NURSING DIAGNOSIS: Activity intolerance

related to:
  1. tissue hypoxia associated with impaired gas exchange;
  2. difficulty resting and sleeping associated with excessive coughing, dyspnea, discomfort, unfamiliar environment, anxiety, and frequent assessments and treatments;
  3. inadequate nutritional status;
  4. increased energy expenditure associated with persistent coughing and the increased metabolic rate that is present in an infectious process.
Desired Outcome
The client will demonstrate an increased tolerance for activity as evidenced by:
  1. verbalization of feeling less fatigued and weak
  2. ability to perform activities of daily living without dizziness; increased dyspnea, chest pain, and diaphoresis; and a significant change in vital signs.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of activity intolerance:
    1. statements of fatigue or weakness
    2. exertional dyspnea, chest pain, diaphoresis, or dizziness
    3. abnormal heart rate response to activity (e.g. increase in rate of 20 beats/minute above resting rate, rate not returning to preactivity level within 3 minutes after stopping activity, change from regular to irregular rate)
    4. a significant change (15-20 mm Hg) in blood pressure with activity.
  2. Implement measures to improve activity tolerance:
    1. perform actions to promote rest and/or conserve energy:
      1. maintain activity restrictions as ordered
      2. minimize environmental activity and noise
      3. organize nursing care to allow for periods of uninterrupted rest
      4. limit the number of visitors and their length of stay
      5. assist client with self-care activities as needed
      6. keep supplies and personal articles within easy reach
      7. instruct client in energy-saving techniques (e.g. using shower chair when showering, sitting to brush teeth or comb hair)
      8. implement measures to promote sleep (e.g. elevate head of bed and support arms on pillows to facilitate breathing, maintain oxygen therapy during sleep, discourage intake of fluids high in caffeine in the evening, reduce environmental stimuli, administer prescribed sedative-hypnotics)
      9. implement measures to reduce discomfort (see Diagnoses 4, action d and 5, actions c and d)
      10. implement measures to decrease excessive coughing:
        1. protect client from exposure to irritants such as smoke, flowers, and powder
        2. instruct client to avoid intake of extremely hot or cold foods/fluids (these can stimulate cough)
        3. administer prescribed antitussives if indicated (when cough is productive, antitussives should be used only when coughing is excessive and interfering significantly with the client's ability to rest and sleep)
    2. perform actions to reduce fever and resolve the infectious process (see Diagnosis 6, action b) in order to lower the metabolic rate
    3. discourage smoking and excessive intake of beverages high in caffeine such as coffee, tea, and colas (nicotine and caffeine can increase cardiac workload and myocardial oxygen utilization, thereby decreasing oxygen availability)
    4. perform actions to improve respiratory status (see Diagnosis 1, action b) in order to relieve dyspnea and improve tissue oxygenation
    5. if oxygen therapy is necessary during activity, keep portable oxygen equipment readily available for client's use
    6. perform actions to maintain an adequate nutritional status (see Diagnosis 3, action c)
    7. increase client's activity gradually as allowed and tolerated.
  3. Instruct client to:
    1. report a decreased tolerance for activity
    2. stop any activity that causes increased chest pain, increased shortness of breath, dizziness, or extreme fatigue or weakness.
  4. Consult appropriate health care provider (e.g. respiratory therapist, physician) if signs and symptoms of activity intolerance persist or worsen.