Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. Activity intolerance may also be related to factors such as obesity, malnourishment, side effects of medications, or emotional states such as depression or lack of confidence to exert one’s self. Nursing goals are to reduce the effects of inactivity, promote optimal physical activity, and assist the patient to maintain a satisfactory lifestyle.
- Generalized weakness / Fatigue
- Chronic disease
- Insufficient sleep or rest periods
- Prolonged immobility/bed rest
- Lack of motivation
- Imbalance of oxygen supply and demand
As evidenced by:
- Verbal report of fatigue or weakness
- Inability to begin or perform activity
- Abnormal heart rate or blood pressure (BP) response to activity
- Exertional discomfort or dyspnea
- The patient maintains activity level within capabilities, as evidenced by normal heart rate and blood pressure during activity, as well as absence of shortness of breath, weakness, and fatigue.
- Patient verbalizes and uses energy-conservation techniques.
Nursing Care Plan for Activity Intolerance: Intervention
ON GOING ASSESSMENT
(_) Determine the patient’s perception of causes of fatigue or activity intolerance.
(_) Assess the patient’s level of mobility.
(_) Assess nutritional status.
(_) Assess potential for physical injury with activity, including safety of the immediate environment.
(_) Assess the need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLS).
(_) Assess the patient’s cardiopulmonary status and stability for exercise before activity using the following measures:
o Heart rate – should not increase more than 20 to 30 beats per minute above resting within the routine activities.
o Orthostatic BP changes – older patients are more susceptible to drops in blood pressure with position changes.
o Need for oxygen with increased activity – supplemental oxygen may help compensate for the increase oxygen demands.
(_) Monitor the patient’s sleep pattern and amount of sleep achieved over the past few days. Difficulties in sleeping needs to be addressed before activity progression can be achieved.
(_) Observe and document response of activity. Report any of the following:
o Rapid pulse (20 to 30 beats/minute over resting rate or 120 beats/minute)
o Palpitations/noticeable changes in heart rhythm
o Significant increase in systolic BP (greater than 20 mm Hg)
o Significant decrease in systolic BP (greater than 10 mm Hg)
o Dyspnea, labored breathing, wheezing
o Weakness, fatigue
o Lightheadedness, dizziness, pallor, diaphoresis
o Chest discomfort
(_) Assess emotional response to change in physical status. Depression resulting from the inability to perform required activities can further aggravate activity intolerance.
(_) Establish guidelines and goals of activity with the patient and caregiver. Motivation is enhanced if the patient participates in goal setting.
(_) Encourage adequate rest periods, especially before meals, ADLs, exercise sessions, and ambulation.
(_) Anticipate the patient’s needs (e.g., keep telephone and tissues within reach).
(_) Assist with ADLs as indicated; however, avoid doing for the patients what they can do for themselves. This allows for conservation of energy.
(_) Provide bedside commode as indicated. This reduces energy expenditure.
(_) Assist patients to plan activities for times when they have the most energy. Not all self-care and hygiene activities need to be completed in the morning.
(_) Encourage verbalization of feelings regarding limitations. This aids in coping.
(_) Progress activity gradually, as with the following: (Refer patient to the multidisciplinary health team as appropriate)
o Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing
o Dangling the legs 10 to 15 minutes three times daily
o Deep breathing exercises three or more times daily
o Sitting up in chair 30 minutes three times daily
o Walking in room 1 to 2 minutes three times daily
(_) Provide emotional support while increasing activity. Provide a positive attitude regarding abilities.
(_) Encourage patient to choose activities that gradually build endurance. Physically inactive patients need to improve functional capacity through repetitive exercises over a longer
period of time. Strength training is valuable in enhancing endurance for many ADLs.
EDUCATION / CONTINUITY OF CARE
(_) Teach the patient or caregivers to recognize signs of physical overactivity.
(_) Involve the patient and caregivers in goal setting and care planning
(_) Teach the importance of continued activity at home. This maintains strength, ROM, and endurance gain.
(_) Assist in assigning priority to activities to accommodate energy levels. With a reduced functional capacity, pacing of priority tasks first may better meet the patient’s needs.
(_) Teach energy conservation techniques, such as the following:
o Sitting to do tasks. Standing requires more to work.
o Changing position often. This distributes work to different muscles to avoid fatigue.
o Pushing rather than pulling. This reduces metabolic work.
o Working at an even pace. This allows enough time so not all work is completed in a short period.
o Placing frequently used items within easy reach.
o Resting for at least 1 hour after meals before starting a new activity. Energy is needed to digest food.
(_) Teach appropriate use of environmental aids (e.g. bed rails, elevating head of bed while patient gets out of bed, chair in bathroom, hall rails). These conserve energy and prevent injury from
(_) Teach ROM and strengthening exercises. Exercise promotes increased venous return, prevents contractures, and maintains/increases muscle strength and endurance.
(_) Encourage patient to verbalize concerns about discharge and home environment.
(_) Refer to community resources as indicated. Continuity of care is facilitated through the use of community resources.
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