Nursing diagnosis: fatigue
Definition of fatigue | Nursing care plan for Fatigue
- An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level
Related Factors of fatigue
PSYCHOLOGICAL
- Stress; anxiety; boring lifestyle; depression
ENVIRONMENTAL
- Noise; lights; humidity; temperature
SITUATIONAL
- Occupation; negative life events
PHYSIOLOGICAL
- Increased physical exertion; sleep deprivation Pregnancy; disease states; malnutrition; anemia
- Poor physical condition
- [Altered body chemistry (e.g., medications, drug withdrawal, chemotherapy)]
Defining Characteristics of fatigue | Nursing care plan for Fatigue
SUBJECTIVE
- Verbalization of an unremitting/overwhelming lack of energy; inability to maintain usual routines/level of physical activity
- Perceived need for additional energy to accomplish routine tasks; increase in rest requirements
- Tired; inability to restore energy even after sleep
- Feelings of guilt for not keeping up with responsibilities
- Compromised libido
- Increase in physical complaints
OBJECTIVE
- Lethargic; listless; drowsy; lack of energy
- Compromised concentration
- Disinterest in surroundings; introspection
- Decreased performance [accident-prone]
Desired Outcomes/Evaluation Criteria—Client Will:
- Report improved sense of energy.
- Identify basis of fatigue and individual areas of control.
- Perform ADLs and participate in desired activities at level of ability.
- Participate in recommended treatment program.
Nursing interventions for fatigue | Nursing care plan for Fatigue
NURSING PRIORITY NO.1.To assess causative/contributing factors:
- Identify presence of physical and/or psychological conditions (e.g., pregnancy; infectious processes; blood loss/anemia; connective tissue disorders [e.g., multiple sclerosis, lupus]; trauma/chronic pain syndromes [e.g., arthritis]; cardiopul-monary disorders; cancer and cancer treatments; hepatitis; AIDS; major depressive disorder; anxiety states; substance use/abuse).
- Note age, gender, and developmental stage.Althoughsome studies show a prevalence of fatigue in adolescent girls, the condition may be present in any person at any age.
- Review medication regimen/use. Certain medications, including prescription (especially beta-adrenergic blockers, chemotherapy), over-the-counter, herbal supplements, and combinations of drugs and/or substances, are known to cause and/or exacerbate fatigue.
- Ascertain client’s belief about what is causing the fatigue.
- Assess vital signs to evaluate fluid status and cardiopul-monary response to activity.
- Determine presence/degree of sleep disturbances.Fatigue can be a consequence of, and/or exacerbated by, sleep deprivation.
- Note recent lifestyle changes, including conflicts (e.g., expanded responsibilities/demands of others, job-related conflicts); maturational issues (e.g., adolescent with eating disorder); and developmental issues (e.g., new parenthood, loss of spouse/SO).
- Assess psychological and personality factors that may affect reports of fatigue level.
- Evaluate aspect of “learned helplessness” that may be mani-fested by giving up. Can perpetuate a cycle of fatigue, impaired functioning, and increased anxiety and fatigue.
- NURSING PRIORITY NO.2.To determine degree of fatigue/impact on life:
- Obtain client/SO descriptions of fatigue (i.e., lacking energy or strength, tiredness, weakness lasting over length of time). Note presence of additional concerns (e.g., irritability, lack of concentration, difficulty making decisions, problems with leisure, relationship difficulties) to assist in evaluating impact on client’s life.
- Ask client to rate fatigue (1–10 scale) and its effects on ability to participate in desired activities.
- Discuss lifestyle changes/limitations imposed by fatigue state.
- Interview parent/caregiver regarding specific changes observed in child/elder.These individuals may not be able to verbalize feelings or relate meaningful information.
- Note daily energy patterns (i.e., peaks/valleys).Helpful in determining pattern/timing of activity.
- Measure physiological response to activity (e.g., changes in blood pressure or heart/respiratory rate).
- Evaluate need for individual assistance/assistive devices.
- Review availability and current use of support systems/resources.
- Perform/review results of testing, such as the Multidimensional Assessment of Fatigue (MAF); Piper Fatigue Scale; Global Fatigue Index, as appropriate.Can help determine manifesta-tion, intensity, duration, and emotional meaning of fatigue.
NURSING PRIORITY NO.3.To assist client to cope with fatigue and manage within individual limits of ability:
- Accept reality of client reports of fatigue and do not underes-timate effect on client’s quality of life. For example, clients with MS are prone to more frequent/severe fatigue follow-ing minimal energy expenditure and require a longer recov-ery period than is usual; post-polio clients often display a cumulative effect if they fail to pace themselves and rest when early signs of fatigue develop.
- Establish realistic activity goals with client and encourage for-ward movement.Enhances commitment to promoting opti-mal outcomes.
- Plan interventions to allow individually adequate rest periods. Schedule activities for periods when client has the most energy to maximize participation.
- Involve client/SO(s) in schedule planning.
- Encourage client to do whatever possible (e.g., self-care, sit up in chair, go for walk, interact with family, play game). Increase activity level, as tolerated.
- Instruct in methods to conserve energy: Sit instead of stand during daily care/other activities. Carry several small loads instead of one large load. Combine and simplify activities. Take frequent short rest breaks during activities. Delegate tasks. Ask for/accept assistance. Say “no” or “later.” Plan steps of activity before beginning so that all needed materials are at hand.
- Encourage use of assistive devices (e.g., wheeled walker, hand-icap parking spot, elevator, backpack for carrying objects), as needed,to extend active time/conserve energy for other tasks.
- Assist with self-care needs; keep bed in low position and trav-elways clear of furniture; assist with ambulation, as indicated.
- Avoid/limit exposure to temperature and humidity extremes, which can negatively impact energy level.
- Provide diversional activities. Avoid overstimulation/under-stimulation (cognitive and sensory).Participating in pleas-urable activities can refocus energy and diminish feelings of unhappiness, sluggishness, and worthlessness that can accompany fatigue.
- Discuss routines to promote restful sleep.
- Encourage nutritionally dense, easy to prepare/consume foods and to avoid caffeine and high sugar foods/drinks to promote energy.
- Instruct in/implement stress-management skills of visualiza-tion, relaxation, and biofeedback, when appropriate.
- Refer to comprehensive rehabilitation program, physical/occupational therapy for programmed daily exercises and activities to improve stamina, strength, and muscle tone and to enhance sense of well-being.
NURSING PRIORITY NO.4.To promote wellness (Teaching/Discharge Considerations):
- Discuss therapy regimen relating to individual causative fac-tors (e.g., physical and/or psychological illnesses) and help client/SO(s) to understand relationship of fatigue to illness.
- Assist client/SO(s) to develop plan for activity and exercise within individual ability. Stress necessity of allowing sufficient time to finish activities.
- Instruct client in ways to monitor responses to activity and significant signs/symptoms that indicate the need to alter activity level.
- Promote overall health measures (e.g., nutrition, adequate fluid intake, appropriate vitamin/iron supplementation).
- Provide supplemental oxygen, as indicated.Presence of ane-mia/hypoxemia reduces oxygen available for cellular uptake and contributes to fatigue.
- Encourage client to develop assertiveness skills, to prioritize goals/activities, to learn to delegate duties/tasks, or to say “No.” Discuss burnout syndrome, when appropriate, and actions client can take to change individual situation.
- Assist client to identify appropriate coping behaviors.Pro-motes sense of control and improves self-esteem.
- Identify support groups/community resources.
- Refer to counseling/psychotherapy, as indicated.
- Identify resources to assist with routine needs (e.g., Meals on Wheels, homemaker/housekeeper services, yard care).
This sample of nursing care plan for fatigue.
