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.
- Physical impairment
- Cognitive impairment
- Prolonged bed rest
- Prescribed activity restriction such as a limb immobilizer
- Muscle weakness
- Sedentary lifestyle
- Insufficient sleep
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Verbalizes pain on a numeric pain scale higher than 3
- Verbalizes weakness
- Verbalizes feeling of shortness of breath
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Difficulty to engage in activities
- Elevated blood pressure
- Elevated heart rate
- Signs of pain (frequent grimace, reluctancy to initiate activities)
- EKG changes reflecting strain
- Lack of effort when standing or engaging in activities
- Frequent refusal of engaging in exercises
- Requires increased amount of supplemental oxygen
- The patient will participate in physical activities with PT and OT
- The patient will achieve an increased conditioned physical state.
- The patient will have normalized vital signs:
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 patient will verbalize the importance of continued physical exercise
- The patient will report the onset of pain during exercises right away
- The patient will report an increased tolerance to perform activities
- The patient will demonstrate energy management techniques
|Assess for the cause of the activity intolerance. |
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.
|Assess ability and tolerance to engage in activities. |
This information provides a baseline for planning care.
|Assess the appropriateness of daily ordered activities. |
The patient’s condition might change on a day to day basis. Frequent assessments are key to mobilizing the patient as soon as possible.
|Assess possible contributing factors to intolerance. |
Other factors that enhance intolerance need to be addressed and treated as part of the care plan.
|Assess nutritional status. |
Nutritional needs are important because they provide an energy source to engage in activities.
|Complete a medication reconciliation. |
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.
|Assess the vital signs before initiating exercises. |
Resting vital signs serve as a baseline and give information in case of overexertion during exercises.
|Monitor vital signs 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.
|Determine if the patient needs any assistive devices such as a gait belt, a walker, or braces. |
These devices may facilitate activities as they compensate for some limitations.
|Assess the patient’s emotional and motivational status. |
Patients might often be depressed or frustrated over their situation and condition. Performance strongly depends on the patient’s mental state and mood.
Nursing Interventions for Activity Intolerance
|Encourage activity progressively. |
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.
|Perform range of motion (ROM) as tolerated. |
ROM exercises increase circulation and help prevent contractures.
|Encourage the patient to perform active ROM exercises. |
Regular exercise maintains muscle strength, flexibility, and joint and tendon alignment. Over time, repeated exercises help increase tolerance, which is vital to perform ADLs.
|Group specific tasks together so the patient can rest. |
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.
|Coordinate rest periods before straining activities such as eating, bathing, and ambulating.|
Rest periods allow the patient to conserve energy. It allows for heart rate and breathing to normalize.
|Assist the patient as much as necessary, but as little as possible. |
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.
|Provide enough time for the patient to perform tasks. |
It is most beneficial for the patient if they are allowed to perform exercises and ADLs as independently as possible.
|Provide opportunities for the patient to express positive and negative feelings. |
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.
|If the patient is on bed, rest or unable to sit up, place the patient in an upright position several times per day. |
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.
|Observe for symptoms of intolerance when getting the patient up. Symptoms may include nausea, pallor, dizziness, visual impairment, loss of consciousness, and vital signs changes. |
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.
|Monitor skin integrity several times per day. |
Prolonged immobility may lead to the development of pressure ulcers.
|Asses for constipation. |
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.
|Consult physical and occupational therapy.|
Physical and occupational therapy will help with regular exercise. Regular exercise, over time, increase activity levels, strength, and endurance.
|Consult a dietitian to meet the patient’s nutritional needs. |
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.
|Consult specialized departments such as cardiology or pulmonology if the patient has comorbidities such as heart failure, COPD, or other chronic diseases that affect mobility. |
Specialized care and treatment can help optimize, for example, cardiac or pulmonary function within the patient’s limits.
|Teach the family and caregiver to recognize the signs and symptoms of physical exhaustion. |
Knowledge about how to recognize the patient’s limits is essential for maintaining exercise regimens safely.
|Teach the patient and the family/caregiver the importance of continuing activities. |
Regular exercise maintains muscle strength and helps maintain a conditioned state.
|Teach the patient and family energy conserving measures. |
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.
|Teach the family and patient the proper use of equipment. |
Knowledge about the appropriate use of aids promotes safety and reduces the risk of falls and injuries.
|Begin the discharge process as soon as the patient is admitted. |
The sooner social workers and case managers are involved, the easier the transitioning process from hospital to home.
|Assess the home environment before discharge. |
Changes might be necessary before the patient can be discharged home.
|Suggest the use of community services. |
Community services may help facilitate continuity of care at home.
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