Activity intolerance is a crucial nursing diagnosis defined as insufficient physiological or psychological energy to perform or complete desired or necessary daily activities. This condition affects individuals across all age groups, from children to the elderly, and is particularly prevalent in those with a history of reduced activity or previous intolerance. Recognizing and addressing activity intolerance is vital in nursing care, as it can significantly impact a patient’s quality of life and recovery.
Note: It’s important to acknowledge that the nursing diagnosis “Activity Intolerance” has been updated to “Decreased Activity Tolerance” by NANDA International. While the official terminology is evolving, this article will continue to use “Activity Intolerance” to align with common usage and search terms, ensuring wider accessibility and understanding for nursing professionals and students.
Unpacking the Causes of Activity Intolerance
Understanding the root causes of activity intolerance is the first step in effective nursing care. Numerous underlying conditions and factors can contribute to this diagnosis. Here are some common causes:
- Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD) directly impact oxygen intake and utilization, leading to fatigue and reduced activity tolerance.
- Anemia: Anemia, characterized by a deficiency in red blood cells or hemoglobin, reduces the oxygen-carrying capacity of the blood, resulting in weakness and intolerance to activity.
- Malnutrition: Inadequate nutrition, or malnutrition, deprives the body of essential energy and nutrients needed for physical activity, leading to muscle weakness and fatigue.
- Depression: Mental health conditions like depression can significantly decrease energy levels and motivation, contributing to activity intolerance.
- Pain: Both acute pain and chronic pain can limit mobility and make physical activity uncomfortable or unbearable, leading to decreased tolerance.
- Decreased Mobility: Reduced mobility, often following surgery or injury (as in Impaired Physical Mobility), directly restricts physical activity and can lead to deconditioning and activity intolerance.
- Inadequate Sleep: Lack of sufficient, restful sleep impairs the body’s ability to recover and replenish energy stores, resulting in fatigue and reduced tolerance for activity.
- Cognitive Impairment: Cognitive deficits can affect a patient’s ability to understand and follow instructions for physical activity or engage in self-care activities, indirectly contributing to activity intolerance.
- Generalized Weakness: Overall physical weakness from various causes, including prolonged illness or inactivity, can directly limit the capacity for physical exertion.
Understanding these related factors enables nurses to provide targeted and effective interventions to improve patient outcomes.
Recognizing the Signs and Symptoms of Activity Intolerance
Identifying activity intolerance requires careful observation and assessment of both subjective patient reports and objective clinical findings. These signs and symptoms can be categorized as follows:
Subjective Data (Patient-Reported Symptoms)
- Patient report of decreased activity or weakness: Patients may verbally express feeling less active than usual or describe a general sense of weakness or lack of energy.
- Shortness of breath with exertion: Dyspnea, or shortness of breath, that occurs or worsens with physical activity is a key subjective indicator.
- Fatigue: Patients frequently report feeling unusually tired or fatigued, especially after or during activities that were previously manageable.
- Exertional discomfort: This includes any pain, chest discomfort, or general discomfort experienced during or after physical activity.
Objective Data (Nurse-Assessed Signs)
- Abnormal blood pressure and heart rate response to activity: An excessive increase or decrease in blood pressure or heart rate that is disproportionate to the level of activity is an objective sign.
- Changes to ECG: Electrocardiogram (ECG) changes during or after activity may indicate cardiac stress or ischemia related to activity intolerance.
- Signs of pain with movement/activity: Observable signs of pain, such as grimacing, guarding, or reluctance to move, during activity are objective indicators.
- Difficulty engaging in activity: Observable struggle or inability to initiate or sustain physical activity, such as getting out of bed or walking, is a significant sign.
- Increased oxygen demands: Clinical signs like increased respiratory rate, use of accessory muscles for breathing, or decreased oxygen saturation during activity suggest increased oxygen demand and intolerance.
By carefully assessing both subjective and objective data, nurses can accurately diagnose activity intolerance and develop appropriate care plans.
Expected Outcomes: Goals for Improved Activity Tolerance
Establishing clear and measurable expected outcomes is essential for guiding nursing care and evaluating its effectiveness. For patients with activity intolerance, typical expected outcomes include:
- Normalization of vital signs with activity: The patient’s blood pressure, heart rate, and respiratory rate will remain within acceptable limits during and after activity.
- Participation in physical and occupational 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.
- Independent completion of Activities of Daily Living (ADLs): The patient will be able to perform essential self-care tasks, such as bathing, dressing, and eating, independently or with minimal assistance.
- Stable heart rhythm throughout activity: For patients with cardiac concerns, maintaining a stable heart rhythm during activity is a critical outcome.
- Verbalized understanding of gradual activity increase: The patient will demonstrate understanding of the importance of gradually increasing activity levels and the methods to achieve this safely at home.
These outcomes provide a framework for nursing interventions and a benchmark for measuring progress in addressing activity intolerance.
Comprehensive Nursing Assessment for Activity Intolerance
A thorough nursing assessment is the foundation for developing individualized care plans. Key assessment areas for activity intolerance include:
1. Current Activity Level and Tolerance: Assess the patient’s baseline activity level and their current ability to tolerate physical activity. This includes asking about their daily routines, any limitations they experience, and what activities cause fatigue or discomfort. This baseline is crucial for tracking progress.
2. Vital Signs Evaluation: Regularly monitor and record the patient’s vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, both at rest and during activity. This provides objective data on their physiological response to exertion.
3. Identify Underlying Causes: Investigate and document any underlying medical conditions, medications, or other factors that may be contributing to activity intolerance. This could involve reviewing medical history, lab results, and consulting with other healthcare providers.
4. Medication Review: Carefully review the patient’s medication list, noting any medications that have side effects such as fatigue or weakness. Discuss potential alternatives or timing adjustments with the physician if medications are contributing to activity intolerance.
5. Nutritional Status Evaluation: Assess the patient’s nutritional status to identify any deficiencies that could be impacting energy levels and activity tolerance. Consider dietary history, weight changes, and lab values related to nutrition.
6. Need for Assistive Devices: Determine if the patient requires assistive devices, such as walkers, canes, or wheelchairs, to safely increase their activity level. Ensure these devices are readily available and that the patient knows how to use them properly.
7. Frequent Skin Integrity Assessment: Patients with decreased activity are at higher risk for pressure ulcers. Regularly assess skin integrity to identify and prevent skin breakdown.
By conducting a comprehensive assessment, nurses can gain a holistic understanding of the patient’s activity intolerance and tailor interventions to their specific needs.
Effective Nursing Interventions to Improve Activity Tolerance
Nursing interventions are critical in helping patients overcome activity intolerance and improve their functional capacity. Key interventions include:
1. Graduated Exercise Programs (Starting with ROM): For patients with limited mobility, initiate with range of motion (ROM) exercises, even if bed-rest is required. Gradually increase the intensity and duration of exercises as tolerated, ensuring activities are adapted to the patient’s current capacity.
2. Vital Signs Monitoring During Activity: Continuously monitor vital signs before, during, and after activity to ensure the patient remains stable and to detect any adverse responses.
3. Supplemental Oxygen Administration: Provide supplemental oxygen therapy as prescribed for patients who experience shortness of breath or decreased oxygen saturation during activity.
4. Frequent Position Changes: For patients on bed rest or chair rest, implement a schedule of frequent position changes to prevent skin breakdown and respiratory complications.
5. Nutritional Support: Address any nutritional deficits by providing appropriate nutritional supplements or dietary modifications to ensure the patient has adequate energy for activity.
6. Assistive Device Provision and Training: Ensure patients have access to and are properly trained in the use of necessary assistive devices to promote safe mobility and activity.
7. Pain Management: Effectively manage pain, especially before activity, to minimize discomfort and enable greater participation in physical activity. Administer pain medication as prescribed and explore non-pharmacological pain management techniques.
8. Physical and Occupational Therapy Consultations: Collaborate with physical and occupational therapists to develop comprehensive rehabilitation plans and exercises tailored to the patient’s needs and goals. PT/OT professionals can guide patients in safely and progressively increasing activity levels.
9. Emotional Support and Encouragement: Provide ongoing emotional support and encouragement to patients who may become discouraged by their activity limitations. Positive reinforcement and celebrating small achievements can enhance motivation and adherence to activity plans.
10. Patient Education on Home Activity Management: Educate patients and caregivers on strategies for safely increasing activity levels at home. This includes teaching energy conservation techniques, pacing activities, recognizing signs of overexertion, and the importance of gradual progression. Empowering patients with knowledge promotes self-management and long-term improvement.
By implementing these interventions, nurses play a pivotal role in helping patients regain activity tolerance and improve their overall well-being.
Nursing Care Plans for Activity Intolerance: Examples and Applications
Nursing care plans provide structured frameworks for organizing assessments, interventions, and expected outcomes. Here are examples of care plans addressing activity intolerance in different clinical scenarios:
Care Plan #1: Activity Intolerance related to Generalized Weakness
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, systolic BP within 20mmHg of resting, respiratory rate < 20 breaths/min).
- Patient will report a Rate of Perceived Exertion (RPE) of 0 or decreased after physical activity.
- Patient will report absence of fatigue.
- Patient will perform activities of daily living (ADLs).
Assessments:
- Precipitating Factors: Assess for underlying chronic diseases (pulmonary, anemia, malignancy, hypothyroidism) that may contribute to generalized weakness.
- Cardiopulmonary Status: Monitor heart rate, rhythm, orthostatic BP, respiratory rate, level of consciousness, skin color, and chest discomfort to guide activity progression.
Interventions:
- ADL Assistance (Balance Independence): Assist with ADLs to conserve energy, but avoid promoting dependency. Encourage patient participation to enhance self-esteem and activity tolerance.
- Rest Periods: Encourage adequate rest, especially before meals, ADLs, and exercise, to conserve energy.
- Activity Planning: Assist the patient in planning activities for periods of peak energy.
- Endurance Exercise: Encourage physical activity and endurance-enhancing exercises to maintain muscle strength and joint ROM.
- Gradual Activity Progression: Implement a progressive activity plan:
- Active ROM exercises in bed → sitting and standing
- Dangling legs 10-15 minutes daily
- Deep breathing exercises 3x daily
- Walking in room 1-2 minutes 3x daily → walking outside
- Assistive Devices: Encourage use of assistive devices (transfer chairs, wheelchairs, bath benches) to reduce fatigue and discomfort.
Care Plan #2: Activity Intolerance related to Compromised Oxygen Transport (Atelectasis)
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 < 20, absence of dyspnea, pink skin/nails, no accessory muscle use, no clubbing, O2 saturation > 95%).
- Patient will use energy-conservation techniques.
Assessments:
- Atelectasis Signs and Symptoms: Assess for decreased breath sounds, crackles, cough, sputum production, dyspnea, tachypnea, diminished chest expansion, and cyanosis.
- Laboratory Findings: Monitor chest x-ray, arterial blood gases (ABGs), and chest CT for indicators of atelectasis.
Interventions:
- Medication Administration: Administer mucolytics (acetylcysteine) or other medications as indicated to address atelectasis and underlying causes.
- Deep Breathing and Incentive Spirometry: Encourage deep breaths and incentive spirometry to promote lung re-expansion.
- Energy Conservation Techniques: Teach techniques like:
- Frequent position changes
- Pushing instead of pulling
- Sitting for tasks
- Resting 1 hour after meals
- Work-rest-work schedule
- Pulmonary Rehabilitation Referral: Refer to respiratory therapy for pulmonary rehabilitation to improve lung function and quality of life.
- Supplemental Oxygenation: Provide supplemental oxygen to improve oxygen saturation and support lung re-expansion.
Care Plan #3: Activity Intolerance related to Physical Deconditioning/Immobility
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.
Assessments:
- Physical Activity and Mobility Level: Assess baseline functional capacity and assistance needed to improve activity tolerance.
- Cause of Activity Intolerance: Determine if the cause is physical, psychological, or motivational to tailor interventions.
- Activity Tolerance Monitoring: Monitor and record vital signs and signs of cardiac decompensation (dyspnea, palpitations, chest discomfort, hypo/hypertension, tachycardia, decreased O2 saturation, lightheadedness) before, during, and after activity.
Interventions:
- Upright Positioning (Bed Rest): Position patient upright to minimize cardiovascular deconditioning during bed rest.
- Progressive Activity Assistance: Assist with self-care, positioning, and transferring, gradually increasing activity from bed to dangling, standing, and ambulating. Monitor for postural hypotension.
- Range of Motion (ROM) Exercises: Perform ROM exercises for immobile patients to maintain joint mobility and reduce pain.
- Physical Therapy Referral: Refer to physical therapy for a tailored activity plan to increase strength and activity levels.
- Emotional Support and Goal Setting: Provide emotional support and encouragement, setting mutual goals for gradual activity increases.
- Assistive Devices Provision: Obtain necessary assistive devices (walkers, canes, crutches, portable oxygen) before ambulation.
These care plan examples illustrate how nursing diagnoses of activity intolerance can be addressed with specific, patient-centered interventions to promote recovery and improve functional status.
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 edition). 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
