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Monday, September 6, 2010

Nursing Care Plan: Activity Intolerance related to generalized weakness, sedentary lifestyle, insufficient sleep or rest periods and pain.

Scientific Basis:

Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in older 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 may also related to factors such as obesity, malnourishment, anemia, side of effects of medication, or are to reduce as depression or lack of confidence to exert oneself. Nursing goals are to reduce the effects of inactivity, promote optimal physical activity. And assist the client to maintain a satisfactory quality of life.

Gulanick, 2007


Intervention and Rationale

I: Monitor vital signs before and immediately after activity.
R: Vital signs should return to baseline levels in 3 minutes. The development of dyspnea may indicate a need for an alteration in exercise regimen or medication.

I: Identify causative factors leading to intolerance of activity.
R: To plan for appropriate intervention.

I: Determine the client’s perception of cause of fatigue or activity intolerance.
R: These may be temporary or permanent, physical, psychological.

I: Asses the client’s level of mobility.
R: This aids in defining what the client is capable of, which is necessary before setting realistic goals.

I: Assess nutritional status.
R: Adequate energy reserves are required for activity.

I: Assess potential for physical injury with activity. Including safety of the immediate environment.
R: Injury may be related to falls, or overexertion. Obstacles such as throw rugs, toys etc which can impede one’s ability to ambulate safely.

I: Assess the need for ambulation aids: cane or equipment modification for activities of daily living (ADLs).
R: Some aids may require more energy expenditure for clients who have reduced upper arm strength. Adequate assessment of energy requirements is indicated.

I: Assess vital signs such as the heart rate.
R: Heart rate should not increase more than 20 to 30 beats/minute above resting with routine activities. This number will change depending on the intensity of exercise the client is attempting.

I: Check for orthostatic blood pressure.
R: Older clients are more susceptible to drops in blood pressure with position change.

I: Monitor the client’s sleep patter and amount of sleep achieved over the past few days.
R: Difficulties sleeping need to be addressed before activities progression can be achieved.

I: Assess emotional response to change in physical status.
R: Depression resulting from the inability to perform required activities can further aggravate activity intolerance.

I: Establish guidelines and goals of activity with the clients and caregiver.
R: Motivation is enhanced if the client participates in goal setting. Depending on the etiological factors of activity intolerance, some clients may be able to live independently and work outside the home. Other clients with chronic debilitating disease may remain.

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

I: Refrain from performing nonessential procedures.
R: Clients with limited activity tolerance need to prioritize tasks.

I: Anticipate the client’s need.
R: This reduces risk for falling while reaching.

I: Assist with ADLs as indicated: however, avoid doing for client what they can do for themselves.
R: Assisting the client with ADLs allows for conservation of energy/ caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the client’s activity tolerance and self-esteem.

I: Encourage physical activity consistent with client’s energy resources.
R: This promotes a sense of autonomy while being realistic about capabilities.

I: Assist client to plan with activities for times when they have most energy.
R: This promotes a sense of autonomy while being realistic about capabilities.

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

I: Encourage active ROM exercises. If further reconditioning is needed, confer with rehabilitation personnel.
R: Exercise maintains muscle strength.

I: Provide emotional support while increasing activity. Promote positive attitude regarding abilities
R: Clients may be fearful of overexertion. Appropriate supervision during early efforts can enhance confidence.

I: Encourage the client to choose activities gradually build endurance.
R: Physically inactive clients need to improve functional capacity through repetitive exercises over a longer period of time. Strength training is valuable in enhancing endurance for many ADLs.

I: May provide the client with the adaptive equipment needed for completing ADL activities.
R: Appropriate aids will enable the client to achieve optimal independence for self-care.

I: Teach the client and caregivers to recognize signs of physical over activity.
R: This promotes awareness of when to reduce activity.

I: Involve client and caregivers in goal setting and care planning.
R: Setting, attainable goals can increase self-confidence and self-esteem.

I: Assist in assigning priority to activities to accommodate energy levels.
R: With a reduced functional capacity, pacing of priority tasks first may be better meet the client’s needs.

I: Teach ROM and strengthening exercises.
R: Exercise promotes increased venous return, prevents contractures, and maintain / increases muscle strength.

I: Encourage client to verbalize concerns about discharge and home environment.
R: This can reduce feelings of anxiety and fear and open doors for ongoing communication.

I: Teach conservation techniques, such as the following:
R: These reduces oxygen consumption, allowing more prolonged activities.

I: Sitting to do the task.
R: Standing requires more work.

I: Change position often.
R: This distributes work to different muscles to avoid fatigue.

I: Pushing rather than pulling.
R: This reduces metabolic work.

I: Sliding rather than lifting.
R: This reduces upper body work.

I: Working at an even pace.
R: This allows enough time so not all work is completed in a short period.

I: Placing frequently used items within easy reach.
R: This avoids bending and reaching.

I: Resting at least 1 hour after meals before starting a new activity.
R: Energy is needed to digest food.

I: Organizing a work-rest-work schedule.
R: This reduces strain on energy resources.

Doenges, et al, 2008; Gulanick, 2007; Kruse, et al, 2003

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