related to:
  1. a build up of cellular waste products associated with rapid lysis of cancerous and normal cells exposed to cytotoxic drugs;
  2. difficulty resting and sleeping associated with fear, anxiety, and discomfort;
  3. tissue hypoxia associated with anemia (a result of malnutrition and chemotherapy-induced bone marrow suppression);
  4. overwhelming emotional demands associated with the diagnosis of cancer and treatment with chemotherapy;
  5. increased energy expenditure associated with an increase in the metabolic rate resulting from continuous, active tumor growth and increased levels of certain cytokines (e.g. tumor necrosis factor, interleukin-1);
  6. malnutrition;
  7. effects of medications used for control of pain, nausea, and anxiety.

Some of the etiological factors presented here are under investigation.

Desired Outcome
The client will experience a reduction in fatigue as evidenced by:
  1. verbalization of feelings of increased energy
  2. ability to perform usual activities of daily living
  3. increased interest in surroundings and ability to concentrate.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for:
    1. signs and symptoms of fatigue (e.g. verbalization of lack of energy and inability to maintain usual routines, lack of interest in surroundings, decreased ability to concentrate, lethargy)
    2. client's perception of the severity of fatigue using a fatigue rating scale; have client try to determine the severity of fatigue currently and an average for each week since last treatment.
  2. Inform client that a feeling of persistent fatigue is not unusual and is a result of the disease itself as well as a side effect of chemotherapy.
  3. Assist client to identify personal patterns of fatigue (e.g. time of day, after certain activities) and to plan activities so that times of greatest fatigue are avoided.
  4. Implement measures to reduce fatigue:
    1. perform actions to promote rest and/or conserve energy:
      1. schedule several short rest periods during the day
      2. minimize environmental activity and noise
      3. limit the number of visitors and their length of stay
      4. assist client with self-care activities as needed
      5. keep supplies and personal articles within easy reach
      6. implement measures to reduce fear and anxiety (see Diagnosis 1, action b)
      7. implement measures to promote sleep (e.g. encourage relaxing diversional activities in the evening, allow client to continue usual sleep practices unless contraindicated, reduce environmental stimuli, administer prescribed sedative-hypnotics)
      8. implement measures to reduce discomfort (see Diagnoses 3, action d and 4, action c)
      9. instruct client in energy-saving techniques (e.g. using shower chair when showering, sitting to brush teeth or comb hair, prioritizing activities and eliminating those that are optional)
    2. perform actions to promote an adequate nutritional status (see Diagnosis 2, action c)
    3. encourage client to maintain a fluid intake of at least 2500 ml/day to promote elimination of the by-products of cellular breakdown
    4. administer the following if ordered for treatment of anemia:
      1. folate, iron
      2. epoetin alfa (EPO)
      3. blood transfusions (e.g. packed red blood cells)
      4. peripheral blood stem cell transplantation
    5. increase activity gradually as tolerated
    6. perform actions to facilitate client's psychological adjustment to the diagnosis of cancer and the treatment regimen and its effects (see Diagnoses 10, actions c-j and 11, action b).
  5. Consult appropriate health care provider (e.g. oncology nurse specialist, physician) if signs and symptoms of fatigue worsen.