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.