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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Activity Intolerance - Weakness; deconditioned; sedentary
Meg Gulanick, RN, PhD

NANDA: A state in which an individual has insufficient physiological or psychological energy to endure or complete required or desired daily activities

Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in elderly patients with a history of orthopedic, cardiopulmonary, diabetic, or pulmonary-related problems. The aging process itself causes reduction in muscle strength and function, which can impair the ability to maintain activity. Activity intolerance may also be related to factors such as obesity, malnourishment, side effects of medications (e.g., beta-blockers), 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.

Related Factors

Defining Characteristics

Expected Outcomes

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.

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Determine patient's perception of causes of fatigue or activity intolerance.
May be temporary or permanent, physical, or psychological. Assessment guides treatment.
(i) Assess patient's level of mobility.
Aids in defining what patient is capable of, which is necessary before setting realistic goals.
(i) Assess nutritional status.
Adequate energy reserves are required for activity.
(i) Assess potential for physical injury with activity.
Injury may be related to falls or overexertion.
(i) Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs).
Some aids may require more energy expenditure (walking with crutches) for patients who have reduced upper arm strength. Adequate assessment of energy requirements is indicated.
(i) Assess patient's cardiopulmonary status before activity using the following measures:
(i) Monitor patient's sleep pattern and amount of sleep achieved over past few days.
Difficulties sleeping need to be addressed before activity progression can be achieved.
(i) Observe and document response to activity.
Close monitoring serves as a guide for optimal progression of activity.
Report any of the following:
(i) Assess emotional response to change in physical status.
Depression over inability to perform required activities can further aggravate the activity intolerance.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Establish guidelines and goals of activity with the patient and caregiver.
Motivation is enhanced if the patient participates in goal setting. Depending on the etiologic factors of the activity intolerance, some patients may be able to live independently and work outside the home. Other patients with chronic debilitating disease may remain homebound.
(i) Encourage adequate rest periods, especially before meals, other activities of daily living, exercise sessions, and ambulation.
To reduce cardiac workload.
(i) Refrain from performing nonessential procedures.
To promote rest. Patients with limited activity tolerance need to prioritize tasks.
(i) Anticipate patient's needs (e.g., keep telephone and tissues within reach).
(i) Assist with ADLs as indicated.
To reduce energy expenditure.
However, avoid doing for patient what he or she can do for self.
To optimize patient's self-esteem.
(i) Provide bedside commode as indicated.
To reduce energy expenditure. NOTE: Bedpans require more energy than commode.

(i) Encourage physical activity consistent with patient's energy resources.

(i) Assist patient to plan activities for times when he or she has the most energy.
Not all self-care and hygiene activities need to be completed in the morning. Likewise, not all housecleaning needs to be completed in one day.

(i) Encourage verbalization of feelings regarding limitations.
Acknowledgment that living with activity intolerance is both physically and emotionally difficult aids coping.

(i) Progress activity gradually.
To prevent overexerting the heart and promote attainment of short-range goals, as with the following:
(i) Encourage active ROM exercises three times daily. If further reconditioning is needed, confer with rehabilitation personnel.
To maintain muscle strength and joint range of motion.
(i) Provide emotional support while increasing activity. Promote a positive attitude regarding abilities.
(i) Encourage patient to choose activities that gradually build endurance.
(i) Improvise in adapting ADL equipment or environment.
Appropriate aids will enable the patient to achieve optimal independence for self-care.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Teach patient/caregivers to recognize signs of physical overactivity.
Promotes awareness of when to reduce activity.
(i) Involve patient and caregivers in goal setting and care planning.
Setting small attainable goals can increase self-confidence and self-esteem.
(i) When hospitalized, encourage significant others to bring ambulation aid: walker or cane.
(i) Teach the importance of continued activity at home.
To maintain strength, ROM, and endurance gain.
(i) Assist in assigning priority to activities to accommodate energy levels.
(i) Teach energy conservation techniques.
They reduce oxygen consumption, allowing more prolonged activity.
Some examples include the following:
(i) Teach appropriate use of environmental aids (e.g., bed rails, elevation of head of bed while patient gets out of bed, chair in bathroom, hall rails).
To conserve energy and prevent injury from fall.
(i) Teach ROM and strengthening exercises.
(i) Encourage patient to verbalize concerns about discharge and home environment
To reduce feelings of anxiety and fear.
(i) Refer to community resources as indicated.

NIC

Energy Management; Teaching: Prescribed Activity/Exercise

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