Activity Intolerance Nursing Diagnosis: A Comprehensive Care Plan Guide

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 diverse patient population, ranging from children to older adults. Individuals with a history of reduced activity or previous episodes of intolerance are at a higher risk of experiencing it again. A multitude of underlying health issues and factors can predispose a person to activity intolerance.

Note on Terminology: It’s important to be aware that the nursing diagnosis “Activity Intolerance” has been updated to “Decreased Activity Tolerance” by the NANDA International Diagnosis Development Committee (DDC) as part of ongoing efforts to standardize nursing language. While the official term is now “Decreased Activity Tolerance,” this article will continue to use “Activity Intolerance” to ensure clarity and familiarity for readers who may still be more accustomed to the older terminology, until the updated term gains wider recognition.

Common Causes of Activity Intolerance

Activity intolerance can stem from a variety of factors that diminish a person’s energy reserves or ability to perform physical tasks. Identifying the root cause is crucial for developing an effective nursing care plan. Here are some of the prevalent causes:

• Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD), asthma, and pneumonia directly impact oxygen intake and lung function. Reduced respiratory capacity leads to shortness of breath and fatigue, significantly limiting activity tolerance. For example, a patient with COPD may experience significant breathlessness after minimal exertion like walking across a room.
• Anemia: Anemia, characterized by a deficiency in red blood cells or hemoglobin, reduces the blood’s oxygen-carrying capacity. This oxygen deficit results in fatigue and weakness, making it difficult to sustain physical activity. Patients with anemia may feel constantly tired and easily winded.
• Malnutrition: Inadequate nutrition deprives the body of essential energy and nutrients required for cellular function and physical exertion. Malnourished individuals often experience muscle weakness and fatigue, leading to decreased activity tolerance. This can be seen in elderly patients with poor diets or individuals with eating disorders.
• Depression and Mental Health Conditions: Mental health conditions like depression can profoundly impact energy levels and motivation. Fatigue, a common symptom of depression, can significantly hinder a person’s desire and ability to engage in physical activity. Patients with depression may report feeling too tired to perform even simple tasks.
• Acute and Chronic Pain: Pain, whether acute (like post-surgical pain) or chronic (such as arthritis pain), can severely restrict movement and activity. Pain discourages activity due to discomfort and fear of worsening the pain, leading to activity intolerance. A patient recovering from surgery may experience activity intolerance due to pain at the incision site.
• Decreased Mobility: Conditions that impair physical mobility, such as surgery, injuries, stroke, or musculoskeletal disorders, directly limit the ability to move and be active. Prolonged immobility also leads to muscle weakness and deconditioning, further exacerbating activity intolerance. A patient recovering from a hip fracture may have decreased mobility and subsequent activity intolerance.
• Inadequate Sleep: Insufficient or poor-quality sleep disrupts the body’s restorative processes, leading to fatigue and reduced energy levels. Lack of sleep makes it challenging to perform activities and reduces overall activity tolerance. Individuals with chronic insomnia often struggle with activity intolerance.
• Cognitive Impairment: Cognitive impairments, such as dementia or delirium, can affect a person’s ability to understand and follow instructions for physical activity or even remember to engage in activities. This can indirectly lead to decreased activity levels and intolerance. Patients with Alzheimer’s disease may exhibit activity intolerance due to cognitive decline.
• Generalized Weakness: Generalized weakness can result from various underlying conditions, including prolonged illness, muscle atrophy due to inactivity, or certain medical treatments. This overall weakness makes it difficult to perform physical tasks and reduces activity tolerance. A patient recovering from a prolonged hospital stay may experience generalized weakness and activity intolerance.

Alt text: A nurse attentively checks a patient’s breathing, assessing respiratory rate and effort, crucial steps in identifying activity intolerance related to respiratory problems.

Recognizing Activity Intolerance: Signs and Symptoms

Identifying activity intolerance involves recognizing both subjective symptoms reported by the patient and objective signs observed by the nurse. Differentiating between these helps in a comprehensive assessment.

Subjective Symptoms (Patient Reports)

These are symptoms that the patient verbally expresses. They are crucial indicators of how the patient is experiencing activity intolerance:

• Patient’s report of decreased activity/weakness: The patient may state feeling weaker than usual or unable to perform their usual activities. They might say, “I just can’t do as much as I used to,” or “I feel too weak to even get out of bed.”
• Shortness of breath with exertion (Dyspnea): Patients may report feeling breathless or winded after minimal activity. This is a key indicator, especially for conditions affecting respiratory or cardiovascular function. A patient might say, “I get so short of breath just walking to the bathroom.”
• Fatigue: An overwhelming feeling of tiredness and lack of energy is a hallmark symptom. This fatigue is often disproportionate to the activity performed and not relieved by rest. Patients may describe it as “constant exhaustion” or “feeling drained all the time.”
• Exertional discomfort: This can manifest as chest pain, muscle aches, or general discomfort during or after activity. It signals that the body is struggling to meet the demands of physical exertion. Patients might report, “My chest starts to hurt when I try to walk,” or “My legs ache after just a few minutes of standing.”

Objective Signs (Nurse Assesses)

These are observable signs that the nurse can assess and measure. They provide tangible data to support the diagnosis of activity intolerance:

• Abnormal blood pressure and heart rate response to activity: An exaggerated increase or decrease in blood pressure or heart rate during or after activity is a significant objective sign. This indicates the cardiovascular system is not adapting appropriately to exertion. For instance, a patient’s heart rate might spike excessively with minimal activity, or their blood pressure might drop dangerously low.
• Changes to ECG: Electrocardiogram (ECG) changes during activity, such as arrhythmias or signs of ischemia, can indicate underlying cardiac issues contributing to activity intolerance. These changes are objective measures of heart function under stress.
• Signs of pain with movement/activity: Observable signs like grimacing, guarding, or reluctance to move indicate pain limiting activity. While pain is subjective, these outward signs are objective confirmations of pain during activity.
• Difficulty engaging in activity: Observable struggles to initiate or continue physical activity, such as needing frequent rests, appearing labored, or stopping activity prematurely, are objective signs of intolerance. The nurse might observe a patient struggling to get out of bed or needing to stop and rest after only a few steps.
• Increased oxygen demands: Signs like increased respiratory rate, use of accessory muscles for breathing, or decreased oxygen saturation during activity indicate the body’s increased need for oxygen and potential intolerance to activity. Monitoring oxygen saturation levels during activity can provide objective data on oxygen demand.

Alt text: A nurse measures a patient’s blood pressure, a key objective assessment to monitor cardiovascular response and identify potential activity intolerance.

Expected Outcomes and Goals for Activity Intolerance Care

Setting realistic and measurable goals is essential in the nursing care plan for activity intolerance. Expected outcomes should focus on improving the patient’s ability to participate in activities safely and comfortably. Common goals include:

• Patient’s vital signs will normalize with activity: This indicates improved cardiovascular response to exertion. Normalization means heart rate, blood pressure, and respiratory rate return to within acceptable limits during and after activity.
• Patient will be able to participate in PT and OT sessions: This signifies progress in activity tolerance, allowing participation in rehabilitation therapies aimed at improving physical function and endurance.
• Patient’s activity will return to baseline activity level: For patients who have experienced a decline in activity, the goal is to help them return to their previous level of function, as much as medically possible.
• Patient will be able to independently complete activities of daily living (ADLs): This focuses on functional independence, ensuring the patient can perform essential self-care tasks like bathing, dressing, and eating without excessive fatigue or distress.
• Patient’s heart rhythm will remain stable throughout activity: For patients with cardiac concerns, maintaining a stable heart rhythm during activity is a critical outcome, ensuring safety and preventing complications.
• Patient will verbalize understanding of the need to gradually increase activity level and how to accomplish this: Patient education is key. The goal is for the patient to understand the importance of progressive activity and learn strategies for safely increasing their activity levels at home.

Comprehensive Nursing Assessment for Activity Intolerance

A thorough nursing assessment is the foundation of effective care for activity intolerance. It involves gathering both subjective and objective data to understand the patient’s limitations and needs. Key assessment areas include:

1. Assess the patient’s present level of activity and tolerance to activity: This initial assessment establishes a baseline. Ask questions about their daily routines, what activities they can currently perform, and how they feel during and after activity. Use standardized tools like activity logs or questionnaires to quantify their current activity level.
2. Assess the patient’s vital signs: Measure baseline vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) at rest. Monitor vital signs before, during, and after activity to observe their physiological response to exertion. Note any abnormal changes or delayed recovery to baseline.
3. Assess the underlying cause of activity intolerance: Investigate potential contributing factors. Review the patient’s medical history, current diagnoses, and recent health events. Consider conditions like respiratory issues, anemia, cardiac problems, pain, depression, and medication side effects. Diagnostic tests may be needed to confirm underlying conditions.
4. Review medication list: Certain medications can contribute to fatigue and decreased activity tolerance as side effects. Identify medications with potential side effects like drowsiness, muscle weakness, or cardiovascular effects. Discuss with the physician if medication adjustments or alternative timing of medications are possible.
5. Assess nutritional status: Evaluate the patient’s nutritional intake and identify any deficiencies. Poor nutrition can lead to weakness and fatigue. Assess dietary habits, appetite, weight changes, and consider lab tests to evaluate nutritional status. Consult with a dietitian if nutritional deficits are identified.
6. Assess potential need for assistive devices with activity: Determine if the patient requires assistive devices to enhance their mobility and activity level. Assess their current use of devices (if any) and identify needs for walkers, canes, wheelchairs, or other aids. Ensure devices are properly fitted and readily available.
7. Assess skin integrity frequently: Patients with decreased activity are at increased risk for pressure ulcers. Regularly assess skin, especially bony prominences, for signs of redness or breakdown. Implement preventive measures like frequent repositioning and pressure-relieving devices.

Alt text: A nurse guides a patient through range of motion exercises, a vital nursing intervention to improve mobility and address activity intolerance.

Effective Nursing Interventions for Managing Activity Intolerance

Nursing interventions are crucial for improving activity tolerance and promoting patient recovery. Interventions should be tailored to the individual patient’s needs and limitations. Key interventions include:

1. If the patient is limited to bed-rest, begin with range of motion (ROM) exercises: For immobile patients, initiate passive and active ROM exercises to maintain joint mobility, prevent muscle atrophy, and improve circulation. Start with simple exercises and gradually increase intensity and duration as tolerated.
2. Monitor vital signs throughout activity: Closely monitor heart rate, blood pressure, respiratory rate, and oxygen saturation before, during, and after any activity. This helps ensure patient safety and allows for adjustments to activity levels based on physiological response. Stop activity if abnormal vital signs or signs of distress occur.
3. Provide supplemental oxygen therapy as needed: If the patient experiences shortness of breath or desaturation during activity, administer supplemental oxygen as prescribed to maintain adequate oxygenation. Monitor oxygen saturation levels closely and adjust oxygen flow as needed.
4. Provide frequent position changes: For patients with limited mobility, implement a schedule for frequent position changes (every 2 hours or more frequently). This helps prevent pressure ulcers, promotes respiratory function, and improves comfort.
5. Provide appropriate nutritional supplements when indicated: Address nutritional deficits by providing appropriate supplements as recommended by a dietitian or physician. Ensure adequate intake of protein, calories, and essential nutrients to support energy levels and muscle strength.
6. Utilize appropriate assistive devices if needed: Ensure patients have access to and use appropriate assistive devices (walkers, canes, wheelchairs, etc.) to facilitate safe mobility and increase activity levels. Provide education on proper use and safety precautions for assistive devices.
7. Treat pain as needed: Manage pain effectively to improve activity tolerance. Administer pain medication as prescribed, especially before planned activities. Utilize non-pharmacological pain management techniques as well, such as positioning, heat/cold therapy, and relaxation techniques.
8. Discuss order for PT/OT with MD: Collaborate with the physician to obtain orders for physical therapy (PT) and occupational therapy (OT) consultations. PT and OT professionals can develop individualized exercise programs to improve strength, endurance, and functional mobility.
9. Provide emotional support to the patient: Acknowledge the patient’s frustration and discouragement related to activity limitations. Provide encouragement and positive reinforcement for their efforts to increase activity. Help set realistic goals and celebrate progress.
10. Educate the patient on how to safely increase activity level at home: Provide clear and concise education on gradually increasing activity levels at home. Teach energy conservation techniques, pacing strategies, and warning signs to watch for. Develop a written home exercise plan if appropriate.

Activity Intolerance Nursing Care Plan Examples

Nursing care plans provide a structured approach to addressing activity intolerance. Here are three examples of care plans, each focusing on a different related factor:

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 a stable cardiopulmonary status during activity, evidenced by:
  • Heart rate within patient’s normal range or as prescribed by physician.
  • Systolic blood pressure increase of no more than 20mmHg over resting systolic BP.
  • Respiratory rate less than 20 breaths per minute and within patient’s baseline.
• Patient will report a Rate of Perceived Exertion (RPE) of 3 or less (on a scale of 0-10) during and after planned physical activity.
• Patient will report feeling rested and less fatigued by end of shift/day.
• Patient will participate in activities of daily living (ADLs) with minimal assistance.

Assessment:

1. Assess precipitating factors: Explore potential underlying causes of generalized weakness, such as chronic diseases (pulmonary, cardiac, endocrine), anemia, malnutrition, prolonged illness, or deconditioning. Review medical history and recent lab results.
2. Monitor the patient’s cardiopulmonary status: Regularly assess and document:
   • Heart rate and rhythm (apical and radial pulse).
   • Orthostatic blood pressure changes (lying, sitting, standing).
   • Respiratory rate, depth, and effort.
   • Level of consciousness and any changes.
   • Skin color and temperature.
   • Reports of chest discomfort or palpitations.
   • Oxygen saturation.

Interventions:

1. Assist with ADLs as indicated, but promote independence: Provide assistance with ADLs to conserve energy, but encourage patient participation and self-care to maintain independence and self-esteem. Balance assistance with fostering endurance.
2. Encourage adequate rest periods: Schedule planned rest periods throughout the day, especially before meals, ADLs, and planned exercises. Promote uninterrupted nighttime sleep.
3. Assist the patient with planning activities: Help the patient prioritize and schedule activities for times when energy levels are typically highest. Encourage pacing and breaking down large tasks into smaller, manageable steps.
4. Encourage physical activity: Promote endurance-enhancing exercises as tolerated. Start with active ROM exercises in bed, progressing to sitting, standing, and short walks. Incorporate strength training exercises gradually.
5. Progress activities gradually: Implement a progressive activity plan:
   • Start with active ROM exercises in bed, several times daily.
   • Progress to dangling legs at bedside for 10-15 minutes daily.
   • Encourage deep breathing exercises at least 3 times daily.
   • Initiate short walks in room (1-2 minutes, 2-3 times daily), gradually increasing duration and frequency.
   • Progress to walking outside room/house as tolerated.
6. Encourage and assist with assistive devices: Provide and instruct on the use of assistive devices (transfer chairs, wheelchairs, walkers, bath benches) to reduce fatigue and discomfort during activities.

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 demonstrate improved respiratory function, evidenced by:
  • Respiratory rate within normal limits (12-20 breaths/min) and patient’s baseline.
  • Absence of dyspnea and shortness of breath at rest and with activity.
  • Pinkish skin and mucous membranes, absence of cyanosis.
  • Absence of accessory muscle use for breathing.
  • Absence of digital clubbing.
  • Oxygen saturation (SpO2) >95% on room air or patient’s baseline.
  • Clear breath sounds bilaterally.
• The patient will effectively utilize energy-conservation techniques during activities.

Assessment:

1. Assess for signs and symptoms of atelectasis: Monitor for indicators of lung collapse:
   • Decreased or absent breath sounds, particularly in affected lobes.
   • Crackles or rales in affected lung areas.
   • Presence and nature of cough (productive or non-productive).
   • Sputum production (amount, color, consistency).
   • Dyspnea, tachypnea, and increased work of breathing.
   • Diminished chest expansion on affected side.
   • Cyanosis (peripheral or central).
2. Monitor laboratory and diagnostic findings: Review results of:
   • Chest X-ray: Assess for tracheal shift, pulmonary opacities, and fissure displacement.
   • Arterial Blood Gases (ABGs): Evaluate for hypoxemia (decreased PaO2) and respiratory alkalosis (decreased PaCO2).
   • Chest CT scan: Assess for lung densities and volume reduction.

Interventions:

1. Administer medications as indicated: Administer prescribed medications for atelectasis and underlying conditions. This may include:
   • Mucolytics (e.g., acetylcysteine) to reduce mucous plugging.
   • Bronchodilators to open airways.
   • Antibiotics if infection is contributing to atelectasis.
   • Pain medication to facilitate deep breathing and coughing.
2. Encourage deep breathing exercises and incentive spirometry: Instruct and assist the patient with deep breathing exercises every 1-2 hours while awake. Encourage use of incentive spirometry to promote lung expansion and prevent further atelectasis.
3. Teach energy conservation techniques: Educate the patient on strategies to reduce oxygen consumption and conserve energy during activities:
   • Changing positions frequently to improve lung expansion and reduce fatigue.
   • Pushing rather than pulling objects to reduce exertion.
   • Sitting down to perform tasks whenever possible.
   • Resting for at least 1 hour after meals before activity.
   • Organizing a work-rest-work schedule to pace activities.
4. Refer the patient to a respiratory therapist for pulmonary rehabilitation: Consult with a respiratory therapist for pulmonary rehabilitation program referral. Pulmonary rehab can improve lung function, exercise tolerance, and quality of life.
5. Provide supplemental oxygenation: Administer supplemental oxygen as prescribed to maintain SpO2 >90% or as ordered, especially during activities. Monitor oxygen saturation closely and adjust flow rate as needed.

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 objectively increased tolerance to physical activity, evidenced by:
  • Ability to perform progressively longer durations of activity without significant dyspnea.
  • Appropriate heart rate, blood pressure, and respiratory rate responses to activity (within acceptable limits as defined by physician or patient’s baseline).
• Patient will actively participate in prescribed physical activity and exercise regimen.

Assessment:

1. Assess the level of physical activity and mobility: Determine the patient’s current functional capacity and mobility level. Assess:
   • Baseline activity level before illness or immobility.
   • Current ability to perform ADLs and instrumental ADLs (IADLs).
   • Level of assistance needed for mobility and transfers.
   • Use of mobility aids or assistive devices.
2. Determine the cause of activity intolerance: Identify factors contributing to deconditioning:
   • Prolonged bed rest or immobility.
   • Medical conditions limiting activity.
   • Psychological factors (e.g., fear of falling, depression).
   • Motivational factors and patient’s willingness to engage in activity.
3. Monitor and record the patient’s tolerance to activity: Assess and document:
   • Vital signs (heart rate, BP, respiratory rate, SpO2) before, during, and after activity.
   • Subjective reports of dyspnea, fatigue, chest pain, dizziness, or lightheadedness.
   • Objective signs of cardiac decompensation (dyspnea, palpitations, chest discomfort, hypotension/hypertension, tachycardia, decreased SpO2, lightheadedness).

Interventions:

1. Position patient upright if on bed rest: Elevate the head of the bed to an upright position as tolerated (semi-Fowler’s or high-Fowler’s) to minimize cardiovascular deconditioning effects of bed rest.
2. Assist with self-care activities and progressive mobilization: Assist with ADLs, positioning, and transfers, gradually increasing patient participation and independence. Progress activity level step-wise:
   • Progress from bed rest to sitting in bed, dangling legs, standing, and ambulating.
   • Ensure patient dangles legs at bedside before standing to assess for postural hypotension.
   • Gradually increase ambulation distance and duration as tolerated.
3. Perform range-of-motion (ROM) exercises: Implement active and passive ROM exercises if patient is immobile or has limited activity tolerance. Perform ROM exercises at least twice daily to maintain joint mobility and muscle function.
4. Refer to physical therapy: Obtain a PT consultation for comprehensive assessment and development of an individualized physical activity plan. PT can provide expert guidance on exercise progression and strength training.
5. Provide emotional support and encouragement: Offer emotional support and encouragement to address fear, anxiety, or discouragement related to activity limitations. Set mutual, realistic goals for activity increases and provide positive reinforcement for progress.
6. Obtain necessary assistive devices: Ensure availability and proper fitting of assistive devices (walkers, canes, crutches, portable oxygen) before ambulation and activity. Instruct patient on safe and correct use of devices.

References

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