Nursing diagnosis: activity intolerance
Definition of activity intolerance
- Insufficient physiological or psychological energy to endure or complete required or desired daily activities
- Generalized weakness
- Sedentary lifestyle
- Bedrest or immobility
- Imbalance between oxygen supply and demand
- [Cognitive deficits/emotional status; secondary to underlying disease process/depression]
- [Pain, vertigo, extreme stress]
Defining Characteristics of activity intolerance| Nursing Care Plan for Activity Intolerance
- Report of fatigue or weakness
- Exertional discomfort or dyspnea
- [Verbalizes no desire and/or lack of interest in activity]
- Abnormal heart rate or blood pressure response to activity
- Electrocardiographic changes reflecting dysrhythmias or ischemia
- [Pallor, cyanosis]
Functional Level Classification (Gordon, 1987) | Nursing Care Plan for Activity Intolerance
- Level I: Walk, regular pace, on level indefinitely; one flight or more but more short of breath than normally
- Level II: Walk one city block [or] 500 ft on level; climb one flight slowly without stopping
- Level III: Walk no more than 50 ft on level without stopping; unable to climb one flight of stairs without stopping
- Level IV: Dyspnea and fatigue at rest
Desired Outcomes/Evaluation of activity intolerance| Nursing Care Plan for Activity Intolerance
- Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible.
- Use identified techniques to enhance activity tolerance.
- Participate willingly in necessary/desired activities.
- Report measurable increase in activity tolerance.
- Demonstrate a decrease in physiologic signs of intolerance (e.g., pulse, respirations, and blood pressure remain within client’s normal range).
Nursing interventions for activity intolerance| Nursing Care Plan for Activity Intolerance
NURSING PRIORITY NO. 1. To identify causative/precipitating factors:
- Note presence of factors contributing to fatigue (e.g., acute or chronic illness, heart failure, hypothyroidism, cancer, and cancer therapies, etc.).
- Evaluate current limitations/degree of deficit in light of usual status. (Provides comparative baseline.)
- Note client reports of weakness, fatigue, pain, difficulty accomplishing tasks, and/or insomnia.
- Assess cardiopulmonary response to physical activity, including vital signs before, during, and after activity. Note progression/accelerating degree of fatigue.
- Ascertain ability to stand and move about and degree of assistance necessary/use of equipment.
- Identify activity needs versus desires (e.g., is barely able to walk upstairs but would like to play racquetball).
- Assess emotional/psychologic factors affecting the current situation (e.g., stress and/or depression may be increasing the effects of an illness, or depression might be the result of being forced into inactivity).
- Note treatment-related factors, such as side effects/interactions of medications.
NURSING PRIORITY NO. 2. To assist client to deal with contributing factors and manage activities within individual limits:
- Monitor vital/cognitive signs, watching for changes in blood pressure, heart and respiratory rate; note skin pallor and/or cyanosis, and presence of confusion.
- Adjust activities to prevent overexertion. Reduce intensity
- Provide/monitor response to supplemental oxygen and medications and changes in treatment regimen.
- Increase exercise/activity levels gradually; teach methods to conserve energy, such as stopping to rest for 3 minutes during a 10-minute walk, sitting down instead of standing to brush hair.
- Plan care with rest periods between activities to reduce fatigue.
- Provide positive atmosphere, while acknowledging difficulty of the situation for the client. (Helps to minimize frustration, rechannel energy.)
- Encourage expression of feelings contributing to/resulting from condition.
- Involve client/SO(s) in planning of activities as much as possible.
- Assist with activities and provide/monitor client’s use of assistive devices (crutches, walker, wheelchair, oxygen tank, etc.) to protect client from injury.
- Promote comfort measures and provide for relief of pain to enhance ability to participate in activities. (Refer to ND Pain, acute or Pain, chronic.)
- Provide referral to other disciplines as indicated (e.g., exercise physiologist, psychologic counseling/therapy, occupational/physical therapists, and recreation/leisure specialists) to develop individually appropriate therapeutic regimens.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/Discharge Considerations):
- Plan for maximal activity within the client’s ability.
- Review expectations of client/SO(s)/providers to establish individual goals. Explore conflicts/differences to reach agreement for the most effective plan.
- Instruct client/SO(s) in monitoring response to activity and in recognizing signs/symptoms that indicate need to alter activity level.
- Plan for progressive increase of activity level as client tolerates.
- Give client information that provides evidence of daily/ weekly progress to sustain motivation.
- Assist client to learn and demonstrate appropriate safety measures to prevent injuries.
- Provide information about the effect of lifestyle and overall health factors on activity tolerance (e.g., nutrition, adequate fluid intake, mental health status).
- Encourage client to maintain positive attitude; suggest use of
- Encourage participation in recreation/social activities and hobbies appropriate for situation. (Refer to ND Diversional Activity, deficient.)
Documentation Focus | Nursing Care Plan for Activity Intolerance
• Level of activity as noted in Functional Level Classification.
• Causative/precipitating factors.
• Client reports of difficulty/change.
PLANNING| Nursing Care Plan for Activity Intolerance
• Plan of care and who is involved in planning.
IMPLEMENTATION/EVALUATION| Nursing Care Plan for Activity Intolerance
- Response to interventions/teaching and actions performed.
- Implemented changes to plan of care based on Assessment/Reassessment findings.
- Teaching plan and response/understanding of teaching plan.
- Attainment/progress toward desired outcome(s).
DISCHARGE PLANNING| Nursing Care Plan for Activity Intolerance
- Referrals to other resources.
- Long-term needs and who is responsible for actions.
This is a sample of Nursing Care Plan for Activity Intolerance.