Activity Intolerance | Nursing Diagnosis for Leukemia

Nursing diagnosis: activity intolerance related to generalized weakness; reduced energy stores, increased metabolic rate from massive production of leukocytes, imbalance between oxygen supply and demand (anemia and hypoxia), therapeutic restrictions—isolation, bedrest; effect of drug therapy

Possibly evidenced by
Verbal report of fatigue or weakness
Exertional discomfort or dyspnea
Abnormal heart rate or BP response

Desired Outcomes/Evaluation Criteria—Client Will
Endurance
Report a measurable increase in activity tolerance.
Participate in ADLs to level of ability.
Demonstrate a decrease in physiological signs of intolerance—pulse, respiration, and BP remain within client’s normal range.

Nursing intervention with rationale:
1. Evaluate reports of fatigue, noting inability to participate in activities or ADLs.
Rationale: Effects of leukemia, anemia, and chemotherapy may be cumulative, especially during acute and active treatment phase, necessitating assistance.

2. Encourage client to keep a diary of daily routines and energy levels, noting activities that increase fatigue.
Rationale: Helps client prioritize activities and arrange them around fatigue pattern.

3. Provide quiet environment and uninterrupted rest periods. Encourage rest periods before meals.
Rationale: Restores energy needed for activity and cellular regeneration and tissue healing.

4. Implement energy-saving techniques, such as sitting, rather than standing and use of shower chair. Assist with ambulation or other activities, as indicated.
Rationale: Maximizes available energy for self-care tasks.

5. Recommend small, nutritious, high-protein meals and snacks throughout the day.
Rationale: Smaller meals require less energy for digestion than larger meals. Increased intake provides fuel for energy.

6. Provide supplemental oxygen.
Rationale: Maximizes oxygen available for cellular uptake, improving tolerance of activity.

7. Administer blood and blood components, as indicated.
Rationale: Correcting anemia improves client’s stamina and tolerance for activity.

Activity Intolerance | Nursing Care Plan for Insomnia

Nursing diagnosis: Activity Intolerance related to Imbalance between oxygen supply or delivery and demand

Possibly evidenced by
Weakness and fatigue
Reports of decreased exercise or activity tolerance
Greater need for sleep or rest
Palpitations, tachycardia, increased BP, and increased respiratory response with minor exertion

Desired Outcomes/Evaluation Criteria—Client Will
Endurance
Report an increase in activity tolerance, including ADLs.
Demonstrate a decrease in physiological signs of intolerance—pulse, respirations, and BP remain within client’s normal range.
Display laboratory values (Hgb/Hct) within acceptable range.

Nursing intervention with rationale
1. Assess client’s ability to perform normal tasks and ADLs, noting reports of weakness, fatigue, and difficulty accomplishing tasks.
Rationale: Influences choice of interventions and needed assistance.

2. Note changes in balance, gait disturbance, and muscle weakness.
Rationale: May indicate neurological changes associated with vitamin B12 deficiency, affecting client safety and increasing risk of injury.

3. Monitor BP, pulse, and respirations during and after activity. Note adverse responses to increased levels of activity— increased heart rate and BP, dysrhythmias, dizziness, dyspnea, tachypnea, and cyanosis of mucous membranes and nailbeds.
Rationale: Cardiopulmonary manifestations result from attempts by the heart and lungs to supply adequate amounts of oxygen to the tissues.

4. Recommend quiet atmosphere and bedrest, if indicated. Monitor and limit visitors, phone calls, and repeated unplanned interruptions.
Rationale: Activity may need to be curtailed until severe anemia is at least partially corrected to lower body’s oxygen requirements and reduce strain on the heart and lungs.

5. Elevate head of bed, as tolerated.
Rationale: Enhances lung expansion to maximize oxygenation for cellular uptake. Note: May be contraindicated if hypotension is present.

6. Suggest client change position slowly; monitor for dizziness.
Rationale: Postural hypotension or cerebral hypoxia may cause dizziness, fainting, and increased risk of injury.

7. Assist client to prioritize ADLs and desired activities. Alternate rest periods with activity periods.
Rationale: Promotes adequate rest, maintains energy level, and alleviates strain on the cardiac and respiratory systems.

8. Provide or recommend assistance with activities and ambulation as necessary, allowing client to be an active participant as much as possible.
Rationale: Although help may be necessary, self-esteem is enhanced when client does some things for self.

9. Plan activity progression with client, including activities that client views as essential. Increase activity levels, as tolerated.
Rationale: Promotes gradual return to normal activity level and improved muscle tone and stamina without undue fatigue. Increases self-esteem and sense of control.

10. Identify and implement energy-saving techniques: shower chair and sitting to perform tasks.
Rationale: Encourages client to do as much as possible, while conserving limited energy and preventing fatigue.

Nursing Diagnosis for Activity Intolerance

Nursing Diagnosis for Activity Intolerance

NANDA Definition : Insufficient physiological or psychological energy to endure or complete required or desired daily activities

Most activity intolerance is related to generalized weakness and debilitation secondary to acute or chronic illness and disease. This is especially apparent in elderly 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 intolerance may also be related to factors such as obesity, malnourishment, side effects of medications (e.g., Beta-blockers), or emotional states such as depression or lack of confidence to exert one's self. Nursing goals are to reduce the effects of inactivity, promote optimal physical activity, and assist the patient to maintain a satisfactory lifestyle.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

• Activity Tolerance
• Energy Conservation
• Knowledge: Treatment Regimen

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

• Energy Management
• Teaching: Prescribed Activity/Exercise

Defining Characteristics :

• Verbal report of fatigue or weakness
• Inability to begin or perform activity
• Abnormal heart rate or blood pressure (BP) response to activity
• Exertional discomfort or dyspnea

Related Factors :

• Generalized weakness
• Deconditioned state
• Sedentary lifestyle
• Insufficient sleep or rest periods
• Depression or lack of motivation
• Prolonged bed rest
• Imposed activity restriction
• Imbalance between oxygen supply and demand
• Pain
• Side effects of medications

Expected Outcomes :

• Patient maintains activity level within capabilities, as evidenced by normal heart rate and blood pressure during activity, as well as absence of shortness of breath, weakness, and fatigue.
• Patient verbalizes and uses energy-conservation techniques.

Nursing Diagnosis for Pneumonia | Activity Intolerance

Nursing diagnosis: activity intolerance related to imbalance between oxygen supply and demand; general weakness; exhaustion associated with interruption in usual sleep pattern because of discomfort, excessive coughing, and dyspnea

Possibly evidenced by

Verbal reports of weakness, fatigue, exhaustion

Exertional dyspnea, tachypnea

Tachycardia in response to activity

Development of, or worsening of, pallor or cyanosis

Desired Outcomes/Evaluation Criteria—Client Will

Activity Tolerance

Report and demonstrate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, with vital signs within client’s acceptable range.

Nursing intervention with rationale:

1. Evaluate client’s response to activity. Note reports of dyspnea, increased weakness and fatigue, and changes in vital signs during and after activities.

Rationale: Establishes client’s capabilities and needs and facilitates choice of interventions.

2. Provide a quiet environment and limit visitors during acute phase as indicated. Encourage use of stress management and diversional activities as appropriate.

Rationale: Reduces stress and excess stimulation, promoting rest.

3. Explain importance of rest in treatment plan and necessity for balancing activities with rest.

Rationale: Bedrest is maintained during acute phase to decrease metabolic demands, thus conserving energy for healing. Activity restrictions thereafter are determined by individual client response to activity and resolution of respiratory insufficiency.

4. Assist client to assume comfortable position for rest and sleep.

Rationale: Client may be comfortable with head of bed elevated, sleeping in a chair, or leaning forward on over-bed table with pillow support.

5. Assist with self-care activities as necessary. Provide for progressive increase in activities during recovery phase.

Rationale: Minimizes exhaustion and helps balance oxygen supply and demand.

Nursing Diagnosis for Myocardial Infarction | Activity Intolerance

Nursing diagnosis: Activity intolerance related to imbalance between myocardial oxygen supply and demand; presence of ischemia and necrotic myocardial tissues; cardiac depressant effects of certain drugs, such as beta blockers, antidysrhythmics.

Possibly evidenced by

Alterations in heart rate and BP with activity

Development of dysrhythmias

Changes in skin color and moisture

Exertional angina

Generalized weakness

Desired Outcomes/Evaluation Criteria—Client Will

Activity Tolerance

Demonstrate measurable, progressive increase in tolerance for activity with heart rate and rhythm, BP within client’s normal

limits, and skin warm, pink, and dry.

Report absence of angina with activity.

Nursing intervention with rationale:

1. Record and document heart rate and rhythm and BP changes before, during, and after activity, as indicated. Correlate with reports of chest pain or shortness of breath.

Rationale: Trends determine client’s response to activity and may indicate myocardial oxygen deprivation that may require decrease in activity level, return to bedrest, changes in medication regimen, or use of supplemental oxygen.

2. Encourage bedrest to chair rest initially. Thereafter, limit activity on basis of pain or adverse cardiac response. Provide nonstress diversional activities.

Rationale: Reduces myocardial workload and oxygen consumption, reducing risk of complications, such as extension of MI. Clients with uncomplicated MI are encouraged to engage in mild activity out of bed, including short walks 12 hours after incident.

3. Instruct client to avoid increasing abdominal pressure, such as straining during defecation.

Rationale: Activities that require holding the breath and bearing down, such as Valsalva’s maneuver, can result in bradycardia with temporarily reduced cardiac output and rebound tachycardia with elevated BP.

4. Explain pattern of graded increase of activity level, such as getting up to commode or sitting in chair, progressive ambulation, and resting after meals.

Rationale: Progressive activity provides a controlled demand on the heart, increasing strength and preventing overexertion.

5. Review signs and symptoms reflecting intolerance of present activity level or requiring notification of nurse or physician.

Rationale: Palpitations, pulse irregularities, development of chest pain, or dyspnea may indicate need for changes in exercise regimen or medication.

Collaborative management:

1. Refer to cardiac rehabilitation program.

Rationale: Provides continued support and additional supervision and promotes participation in recovery and wellness process.

Nursing Diagnosis for Heart Failure: Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand, generalized weakness, prolonged bedrest, immobility

Possibly evidenced by

Weakness, fatigue

Changes in vital signs, presence of dysrhythmias

Dyspnea

Pallor, diaphoresis

Desired Outcomes/Evaluation Criteria—Client Will

Endurance

Participate in desired activities; meet own self-care needs.

Achieve measurable increase in activity tolerance, evidenced by reduced fatigue and weakness and by vital signs within acceptable limits during activity.

Nursing intervention with rationale:

1. Check vital signs before and immediately after activity during acute episode or exacerbation of HF, especially if client is receiving vasodilators, diuretics, or beta blockers.

Rationale: Orthostatic hypotension can occur with activity because of medication effect (vasodilation), fluid shifts (diuresis), or compromised cardiac pumping function.

2. Document cardiopulmonary response to activity. Note tachycardia, dysrhythmias, dyspnea, diaphoresis, and pallor.

Rationale: Compromised myocardium and inability to increase stroke volume during activity may cause an immediate increase in heart rate and oxygen demands, thereby aggravating

weakness and fatigue.

3. Assess level of fatigue, and evaluate for other precipitators and causes of fatigue, for example, HF treatments, pain, cachexia, anemia, and depression.

Rationale: Fatigue because of advanced HF can be profound and is related to hemodynamic, respiratory, and peripheral muscle abnormalities. Fatigue is also a side effect of some medications (e.g., beta blockers). Other key causes of fatigue should be evaluated and treated as appropriate and desired.

4. Evaluate accelerating activity intolerance.

Rationale: May denote increasing cardiac decompensation rather than overactivity.

5. Provide assistance with self-care activities, as indicated. Intersperse activity with rest periods.

Rationale: Meets client’s personal care needs without undue myocardial stress or excessive oxygen demand.

6. Implement graded cardiac rehabilitation and activity program.

Rationale: Strengthens and improves cardiac function under stress if cardiac dysfunction is not irreversible. Gradual increase in activity avoids excessive myocardial workload and oxygen

consumption.

Other possible Nursing Diagnosis for Heart Failure:

Risk for Impaired Gas Exchange

Excess Fluid Volume

Activity Intolerance

Risk for Chronic Pain

Activity Intolerance

Nursing Care Plan for Hypertension

Nursing Diagnosis: Activity intolerance may be related to generalized weakness or imbalance between oxygen supply and demand.

Possibly evidenced by

Verbal report of fatigue or weakness

Abnormal heart rate or BP response to activity

Exertional discomfort or dyspnea

ECG changes reflecting ischemia, dysrhythmias

Desired Outcomes/Evaluation Criteria—Client Will

Endurance

Participate in necessary and desired activities.

Report a measurable increase in activity tolerance.

Demonstrate a decrease in physiological signs of intolerance.

Nursing Care Plan Intervention and Rationale:

1. Assess the client’s response to activity, noting pulse rate more than 20 beats per minute faster than resting rate; marked increase in BP (systolic increases more than 40 mm Hg or diastolic increases more than 20 mm Hg) during and after activity, dyspnea or chest pain, excessive fatigue and weakness, and diaphoresis, dizziness, and syncope.

Rationale: Changes in baseline are helpful in assessing physiological responses to the stress of activity and, if present, are indicators of overexertion.

2. Instruct client in energy-conserving techniques, such as using chair when showering, sitting to brush teeth or comb hair, and carrying out activities at a slower pace.

Rationale: Energy-saving techniques reduce the energy expenditure, thereby assisting in equalization of oxygen supply and demand.

3. Encourage progressive activity and self-care when tolerated. Provide assistance as needed.

Rationale: Gradual activity progression prevents a sudden increase in cardiac workload. Provide assistance only as needed, which encourages independence in performing activities.