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Nursing Care Plans For Activity Intolerance Determining the cause of a disease can help

direct appropriate interventions.


Posted by d.nurisna at Thursday, February 12, Assess client daily for appropriateness of
2009 . Thursday, February 12, 2009 activity and bed rest orders. Inappropriate
Labels: NURSING CARE PLANS prolonged bed rest orders may contribute
toactivity intolerance . A review of 39 studies on
Nursing Diagnosis: Activity intolerance bed rest resulting from 15 disorders
demonstrated that bed rest for treatment of
NANDA Definition: medical conditions is associated with worse
Insufficient physiological or psychological energy outcomes than early mobilization (Allen, Glasziou,
to endure or complete required or desired daily Del Mar, 1999).
activities Minimize cardiovascular deconditioning by
positioning clients as close to the upright position
Defining Characteristics: as possible several times daily. The hazards of
Verbal report of fatigue or weakness, abnormal bed rest in the elderly are multiple, serious, quick
heart rate or blood pressure response to activity, to develop, and slow to reverse. Deconditioning
exertional discomfort or dyspnea, of the cardiovascular system occurs within days
electrocardiographic changes reflecting and involves fluid shifts, fluid loss, decreased
dysrhythmias or ischemia cardiac output, decreased peak oxygen uptake,
and increased resting heart rate (Resnick, 1998).
Related Factors: If appropriate, gradually increase activity,
Bed rest or immobility; generalized weakness; allowing client to assist with positioning,
sedentary lifestyle; imbalance between oxygen transferring, and self-care as possible. Progress
supply and demand from sitting in bed to dangling, to chair sitting, to
standing, to ambulation. Increasing activity helps
NOC Outcomes (Nursing Outcomes to maintain muscle strength, tone, and
Classification) endurance. Allowing the client to participate
Suggested NOC Labels decreases the perception of the client as
Endurance incapable and frail (Eliopoulous, 1998).
Energy Conservation Ensure that clients change position slowly.
Activity Tolerance Consider using a chair-bed (stretcher-chair) for
Self-Care: Activities of Daily Living (ADLs) clients who cannot get out of bed. Monitor for
symptoms ofactivity intolerance . Bed rest in the
Client Outcomes supine position results in loss of plasma volume,
Participates in prescribed physical activity with which contributes to postural hypotension and
appropriate increases in heart rate, blood syncope (Creditor, 1993).
pressure, and breathing rate; maintains monitor When getting clients up, observe for symptoms
patterns (rhythm and ST segment) within normal of intolerance such as nausea, pallor, dizziness,
limits visual dimming, and impaired consciousness, as
States symptoms of adverse effects of exercise well as changes in vital signs. Heart rate and
and reports onset of symptoms immediately blood pressure responses to orthostasis vary
Maintains normal skin color and skin is warm widely. Vital sign changes by themselves should
and dry with activity not define orthostatic intolerance (Winslow, Lane,
Verbalizes an understanding of the need to Woods, 1995).
gradually increase activity based on testing, Perform range-of-motion exercises if client is
tolerance, and symptoms unable to tolerate activity. Inactivity rapidly
Expresses an understanding of the need to contributes to muscle shortening and changes in
balance rest and activity periarticular and cartilaginous joint structure.
Demonstrates increased activity tolerance These factors contribute to contracture and
limitation of motion (Creditor, 1994).
NIC Interventions (Nursing Interventions Refer client to physical therapy to help increase
Classification) activity levels and strength.
Suggested NIC Labels Monitor and record client's ability to tolerate
Energy Management activity: note pulse rate, blood pressure, monitor
Activity Therapy pattern, dyspnea, use of accessory muscles, and
skin color before and after activity. If the following
Nursing Interventions and Rationales signs and symptoms of cardiac decompensation
Determine cause of activity intolerance (see develop, activity should be stopped immediately
Related Factors) and determine whether cause is (ACSM, 1995):
physical, psychological, or motivational. o Excessive fatigue
o Lightheadedness, confusion, ataxia, pallor, urge incontinence (Nazarko, 1997).
cyanosis, dyspnea, nausea, or any peripheral Consider dietitian referral to assess nutritional
circulatory insufficiency needs related to activity intolerance. Severe
o Onset of angina with exercise malnutrition can lead to activity intolerance.
o Palpitations Dietitians can recommend dietary changes that
o Dysrhythmia (symptomatic supraventricular can improve the client's health status
tachycardia, ventricular tachycardia, exercise- (Peckenpaugh, Poleman, 1999).
induced left bundle block, second- or third-degree Refer the cardiac client to cardiac rehabilitation
atrioventricular block, frequent premature for assistance in developing safe exercise
ventricular contractions) guidelines based on testing and medications.
o Exercise hypotension (drop in systolic blood Cardiac rehabilitation exercise training improves
pressure of more than 10 mm Hg from baseline objective measures of exercise tolerance in both
blood pressure despite an increase in workload, men and women, including elderly patients with
when accompanied by other evidence of coronary heart disease and heart failure. This
ischemia) functional improvement occurs without significant
o Excessive rise in blood pressure (systolic cardiovascular complications or other adverse
greater than 220 mm Hg or diastolic greater than outcomes (Wenger et al, 1995).
110 mm Hg); NOTE: these are upper limits; Ensure that the chronic pulmonary client has
activity may be stopped before reaching these oxygen saturation testing with exercise. Use
values supplemental oxygen to keep oxygen saturation
o Inappropriate bradycardia (drop in heart rate 90% or above or as prescribed with activity.
greater than 10 beats/min) with no change or Supplemental oxygen increases circulatory
increase in workload oxygen levels and improves activity tolerance
o Increased heart rate above the prescribed limit (Petty, Finigan, 1968; Casaburi, Petty, 1993).
Instruct client to stop activity immediately and Monitor a chronic obstructive pulmonary
report to physician if experiencing the following disease (COPD) client's response to activity by
symptoms: new or worsened intensity or observing for symptoms of respiratory intolerance
increased frequency of discomfort, tightness, or such as increased dyspnea, loss of ability to
pressure in chest, back, neck, jaw, shoulders, control breathing rhythmically, use of accessory
and/or arms; palpitations; dizziness; weakness; muscles, and skin tone changes such as pallor
unusual and extreme fatigue; excessive air and cyanosis.
hunger. These are common symptoms of angina Instruct and assist COPD clients in using
and are caused by a temporary insufficiency of conscious controlled breathing techniques such
coronary blood supply. Symptoms typically last as pursing their lips and diaphragmatic breathing.
for minutes as opposed to momentary twinges. If Training clients with COPD to slow their
symptoms last longer than 5 to 10 minutes, the respiratory rate with a prolonged exhalation (with
client should be evaluated by a physician or without pursed lips) helps control dyspnea and
(McGoon, 1993). The client should be evaluated results in improved ventilation, increased tidal
before resuming activity (Thompson, 1988). volume, decreased respiratory rate, and a
Allow for periods of rest before and after reduced alveolar-arterial oxygen difference. This
planned exertion periods such as meals, baths, breathing pattern not only helps relieve dyspnea
treatments, and physical activity. Rest periods but can improve the ability to exercise and carry
decrease oxygen consumption (Prizant-Weston, out ADLs (Mueller, Petty, Filley, 1970; Casaburi,
Castiglia, 1992). Petty, 1993).
Observe and document skin integrity several Provide emotional support and encouragement
times a day. Activity intolerance may lead to to client to gradually increase activity. Fear of
pressure ulcers. Mechanical pressure, moisture, breathlessness, pain, or falling may decrease
friction, and shearing forces all predispose to willingness to increase activity.
their development (Resnick, 1998). Refer the COPD client to a pulmonary
Assess urinary incontinence related to rehabilitation program. Pulmonary rehabilitation
functional ability. Assess independent ability to has been shown to improve exercise capacity,
get to the toilet and remove and adjust clothing. walking ability, and sense of well-being (Fishman,
The loss of functional ability that accompanies 1994).
disease often leads to continence problems. The Observe for pain before activity. If possible,
cause may not be the person's bladder instability treat pain before activity, and ensure that client is
but his or her ability to get to the toilet quickly not heavily sedated. Pain restricts the client from
(Nazarko, 1997). achieving a maximal activity level and is often
Assess for constipation. Impaired mobility is exacerbated by movement.
associated with increased risk of bowel Obtain any necessary assistive devices or
dysfunction, including constipation. Constipation equipment needed before ambulating client (e.g.,
increases the risk of urinary tract infection and walkers, canes, crutches, portable oxygen).
Assistive devices can increase mobility by helping of maintaining proper nutrition and rest for
the client overcome limitations. energy conservation and rehabilitation.
Use a walking belt when ambulating a client Refer to medical social services as necessary to
who is unsteady. With a walking belt the client assist the family in adjusting to major changes in
can walk independently, but the nurse can patterns of living.
provide support if the client's knees buckle. Assess the need for long-term supports for
Work with client to set mutual goals that optimal activity tolerance of priority activities
increase activity levels. (e.g., assistive devices, oxygen, medication,
catheters, massage), especially for hospice
Geriatric patients. Evaluate intermittently. Assessments
Slow the pace of care. Allow client extra time to ensure the safety and appropriate use of these
carry out activities. supports.
Encourage families to help/allow elder to be Refer to home health aide services to support
independent in whatever activities possible. the client and family through changing levels of
Sometimes families believe they are assisting by activity tolerance. Introduce aide support early.
allowing clients to be sedentary. Encouraging Instruct the aide to promote independence in
activity not only enhances good functioning of activity as tolerated. Providing unnecessary
the body's systems but also promotes a sense of assistance with transfers and bathing activities
worth by providing an opportunity for productivity may promote dependence and a loss of mobility
(Eliopoulous, 1997). (Mobily, Kelley, 1991).
When mobilizing the elderly client, watch for Be aware of increased risk of bone fracture
orthostatic hypotension accompanied by even after muscle strength is normalized,
dizziness and fainting. Orthostatic hypotension is especially in osteopenic-prone individuals such as
common in the elderly as a result of estrogen-deficient women and the elderly.
cardiovascular changes, chronic diseases, and Reduction in weight bearing muscle activity
medication effects (Mobily, Kelley, 1991). during bed rest invariably produces significant
changes in calcium balance and, in weeks,
Home Care Interventions changes in bone mass (Bloomfield, 1997)
Begin discharge planning as soon as possible Allow terminally ill clients and their families to
with case manager or social worker to assess guide care. Control by the client or family
need for home support systems and the need for promotes effective coping.
community or home health services. Provide increased attention to comfort and
Assess the home environment for factors that dignity of the terminally ill client in care planning.
precipitate decreased activity tolerance: presence For example, oxygen may be more valuable as a
of allergens such as dust, smoke, and those support to the client's psychological comfort than
associated with pets; temperature; energy- as a booster of oxygen saturation.
intensive activity patterns; and furniture
placement. Refer to occupational therapy if
needed to assist the client in restructuring the Client/Family Teaching
home and activity of daily living patterns. Clients Instruct client on rationale and techniques for
and families often estimate energy requirements avoiding activity intolerance.
inaccurately during hospitalization because of the Teach client to use controlled breathing
availability of support. techniques with activity.
Teach the client/family the importance of and Teach client the importance and method of
methods for setting priorities for activities, coughing, clearing secretions.
especially those having a high energy demand Instruct client in the use of relaxation
(e.g., home/family events). techniques during activity.
Provide client/family with resources such as Help client with energy conservation and work
senior centers, exercise classes, educational and simplification techniques in ADLs.
recreational programs, and volunteer Teach client the importance of proper nutrition.
opportunities that can aid in promoting Describe to client the symptoms of activity
socialization and appropriate activity. Social intolerance, including which symptoms to report
isolation can contribute to activity intolerance. to the physician.
Discuss the importance of sexual activity as Explain to client how to use assistive devices or
part of daily living. Instruct the client in adaptive medications before or during activity.
techniques to conserve energy during sexual Help client set up an activity log to record
interactions. Families may make unsafe choices exercise and exercise tolerance.
for sexual activity or place added stress on
themselves trying to cope with this issue without Most activity intolerance is related to generalized
proper support or teaching. weakness and debilitation secondary to acute or
Instruct the client and family in the importance
chronic illness and disease. This is especially
apparent in elderly patients with a history of effects of medications (e.g., -blockers), or
orthopedic, cardiopulmonary, diabetic, or emotional states such as depression or lack of
pulmonary- related problems. The aging process confidence to exert one's self. Nursing goals are
itself causes reduction in muscle strength and to reduce the effects of inactivity, promote
function, which can impair the ability to maintain optimal physical activity, and assist the patient to
activity. Activity intolerance may also be related maintain a satisfactory lifestyle.
to factors such as obesity, malnourishment, side