Nursing Diagnosis: Activity Intolerance

Weakness; Deconditioned; Sedentary

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels • Activity Tolerance • Energy Conservation • Knowledge: Treatment Regimen

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels • Energy Management • Teaching: Prescribed Activity/Exercise

NANDA Definition: 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., [pic]-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.

Defining Characteristics: • 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

Related Factors: • Generalized weakness • Deconditioned state • Sedentary lifestyle • Insufficient sleep or rest periods • Depression or lack of motivation • Prolonged bed rest • Imposed activity restriction • Imbalance between oxygen supply and demand • Pain • Side effects of medications

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

• Determine patient's perception of causes of fatigue or activity intolerance. These may be temporary or permanent, physical or psychological. Assessment guides treatment.

• Assess patient's level of mobility. This aids in defining what patient is capable of, which is necessary before setting realistic goals.

• Assess nutritional status. Adequate energy reserves are required for activity.

• Assess potential for physical injury with activity. Injury may be related to falls or overexertion.

• Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Some aids may require more energy expenditure for patients who have reduced upper arm strength (e.g., walking with crutches). Adequate assessment of energy requirements is indicated.

• Assess patient's cardiopulmonary status before activity using the following measures: o Heart rate Heart rate should not increase more than 20 to 30 beats/min above resting with routine activities. This number will change depending on the intensity of exercise the patient is attempting (e.g., climbing four flights of stairs versus shoveling snow). o Orthostatic BP changes Elderly patients are more prone to drops in blood pressure with position changes. o Need for oxygen with increased activity Portable pulse oximetry can be used to assess for oxygen desaturation. Supplemental oxygen may help compensate for the increased oxygen demands. o How Valsalva maneuver affects heart rate when patient moves in bed Valsalva maneuver, which requires breath holding and bearing down, can cause bradycardia and related reduced cardiac output.

• 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.

• Observe and document response to activity. Report any of the following: o Rapid pulse (20 beats/min over resting rate or 120 beats/min) o Palpitations o Significant increase in systolic BP (20 mm Hg) o Significant decrease in systolic BP (20 mm Hg) o Dyspnea, labored breathing, wheezing o Weakness, fatigue o Lightheadedness, dizziness, pallor, diaphoresis
Close monitoring serves as a guide for optimal progression of activity.

• Assess emotional response to change in physical status. Depression over inability to perform required activities can further aggravate the activity intolerance.

Therapeutic Interventions

• Establish guidelines and goals of activity with the patient and caregiver. Motivation is enhanced if the patient participates in goal setting. Depending on the etiological 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.

• Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and ambulation. Rest between activities provides time for energy conservation and recovery. Heart rate recovery following activity is greatest at the beginning of a rest period.

• Refrain from performing nonessential procedures. Patients with limited activity tolerance need to prioritize tasks.

• Anticipate patient's needs (e.g., keep telephone and tissues within reach).

• Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self. Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the patient's activity tolerance and self-esteem.

• Provide bedside commode as indicated. This reduces energy expenditure. NOTE: A bedpan requires more energy than a commode.

• Encourage physical activity consistent with patient's energy resources.

• 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 1 day.

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

• Progress activity gradually, as with the following: o Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing o Dangling 10 to 15 minutes three times daily o Deep breathing exercises three times daily o Sitting up in chair 30 minutes three times daily o Walking in room 1 to 2 minutes three times daily o Walking in hall 25 feet or walking around the house, then slowly progressing, saving energy for return trip This prevents overexerting the heart and promotes attainment of short-range goals.

• Encourage active ROM exercises three times daily. If further reconditioning is needed, confer with rehabilitation personnel. Exercises maintain muscle strength and joint ROM.

• Provide emotional support while increasing activity. Promote a positive attitude regarding abilities.

• Encourage patient to choose activities that gradually build endurance.

• Improvise in adapting ADL equipment or environment. Appropriate aids will enable the patient to achieve optimal independence for self-care.

Education / Continuity of Care • Teach patient/caregivers to recognize signs of physical overactivity. This promotes awareness of when to reduce activity.

• Involve patient and caregivers in goal setting and care planning. Setting small, attainable goals can increase self-confidence and self-esteem.

• When hospitalized, encourage significant others to bring ambulation aid (e.g., walker or cane).

• 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.

• Teach energy conservation techniques. Some examples include the following: o Sitting to do tasks Standing requires more work. o Changing positions often This distributes work to different muscles to avoid fatigue. o Pushing rather than pulling o Sliding rather than lifting o Working at an even pace This allows enough time so not all work is completed in a short period. o Storing frequently used items within easy reach This avoids bending and reaching. o Resting for at least 1 hour after meals before starting a new activity Energy is needed to digest food. o Using wheeled carts for laundry, shopping, and cleaning needs o Organizing a work-rest-work schedule These reduce oxygen consumption, allowing more prolonged activity.

• 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 fall.

• Teach ROM and strengthening exercises.

• Refer to community resources as indicated.

• Encourage patient to verbalize concerns about discharge and home environment. These reduce feelings of anxiety and fear.