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Monday, September 6, 2010

Nursing Care Plan: Fatigue related to decreased oxygen supply, inadequate tissue oxygenation, sleep deprivation, poor physical condition.

Scientific Basis:

Fatigue is a subjective complaint with both acute and chronic illnesses. In acute illness, fatigue may have a protective function that keeps the persons from sustaining injury from overwork in a weakened condition. As a common symptom, fatigue is associated with a variety of physical and psychological conditions. The patient with a chronic illness experiencing fatigue may be unable to work full-time and maintain acceptance performance on the job. The economic impact on the individual and the family can be significant. The social effects of fatigue occur as the person decreases his participation in social activities.

Feelings of discomfort will enable the tissue to respond to the stimulation that normally cause the muscle to constrict and fatigue is felt to restore energy. Inadequate nutrition intake, abnormal fluid and electrolyte status, and metabolic demands may all contribute to this problem.

One of the ways on how body compensates for tissue hypoxia is to increase cardiac output with achieved by increase HR and increase stroke volume to meet oxygen demands of the tissues. Hence, increase cardiac workload, increases body activity causing fatigue.

Monahan, 2007; Neal, et al, 2004; Black and Hawks, 2005; Gulanick, 2007


Intervention and Rationale

I: Monitor physiological response to activity like changes in blood pressure (BP) heart rate (HR), or respiratory rate (RR)
R: Tolerance varies greatly, depending on the stage of their disease process, nutritional state and fluid balance.

I: Assess the client’s emotional response to fatigue, sleep patterns and other factors that may be aggravating fatigue
R: Recognition of the onset of fatigue assists the patient to maximize the benefits of resting periods.

I: Assess nutritional intake of calories, protein, minerals, and vitamins.
R: Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies.

I: Assess the client’s ability to perform activities of daily living (ADL).
R: Fatigue can limit the person’s ability to participate in self-care and perform his role responsibilities in the family or society.

I: Established realistic activity goals with the patient.
R: Provides a sense of control and feelings of accomplishment.

I: Assist with sitting up, or ambulation; keep bed in low position and clear pathways of furniture.
R: Frequent rest periods are needed to restore/ conserve energy. Planning allows client to be active during times when energy level is higher, which may restore a feeling of well-being and a sense of control.

I: Encourage client to do whatever is possible like self-care, sitting up on bed/chair, walking. Increase activity level as indicated.
R: Increase strength/ stamina and enables client to become more active without undue fatigue.

I: Provide passive/ active ROM exercises to client.
R: Development of healthy lean muscle mass depends on provision of isotonic and isometric exercises.

I: Assist with self-care needs as necessary.
R: Generalized weakness may make ADLs almost impossible for client to complete.

I: Identify energy conservation techniques, e.g., sitting, breaking ADLs into manageable segments. Keep travel ways clear of furniture. Provide and assist with ambulation/self-care needs.
R: Weakness may make ADLs almost impossible for client to complete. Protects client from injury during activities.

I: Limit client’s scheduled activities and provided frequent rest periods and provides conducive environment for adequate sleep and rest, plan nursing care in segments with adequate time for undisturbed rest and instructed client on relaxation techniques (deep breathing).
R: Good relaxation skills assist the client to maximize the benefits of resting periods

I: Plan and provided rest periods between activities.
R: To provide adequate rest and reduce unnecessary energy expenditure.

I: Instruct in stress management techniques, e.g., breathing exercises, visualization, music and light therapy.
R: Reduction of stress factors in patient’s life can minimize energy output.

I: Establish realistic activity goals with the client.
R: Enhances commitment to promoting optimal outcomes.

I: Provide environment conducive to relief of fatigue.
R: Temperature and level of humidity are known to affect exhaustion.

I: Teach the client and family task organization techniques and time management.
R: Organization and time management can help the client conserve energy and prevalent fatigue.

I: Encourage the client and family to verbalize feelings about the impact of fatigue.
R: Fatigue can have a profound negative influence on family processes and social interaction.

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

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