Activity intolerance is a nursing diagnosis defined as insufficient physiological or psychological energy to perform or complete desired or necessary daily activities. This condition affects a broad spectrum of individuals, from children to the elderly. Patients with a history of decreased activity or previous intolerance are at a higher risk of experiencing it again. Various underlying conditions and factors can elevate a person’s risk of activity intolerance.
Important Note: The nursing diagnosis “Activity Intolerance” has been updated to “Decreased Activity Tolerance” by the NANDA International Diagnosis Development Committee (DDC) to reflect changes in standardized language. While the official term is now “Decreased Activity Tolerance,” this article will continue using “Activity Intolerance” for broader recognition and until the updated term is widely adopted in clinical practice and education.
Common Causes of Activity Intolerance
Activity intolerance can stem from a variety of underlying health issues and conditions. Identifying these causes is crucial for developing an effective care plan. The following are frequently associated causes:
- Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD) significantly impact respiratory function, leading to reduced oxygen intake and subsequent activity intolerance.
- Anemia: Anemia, characterized by a deficiency of red blood cells or hemoglobin, reduces the oxygen-carrying capacity of the blood, resulting in fatigue and decreased activity tolerance.
- Malnutrition: Inadequate nutrition or malnutrition deprives the body of essential energy and nutrients required for physical activity, contributing to weakness and intolerance.
- Depression: Mental health conditions such as depression can profoundly affect energy levels and motivation, leading to decreased physical activity and intolerance.
- Pain (Acute or Chronic): Both acute pain and chronic pain can severely limit mobility and willingness to engage in activities due to discomfort and functional limitations.
- Decreased Mobility: Reduced mobility, often following surgery or injury, can lead to muscle weakness and deconditioning, directly impacting activity tolerance. Refer to Impaired Physical Mobility nursing diagnosis for more information.
- Inadequate Sleep: Insufficient or poor-quality sleep can result in fatigue and reduced energy levels, making it difficult to perform daily activities.
- Cognitive Impairment: Conditions affecting cognitive function can impact a patient’s ability to plan and execute activities, leading to decreased participation and tolerance.
- Generalized Weakness: Overall physical weakness from various causes can directly limit a person’s capacity to engage in physical activities.
Recognizing Signs and Symptoms of Activity Intolerance
Identifying the signs and symptoms of activity intolerance is critical for accurate diagnosis and effective intervention. These indicators can be categorized as subjective (reported by the patient) and objective (observed by the nurse). Understanding the difference between subjective and objective data in nursing is essential for comprehensive assessment.
Subjective Symptoms (Patient Reports)
- Patient report of decreased activity or weakness: Patients may verbally express a noticeable decline in their usual activity level or a general feeling of weakness.
- Shortness of breath with exertion: Dyspnea or shortness of breath upon physical effort is a common complaint, indicating the body’s struggle to meet oxygen demands during activity.
- Fatigue: Fatigue is a pervasive feeling of tiredness and reduced energy that is disproportionate to the activity performed and not relieved by rest.
- Exertional discomfort: Patients may experience discomfort, pain, or general unease during or after physical activity.
Objective Signs (Nurse Assessment)
- Abnormal blood pressure and heart rate response to activity: An exaggerated increase or decrease in heart rate or blood pressure beyond normal limits during or after activity is a significant objective sign.
- Changes to ECG: Electrocardiogram (ECG) changes during activity, such as arrhythmias or ischemia, can indicate cardiac intolerance to increased workload.
- Signs of pain with movement or activity: Observable signs of pain, such as grimacing, guarding, or reluctance to move, during attempts at activity.
- Difficulty engaging in activity: Observable struggle or inability to initiate or sustain physical activity, even at a low level.
- Increased oxygen demands: Evidenced by increased respiratory rate, increased work of breathing, or decreased oxygen saturation during activity.
Alt text: A nurse attentively measures a patient’s blood pressure in a hospital bed, highlighting the crucial aspect of vital signs monitoring in assessing activity intolerance.
Expected Outcomes for Activity Intolerance
Setting realistic and measurable expected outcomes is a fundamental part of the nursing care plan. These outcomes guide interventions and provide a framework for evaluating patient progress. Common goals and expected outcomes for patients with activity intolerance include:
- Normalization of vital signs with activity: The patient’s vital signs (heart rate, blood pressure, respiratory rate) will remain within acceptable limits during and after activity.
- Active participation in therapy sessions: The patient will be able to engage in prescribed Physical Therapy (PT) and Occupational Therapy (OT) sessions to improve strength and endurance.
- Return to baseline activity level: The patient will gradually regain their pre-illness or pre-injury activity level, as appropriate for their condition.
- Independent completion of Activities of Daily Living (ADLs): The patient will achieve the ability to perform personal care tasks such as bathing, dressing, and eating independently or with minimal assistance.
- Stable heart rhythm during activity: The patient’s heart rhythm will remain regular and stable without significant arrhythmias during physical exertion.
- Verbalized understanding of activity progression: The patient will demonstrate understanding of the importance of gradually increasing activity levels and the methods to safely achieve this.
Comprehensive Nursing Assessment for Activity Intolerance
A thorough nursing assessment is the cornerstone of developing an individualized care plan for activity intolerance. This assessment involves gathering subjective and objective data across physical, psychosocial, emotional, and diagnostic domains.
1. Evaluate Current Activity Level and Tolerance:
- This initial assessment establishes a baseline. Understanding the patient’s starting point is essential for creating a personalized activity plan and tracking progress effectively.
2. Monitor Vital Signs:
- Baseline vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) provide a crucial reference point. Regular monitoring during and after activity helps gauge physiological responses and detect any adverse reactions.
3. Identify Underlying Causes:
- Determining the root cause of activity intolerance is essential for targeted interventions. Addressing underlying conditions such as respiratory issues, anemia, or pain is paramount for improving activity tolerance.
4. Medication Review:
- Certain medications and their side effects, such as fatigue or drowsiness, can contribute to activity intolerance. Identifying such medications allows for potential adjustments, such as alternative medications or modified administration times, in consultation with the physician.
5. Nutritional Status Assessment:
- Adequate nutrition is vital for energy production and physical function. Assessing nutritional status ensures that any deficiencies are addressed to support the patient’s ability to engage in activity.
6. Need for Assistive Devices:
- Lack of appropriate assistive devices can be a barrier to activity. Assessing the need for devices like walkers, canes, or orthotics and ensuring their availability can significantly enhance a patient’s activity level and safety.
7. Frequent Skin Integrity Assessment:
- Patients with reduced activity are at increased risk for pressure ulcers. Regular skin assessments, especially in pressure-prone areas, are crucial for early detection and prevention of skin breakdown. For detailed information, see Impaired Skin Integrity nursing diagnosis and Pressure Ulcers nursing diagnosis.
Essential Nursing Interventions for Activity Intolerance
Nursing interventions are the actions nurses take to address the identified nursing diagnosis and achieve the expected outcomes. For activity intolerance, these interventions focus on gradually increasing activity levels while ensuring patient safety and comfort.
1. Initiate Range of Motion (ROM) Exercises for Bed-Restricted Patients:
- For patients on bed rest, start with passive or active ROM exercises. This prevents muscle stiffness and atrophy and prepares the body for increased activity. Gradually progress exercises based on the patient’s tolerance.
2. Continuous Vital Signs Monitoring During Activity:
- Monitor vital signs before, during, and after any activity. This ensures the patient’s physiological stability and allows for immediate adjustments if signs of intolerance occur (e.g., excessive heart rate increase, significant blood pressure changes, or desaturation).
3. Administer Supplemental Oxygen Therapy as Needed:
- Provide supplemental oxygen if the patient experiences shortness of breath or decreased oxygen saturation during activity. This supports oxygenation and allows for more comfortable participation in exercises.
4. Frequent Position Changes:
- For patients with limited mobility, frequent repositioning (every 2 hours or more often) is essential to prevent pressure ulcers and promote circulation.
5. Provide Nutritional Supplements When Indicated:
- Address nutritional deficiencies with appropriate supplements as recommended by a dietitian or physician. Adequate nutrition provides the necessary fuel for increased activity and recovery.
6. Utilize Appropriate Assistive Devices:
- Ensure patients have access to and use necessary assistive devices (e.g., walkers, canes, wheelchairs). Proper use of these devices enhances safety and allows for greater participation in activities.
7. Pain Management:
- Address pain proactively, especially before activity. Effective pain management allows patients to participate more comfortably and effectively in exercises and activities. Administer pain medication as prescribed and consider non-pharmacological pain relief methods.
8. Consult Physical Therapy (PT) and Occupational Therapy (OT):
- Request PT and OT consultations. These specialists can develop tailored exercise programs to gradually build endurance and strength, and address specific functional limitations.
9. Provide Emotional Support and Encouragement:
- Acknowledge the patient’s frustration and discouragement related to activity limitations. Offer consistent emotional support and positive reinforcement to motivate gradual progress. Encourage realistic goal setting and celebrate small achievements.
10. Patient Education on Safe Activity Increase at Home:
- Educate patients and caregivers on how to safely increase activity levels at home after discharge. Provide clear guidelines on exercise progression, recognizing signs of intolerance, and when to seek medical advice. This empowers patients to manage their activity levels independently and promotes long-term recovery.
Alt text: A physical therapist expertly guides a patient using a walker through a rehabilitation exercise, illustrating a key intervention strategy for patients experiencing activity intolerance.
Nursing Care Plans for Activity Intolerance: Examples
Nursing care plans provide a structured approach to patient care, outlining diagnoses, expected outcomes, assessments, and interventions. Here are three example care plans for activity intolerance:
Care Plan #1
Diagnostic Statement: Activity intolerance related to generalized weakness as evidenced by verbal reports of fatigue and exertional discomfort.
Expected Outcomes:
- Patient will exhibit stable cardiopulmonary status:
- Heart rate and rhythm within normal limits
- Systolic BP increase within 20mmHg over resting systolic BP
- Respiratory rate less than 20 breaths/min
- Patient will report a Rate of Perceived Exertion (RPE) of 0 or a decreased rating after physical activity (using a 0-10 scale).
- Patient will report absence of fatigue.
- Patient will perform activities of daily living (ADLs) with minimal assistance.
Assessment:
- Assess precipitating factors: Explore potential underlying causes of generalized weakness, fatigue, and exertional discomfort, such as chronic diseases (pulmonary diseases, anemia, malignancy, hypothyroidism).
- Monitor cardiopulmonary status:
- Heart rate and rhythm
- Orthostatic BP changes
- Rate of breathing
- Level of consciousness
- Skin color
- Chest discomfort
- Rationale: Changes in cardiopulmonary status serve as indicators of activity tolerance and guide activity progression.
Interventions:
- Assist with ADLs as needed, while promoting independence:
- Rationale: Conserves energy but avoids fostering dependency. Balance assistance with encouraging self-care to enhance self-esteem and activity tolerance.
- Encourage adequate rest periods:
- Schedule rest periods, especially before meals, ADLs, and exercise.
- Rationale: Rest allows for energy conservation and recovery.
- Plan activities during peak energy levels:
- Collaborate with the patient to identify and schedule activities when they feel most energetic.
- Rationale: Maximizes patient participation and success in activities.
- Promote physical activity and endurance exercises:
- Encourage exercises that build endurance, as appropriate for the patient’s condition.
- Rationale: Maintains muscle strength, joint ROM, and improves overall exercise tolerance. Strength training is beneficial for enhancing endurance.
- Gradually progress activity levels:
- Implement a step-wise approach:
- Active ROM exercises in bed → Sitting and standing
- Dangling legs for 10-15 minutes daily
- Deep breathing exercises at least 3 times daily
- Walking in room for 1-2 minutes 3 times daily → Walking outside the house
- Rationale: Gradual progression prevents cardiac overexertion and promotes safe deconditioning.
- Implement a step-wise approach:
- Utilize assistive devices as needed:
- Provide and instruct on the use of transfer chairs/wheelchairs, bath benches, etc.
- Rationale: Assistive devices reduce fatigue and discomfort, facilitating activity participation.
Care Plan #2
Diagnostic Statement: Activity Intolerance related to compromised oxygen transport system secondary to atelectasis as evidenced by increased respiratory rate and cyanosis.
Expected Outcomes:
- Patient will not exhibit respiratory distress from atelectasis:
- Respiratory rate less than 20 breaths/min
- Absence of dyspnea
- Pinkish skin and nails
- Absence of accessory muscle use
- Absence of clubbing
- O2 saturation >95%
- Patient will utilize energy-conservation techniques.
Assessment:
- Assess for signs and symptoms of atelectasis:
- Decreased or absent breath sounds
- Crackles
- Cough
- Sputum production
- Dyspnea
- Tachypnea
- Diminished chest expansion
- Cyanosis
- Rationale: Early detection of atelectasis is crucial for prompt intervention to prevent further pulmonary complications.
- Monitor laboratory findings:
- Chest x-ray results for tracheal shift, pulmonary opacities, and interlobar fissure displacement.
- Arterial Blood Gases (ABGs) for arterial hypoxemia and respiratory alkalosis.
- Chest CT for lung densities and volume reduction on the affected side.
Interventions:
- Administer medications as indicated:
- Mucolytics (e.g., acetylcysteine) for mucous plugging.
- Medications to treat underlying causes.
- Inhaled medications to open airways.
- Rationale: Medications address underlying causes and manage symptoms of atelectasis.
- Encourage deep breathing and incentive spirometry:
- Instruct patient on proper techniques for deep breathing and using incentive spirometry.
- Rationale: Promotes lung re-expansion and improves oxygenation.
- Teach energy conservation techniques:
- Changing positions frequently
- Pushing rather than pulling objects
- Sitting to perform tasks
- Resting for at least 1 hour after meals before activity
- Organizing a work-rest-work schedule
- Rationale: Reduces oxygen consumption and allows for more sustained activity.
- Refer to respiratory therapist for pulmonary rehabilitation:
- Initiate a referral for comprehensive pulmonary rehabilitation.
- Rationale: Pulmonary rehabilitation improves pulmonary function, reduces symptoms, and enhances quality of life for patients with pulmonary conditions.
- Provide supplemental oxygenation:
- Administer oxygen to maintain O2 saturation >90%.
- Rationale: Supports lung re-expansion and improves arterial oxygen saturation.
Care Plan #3
Diagnostic Statement: Activity intolerance related to physical deconditioning or immobility as evidenced by dyspnea on exertion and abnormal heart rate or blood pressure response to activity.
Expected Outcomes:
- Patient will demonstrate increased tolerance to activity.
- Patient will participate in prescribed physical activity with appropriate vital sign responses (heart rate, blood pressure, breathing rate).
Assessment:
- Assess level of physical activity and mobility:
- Determine baseline functional capacity and level of assistance needed.
- Rationale: Provides a starting point for activity progression and identifies necessary support.
- Determine cause of activity intolerance:
- Differentiate between physical, psychological, or motivational factors contributing to deconditioning.
- Rationale: Guides the selection of evidence-based interventions to address specific causes.
- Monitor and record activity tolerance:
- Assess vital signs and work of breathing before, during, and after activity.
- Monitor for signs of cardiac decompensation (dyspnea, palpitations, chest discomfort, hypotension/hypertension, tachycardia, decreased oxygen saturation, lightheadedness).
- Rationale: Vital sign monitoring provides objective data on activity tolerance. Cardiac decompensation signs necessitate immediate cessation of activity.
Interventions:
- Position bed-rest patient upright:
- Elevate the head of the bed or assist the patient to sit upright when possible.
- Rationale: Minimizes cardiovascular deconditioning associated with bed rest by maintaining fluid distribution and orthostatic tolerance.
- Assist with self-care, positioning, and transferring; gradually increase activity:
- Progress from bed rest to sitting, dangling, standing, and ambulating.
- Always assess for postural hypotension by dangling legs before standing.
- Rationale: Stepwise progression safely increases activity levels while monitoring for physiological responses.
- Perform Range of Motion (ROM) exercises for immobile patients:
- Implement passive or active ROM exercises for patients who cannot tolerate activity.
- Rationale: Maintains joint mobility, reduces stiffness and pain, and promotes functional independence.
- Refer to physical therapy:
- Request PT consultation for a tailored activity plan.
- Rationale: Physical therapists provide specialized expertise in designing and implementing activity programs to improve strength and endurance.
- Provide emotional support and encouragement:
- Set mutual, achievable goals for activity increases.
- Address fears of breathlessness, pain, or falling.
- Rationale: Emotional support enhances motivation, reduces anxiety, and promotes adherence to activity plans.
- Obtain necessary assistive devices:
- Ensure availability of walkers, canes, crutches, or portable oxygen before ambulation.
- Rationale: Assistive devices provide support and safety, enabling increased physical activity.
References
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Mosby.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Grott, K., Chauhan, S.& Dunlap, J.D. (2022). Atelectasis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK545316/
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Sharma, S. (2023). Pulmonary rehabilitation. MedScape. https://emedicine.medscape.com/article/319885-overview
