This nursing diagnosis can nearly affect any patient.
Activity intolerance is a nursing diagnosis defined by NANDA as insufficient physiological or psychological energy to continue or complete necessary or desired activities.
Blood pressure within 20 mmHg increase of resting BP
Respiratory rate less than 20
Heart rate within 20 beats of resting heart rate
Reports pain of less than three on a numeric pain scale from 0-10
The reason why the patient cannot engage in activities will guide planning and interventions. The care plan will have a different focus on whether the cause is physical, psychological, or motivational.
This information provides a baseline for planning care.
The patient’s condition might change on a day to day basis. Frequent assessments are key to mobilizing the patient as soon as possible.
Other factors that enhance intolerance need to be addressed and treated as part of the care plan.
Nutritional needs are important because they provide an energy source to engage in activities.
Sometimes medications and their side effects can contribute to sleepiness and fatigue. Note if the patient takes sleeping aids, muscle relaxers, sedatives, or narcotics. For example, antipsychotics can cause orthostatic hypotension.
Resting vital signs serve as a baseline and give information in case of overexertion during exercises.
Increased heart rate should not exceed 20 to 30 points of the baseline heart rate. Prolonged bed rest and inactivity may lead to orthostatic hypotension. The patient might also need increased oxygen delivery.
These devices may facilitate activities as they compensate for some limitations.
Sitting up in bed
Sitting on the side of the bed and dangle legs
Standing up with assistance
Marching in place
Sitting in the chair for meals
Walking a few steps with rest in between and the opportunity to sit down
The patient might tolerate it much better if activities are increased slowly. It provides more time for the body to adjust.
ROM exercises increase circulation and help prevent contractures.
Regular exercise maintains muscle strength, flexibility, and joint and tendon alignment. Over time, repeated exercises help increase tolerance, which is vital to perform ADLs.
Sufficient rest periods without many interruptions allow for better sleep quality and, therefore, may lead to increased participation in exercises and other activities such as ADLs.
Rest periods allow the patient to conserve energy. It allows for heart rate and breathing to normalize.
There has to be a balance between assisting the patient when needed and fostering independence as much as possible. As the patient’s abilities change, the caregiver has to adjust the amount of assistance provided. The best way to further the patient’s independence and self-esteem is to help only when necessary.
It is most beneficial for the patient if they are allowed to perform exercises and ADLs as independently as possible.
Patients have to go through difficult times with their illnesses and experience a lot of change. It is beneficial for the patient to vent and talk about their emotions.
Upright positioning helps prevent the deconditioning of the heart and lungs. Lying for a prolonged period may contribute to decreased cardiac output, increased resting heart rate, and orthostatic hypotension.
Progressive mobility may decrease symptoms. Sitting the patient up on the side of the bed and dangle legs, standing for a few minutes before ambulating, and sitting up in the chair are great interventions to counteract signs and symptoms of deconditioning.
Prolonged immobility may lead to the development of pressure ulcers.
If the patient suffers from constipation, encourage the use of bowel stimulation. Add stool softeners and laxatives to alleviate stool burden. Immobility and use of pain medication can lead to constipation.
Physical and occupational therapy will help with regular exercise. Regular exercise, over time, increase activity levels, strength, and endurance.
Dietitians can adjust the nutritional needs to the patient’s situation. Adequate intake of nutrients helps with maintaining skin integrity, muscle strength, and immune function.
Specialized care and treatment can help optimize, for example, cardiac or pulmonary function within the patient’s limits.
Knowledge about how to recognize the patient’s limits is essential for maintaining exercise regimens safely.
Regular exercise maintains muscle strength and helps maintain a conditioned state.
Plan ahead to avoid rushing
Sit down to carry out activities
Use extension handles for sponges and brushes
Push rather than pull
Rest before more significant activities such as eating and bathing
Proper use of these techniques reduces oxygen consumption and prevent the patient from fatiguing too quickly.
Knowledge about the appropriate use of aids promotes safety and reduces the risk of falls and injuries.
The sooner social workers and case managers are involved, the easier the transitioning process from hospital to home.
Changes might be necessary before the patient can be discharged home.
