic attack.

  1. Medication. Drug therapy for transient ischemic attacks includes medications that prevent emboli formation.
    • Antiplatelet drugs – medications that inhibit platelets from more readily binding together, forming clots that increase the risk for a second episode. For transient ischemic attack patients, antiplatelet therapy using one or two drugs of the same class is often prescribed for at least a month after the attack. But for patients at higher risk for a repeat episode, therapy may last long-term.
    • Anticoagulants – medications that prevent clotting by targeting clotting proteins. However, they are less often used for managing transient ischemic attacks than anti-platelets and pose a greater risk for bleeding than the latter.  Anticoagulants are usually prescribed for patients with additional cardiac comorbidities, such as atrial fibrillation, wherein there is a greater risk for developing blood clots.
    • Antihypertensive medications – for suspected or diagnosed hypertensive patients, taking antihypertensives is important to regulate blood pressure. Depending on physical assessment and responsiveness to therapy, a patient may be prescribed one or more antihypertensive medications. An important patient education point is to encourage compliance with the therapeutic regimen to prevent unstable blood pressure spikes that could increase the risk for another transient ischemic attack or even a stroke.
    • Statins – for patients with hyperlipidemia, statins can be prescribed to help lower LDL cholesterol, or the bad cholesterol, levels in the blood. Having elevated cholesterol puts the patient at increased risk for atherosclerotic plaque formations in blood vessels, which can then break down into smaller pieces that can potentially block cerebral blood flow.
  2. Surgery. As with drug therapy, surgical management aims to eliminate predisposing factors to another transient ischemic attack.
    • Carotid endarterectomy – if a transient ischemic attack patient is found to have a moderately to severely blocked carotid artery, they may be recommended for carotid endarterectomy. This procedure involves making an incision on the carotid artery to remove the fatty plaque buildup and help prevent a future attack
    • Angioplasty – another procedure to remedy atherosclerosis is angioplasty, wherein a stent, a thin metal wire mesh, is inserted to open a blocked artery and to help maintain its patency.

Prevention of Transient Ischemic Attack

Compliance with treatment and lifestyle modifications are the recommended, proven ways to prevent a transient ischemic attack or a stroke. Lifestyle modifications include:

  • Eating a low salt, low-fat diet with adequate amounts of fruits and vegetables
  • Take time to exercise. Engage in regular, moderate intensity physical activity at least every week.
  • Limit alcohol intake and stop smoking.
  • In addition to complying with the prescribed treatment for a transient ischemic attack, the patient should monitor the underlying health conditions that put them at risk for another attack and comply with treating or controlling them accordingly.

Transient Ischemic Attack Nursing Diagnosis

Transient Ischemic Attack Nursing Care Plan 1

Risk for Ineffective Cerebral Tissue Perfusion

Nursing Diagnosis: Risk for Ineffective Tissue Perfusion (Cerebral) related to previous transient ischemic attack episode secondary to TIA

Desired Outcomes:

  • The patient will be able to maintain optimal levels of consciousness, sensory and motor function.
  • The patient will be free from signs and symptoms of increased intracranial pressure (ICP), and signs and symptoms of further or recurrence of neurosensory deterioration.
Transient Ischemic Attack Nursing InterventionsRationale
 Assess the patient for factors that can lead to decreased cerebral perfusion and the potential for ICP using neurological exams and vital signs monitoring, particularly blood pressure.  Establish baseline data for the patient’s neurological status and vital signs, which will be used to guide the creation of treatment care plans.
Monitor the patient continuously for signs and symptoms of a repeat transient ischemic attack or a stroke, as evidenced by deterioration in neurosensory function, body weakness, and verbal impairments. Frequently assess and monitor for any changes in the patient’s ICP, level of consciousness, vision or eye movement changes, speech or comprehension changes, and vital signs fluctuations.A patient with a previous transient ischemic attack is at risk for another episode or a full-blown stroke, which is either way a medical emergency that will need prompt management.
Keep the patient’s head elevated and maintained in a neutral position.Keeping the head above the heart level can help facilitate more efficient venous return blood flow, reduce arterial pressure, and improve cerebral perfusion.
Provide opportunities for adequate bed rest. Maintain a quiet and relaxing environment. Schedule the patient’s activities during waking hours as much as possible and avoid unnecessary and/or prolonged activity.Ensure that the patient will have adequate rest to prevent an increase in ICP and promote healing. Scheduling the patient’s activities will help maximize the patient’s time and energy while still awake.
Avoid activities that could cause blood pressure fluctuations, such as straining, sudden changes in position or excessive physical exertion.Sudden changes in position, performing Valsalva maneuver via straining, or strenuous physical activity can all affect blood pressure levels and put the patient at risk for another attack or a stroke.

Transient Ischemic Attack Nursing Care Plan 2

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of information or educational resources; cognitive limitation or information misinterpretation secondary to diagnosis of TIA, as evidenced by lack of initial awareness on disease condition, inability to maintain compliance with prescribed treatments.

Desired Outcomes:

  • The patient will be able to participate and demonstrate understanding of patient education regarding transient ischemic attacks and their potential complications, risk factors, and prevention.
  • The patient will verbalize understanding of the necessity of treatment interventions and demonstrate improved compliance with the therapeutic regimen.
Transient Ischemic Attack Nursing InterventionsRationale
 Identify factors or comorbidities that could put the patient at risk for a repeat transient ischemic attack or a stroke, such as: hypertension, diabetes mellitus, obesity, cardiac problems, history of, or is currently, smoking and/or alcoholic drinker.  Determine what puts the patient at risk for a recurrence of a transient ischemic attack or a stroke, and plan with the patient on how to implement changes to promote a healthier lifestyle and reduce their risk for any other health condition, and/or to manage their current comorbidities.
Monitor for signs and symptoms that could be indicative of disease recurrence or progression, such as changes or deterioration of neurological, visual, or musculoskeletal function, any sudden changes in the level of consciousness or cognitive function, and/or severe headache.Educate the patient on what symptoms to watch out for that will require prompt intervention to prevent further neurosensory deterioration.
Discuss disease pathology, taking the patient’s comprehension capabilities in mind. The use of educational materials that the patient can keep, such as brochures or online resources, is encouraged.Helps the patient better understand their current condition, enabling them to set realistic expectations and goals to facilitate a healthier lifestyle, and encourage compliance to prevent future attacks.
Reinforce compliance to the current treatment plan, including medications and activity restrictions, if any.Planning of the patient’s therapeutic care regimen should be done in collaboration with the patient and their caregivers or significant others. Helping the patient better understand their disease and current health condition can enable them to better contribute to and comply with their plan of care.
Assist the patient in planning follow-up consults, and refer to other healthcare services (e.g. home care, nutritional support) as needed.Encourage follow-up consults to monitor the patient’s progress in managing their condition and any of their predisposing comorbidities to transient ischemic attacks. Assistance from ancillary healthcare services can further encourage compliance to lifestyle modifications and the treatment plan.

Transient Ischemic Attack Nursing Care Plan 3

Activity Intolerance

Nursing Diagnosis:
Activity Intolerance related to transient cerebrovascular impairment and/or transient musculoskeletal weakness secondary to TIA, as evidenced by blood pressure or heart activity abnormalities on activity, easy fatigability, and generalized body weakness.

Desired Outcome: The patient will be able to participate in their recommended physical activity plan with acceptable changes in vital signs, tolerate prescribed physical activities, and demonstrate gradual, increased tolerance for continued physical activity.

Transient Ischemic Attack Nursing InterventionsRationale
 Assess the patient’s capability for physical activity and mobility identify any limiting factors, as well as the indicators of their tolerance for said activities (i.e. vital signs). Assess the patient’s understanding of their risk for activity intolerance, and how they perceive their current limitations to physical activity.  Most symptoms of transient ischemic attacks go away on their own after at least an hour, but other comorbidities or interventions may cause limitations to physical activity. Assessment of the patient’s current activity level will establish baseline data for the current level of activity the patient can perform, which can help in creating activity and care plans for the patient.
Collaborate with the patient and the healthcare team to create an activity plan for the patient based on the gathered assessment data, gradually increasing activities as tolerated.Creating an appropriate activity plan for the patient can help encourage compliance to promoting tolerable physical activity.
Instruct the patient on how to plan for activities upon discharge.The patient’s activities should be scheduled during their active hours to ensure effective utilization of their time and energy, and promote adequate resting periods.
Encourage consistent physical activity, especially once they can adequately tolerate moderate physical activity.Exercise is important in maintaining a healthy weight and preventing comorbidities that increase the risk of having another transient ischemic attack or a stroke.

Transient Ischemic Attack Nursing Care Plan 4

Risk for Ineffective Therapeutic Regimen Management

Nursing Diagnosis: Risk for Ineffective Therapeutic Regimen management related to lack of knowledge regarding co-morbid conditions (e.g. hypertension, diabetes mellitus), new-onset comorbid conditions, or poor compliance to the treatment plan.

Desired Outcome: The patient will be able to demonstrate knowledge and understanding of treatment plans for any comorbidities for transient ischemic attacks and their possible complications and demonstrate proper and continued compliance to these treatment plans.

Transient Ischemic Attack Nursing InterventionsRationale
Assess the patient’s history for any care plan for their comorbidities and their efforts to manage their underlying conditions.  Determine patient’s prior knowledge of any of their pre-existing health conditions and any care plans (including medications and therapies) in place to manage them.
Evaluate the patient’s ability to do self-care and manage their condition, including monitoring their signs and symptoms, and knowing how to manage them in case of an emergency.Assessment to gauge the patient’s current self-management capabilities and the amount and type of education needed to ensure adequate self-care.
Provide adequate health education to the patient that is easy to understand and follow.Health education on underlying conditions can be overwhelming to understand for the patient. Ensuring their understanding of the condition will encourage their cooperation in planning for interventions and compliance to the plan.
Provide positive reinforcement for the patient’s efforts in complying with prescribed treatment and lifestyle modifications.Focus on the patient’s efforts to improve their health and to comply with their care plan. Avoid using fear to encourage positive lifestyle changes.
Encourage compliance to follow-up consults as scheduled.                  Monitor the effectiveness of planned interventions and therapeutic modalities, as well as the patient’s compliance to the current care plan.

Transient Ischemic Attack Nursing Care Plan 5

Risk for Injury

Nursing Diagnosis:
Risk for Injury related to body weakness, altered sensory perception (reception, transmission, integration) secondary to TIA

Desired Outcome: The patient will be able to interact appropriately with their environment and will be able to avoid the incidence of fall or injury while the patient is still presenting or is at risk for neurosensory deficit or weakness.

Transient Ischemic Attack Nursing InterventionsRationale
Assess the degree of neurosensory deficit, visual acuity, level of consciousness or muscle weakness.  Establish baseline data for the patient’s neurological status, the physical activity they can perform, and their risk for falls.
Advise the patient to monitor for signs and symptoms of returning or worsening weakness and/or neurosensory defects.Returning or worsening of transient ischemic attack symptoms could be an indication of another attack or a progression to stroke, which is a medical emergency that needs prompt management.
Provide and/or educate the patient on creating a fall-proof, safe, and consistent environment.Ensuring that the patient’s environment is safe will decrease the risk for injury and promote ease of navigation.
Encourage the patient to be constantly aware of their surroundings, consider their limitations and ask for help as needed.          Encouraging the patient to develop environmental awareness and to be aware of their current, transient limitations will enable them to be further aware of their risks for injury and how to avoid them.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


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