Impaired verbal [and/or written] Communication
May be related to:
Impaired cerebral circulation; neuromuscular impairment, loss of facial or oral muscle tone and control; generalized weakness and fatigue
The cortical area that is responsible for integrating the myriad pathways required for the comprehension and formulation of language is called
Broca’s area. It is located in a convolution adjoining
the middle cerebral artery. This area isresponsible for control of the combinations of muscular movements needed to speak
each word. Broca’s area is so close to the left motor area that
a disturbance in the motor area often affects the speech area. This is why so manypatients who are paralyzed on the right side (due to damage or injury to the left side of the brain) cannot speak, whereas those paralyzed on the left side are less likely to have speech disturbances. (Smeltzer et. al. . Brunner andSu
ddarth’s Medical Surgic
al Nursing, 12th edition, p.1908)
Cues Objectives Nursing Interventions RationaleObjective Cues
Impaired articulation; soft speechor does not or cannot speak
Inability to modulate speech, findand name words, identify objects;inability to comprehend written orspoken language, global
Inability to produce writtencommunication, expressive aphasia
Within 8 hours of providing nursinginterventions, the client will:
Be able Indicate understanding of thecommunication problems.
Within 3 days of providing nursinginterventions, the client will:
Establish method of communication inwhich needs can be expressed.
Use resources appropriately.
Assess type and degree of dysfunction, such as receptive aphasia
client doesnot seem to understand words, or expressive aphasia
client has troublespeaking or making self understood:Differentiate aphasia from dysarthria.Listen for errors in conversation and provide feedback.
Ask client to follow simple commands, such as “Shut your
eyes,” “Point tothe door”; repeat simple words or sentences.
Point to objects and ask client to name them.
Have client produce simple sounds, such as “sh,” “cat.”
Ask client to write name and/or a short sentence. If unable to write, haveclient read a short sentence.
Post notice at nurses’ station and client’s room about speech
impairment.Provide special call bell if necessary.Provide alternative methods of communication, such as writing or felt board andpictures. Provide visual clues
—gestures, pictures, “needs” list, and
Anticipate and provide for client’s needs.
Helps determine area and degree of brain involvement and difficulty client haswith any or all steps of the communication process. Client may have troubleunderstanding spoken
words (damage to Wernicke’s speech area), speaking
words correctly (damage to Broca’s speech areas), or may
experience damageto both areas.Choice of interventions depends on type of impairment. Aphasia is a defect inusing and interpreting symbols of language and may involve sensory and/ormotor components, such as inability to comprehend written or spoken wordsor to write, make signs, and speak. A dysarthric person can understand, read,and write language, but has difficulty forming or pronouncing words becauseof weakness and paralysis of oral musculature, resulting in softly spokenspeech.Client may lose ability to monitor verbal output and be unaware thatcommunication is not sensible. Feedback helps client realize why caregiversare not understanding and responding appropriately and provides opportunityto clarify content and meaning.Tests for receptive aphasia.Tests for expressive aphasia
client may recognize item but not be able to nameit.Identifies dysarthria because motor components of speech (tongue, lipmovement, breath control) can affect articulation and may or may not beaccompanied by expressive aphasia.Tests for writing disability (agraphia) and deficits in reading comprehension(alexia), which are also part of receptive and expressive aphasia.Allays anxiety related to inability to communicate and fear that needs will not bemet promptly. Call bell that is activated by minimal pressure is useful whenclient is unable to use regular call system.Provides for communication of needs or desires based on individual situation orunderlying deficit.Helpful in decreasing frustration when dependent on others and unable tocommunicate desires.Reduces confusion and anxiety at having to process and respond to large amount