Activity intolerance is a recognized nursing diagnosis that describes an individual’s state of having insufficient physiological or psychological energy to perform or complete desired or necessary daily activities. This condition affects a broad spectrum of patients, from children to the elderly. Individuals with a history of reduced activity or previous intolerance are at a higher risk of experiencing it again. Numerous underlying conditions and factors can elevate a person’s susceptibility to activity intolerance, making accurate diagnosis and tailored care plans crucial.
Important Note: It’s worth noting that the nursing diagnosis “Activity Intolerance” has been officially renamed to “Decreased Activity Tolerance” by the NANDA International Diagnosis Development Committee (DDC). This change reflects ongoing efforts to standardize nursing language. While the updated term is “Decreased Activity Tolerance,” this article will primarily use “Activity Intolerance” to ensure clarity and familiarity for a wider audience, including those who may still be acquainted with the older terminology.
Common Causes of Activity Intolerance
Several factors and conditions can contribute to activity intolerance. Identifying these underlying causes is the first step in developing an effective Diagnosis Weakness Care Plan.
- Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD) significantly impact respiratory function, leading to reduced oxygen intake and subsequent activity intolerance. The compromised respiratory system makes it difficult for individuals to sustain energy levels required for physical activities.
- Anemia: A deficiency in red blood cells or hemoglobin reduces the oxygen-carrying capacity of the blood. This lack of oxygen delivery to tissues and organs results in fatigue and decreased tolerance for physical exertion.
- Malnutrition: Inadequate nutrition deprives the body of essential fuels and nutrients needed for energy production. Malnourished individuals often experience muscle weakness and fatigue, directly contributing to activity intolerance.
- Depression: Mental health conditions like depression can profoundly affect energy levels and motivation. Psychological fatigue and a lack of interest in activities are common symptoms that manifest as activity intolerance.
- Acute or Chronic Pain: Pain, whether sudden or persistent, can severely limit movement and willingness to engage in activities. Pain can lead to physical limitations and psychological aversion to movement, both contributing to activity intolerance.
- Decreased Mobility due to Surgery: Post-surgical recovery often involves periods of reduced mobility. Surgical procedures can result in pain, weakness, and limitations in movement, temporarily causing activity intolerance.
- Inadequate Sleep: Sleep is crucial for physical and mental restoration. Insufficient or poor-quality sleep leads to fatigue, reduced energy levels, and impaired physical function, directly impacting activity tolerance.
- Cognitive Impairment: Conditions affecting cognitive function can impact an individual’s ability to plan, initiate, and execute activities. Cognitive deficits can lead to decreased awareness of physical limitations or reduced motivation to engage in physical tasks.
- Generalized Weakness: Muscle weakness from various causes, including prolonged illness, aging, or sedentary lifestyles, can significantly reduce physical capacity and result in activity intolerance. This weakness limits the body’s ability to perform even basic activities.
Recognizing Signs and Symptoms of Activity Intolerance
Identifying the signs and symptoms of activity intolerance is crucial for accurate diagnosis and effective intervention. These indicators can be categorized into subjective reports from the patient and objective observations made by healthcare professionals.
Subjective Symptoms (Patient Reports)
These are symptoms reported directly by the patient, reflecting their personal experience of activity intolerance.
- Patient Report of Decreased Activity/Weakness: This is a primary indicator where patients verbally express a noticeable reduction in their usual activity levels and a feeling of overall weakness or lack of strength.
- Shortness of Breath with Exertion: Dyspnea or shortness of breath that occurs during or after physical activity is a common subjective symptom. Patients may describe feeling winded or unable to catch their breath with activities that were previously manageable.
- Fatigue: Overwhelming and persistent tiredness that is not relieved by rest is a significant subjective symptom. Patients may describe feeling constantly drained or lacking energy to perform daily tasks.
- Exertional Discomfort: This refers to any discomfort, pain, or unpleasant sensations experienced during physical activity. It can range from muscle aches to chest discomfort and serves as a signal to reduce or stop activity.
Objective Signs (Nurse Assessments)
These are observable signs and measurable data that nurses and healthcare providers can assess to confirm activity intolerance.
- Abnormal Blood Pressure and Heart Rate Response to Activity: An exaggerated increase or decrease in blood pressure or heart rate that is disproportionate to the level of activity is an objective sign. This indicates the cardiovascular system is not responding appropriately to exertion.
- Changes to ECG: Electrocardiogram (ECG) changes during or after activity can indicate cardiac stress or dysfunction. These changes are objective measures of the heart’s response to physical exertion.
- Signs of Pain with Movement/Activity: Observable signs of pain, such as grimacing, guarding, or limping during movement, are objective indicators of physical discomfort limiting activity.
- Difficulty Engaging in Activity: Observable struggle or inability to initiate or sustain physical activity, such as needing assistance to get out of bed or becoming easily exhausted during simple tasks, are objective signs of activity intolerance.
- Increased Oxygen Demands: Clinical signs suggesting increased oxygen demand, such as increased respiratory rate, use of accessory muscles for breathing, or decreased oxygen saturation levels during activity, are objective measures of physiological strain.
Expected Outcomes and Goals in Care Planning
Setting clear, achievable outcomes is essential when developing a diagnosis weakness care plan for activity intolerance. These outcomes guide interventions and provide measurable targets for patient progress.
- Normalization of Vital Signs with Activity: A primary goal is for the patient’s vital signs (heart rate, blood pressure, respiratory rate) to remain within normal limits or return to baseline levels promptly after activity. This indicates improved cardiovascular and respiratory response to exertion.
- Active Participation in Physical and Occupational Therapy: Successful care plans aim to enable patients to engage actively in Physical Therapy (PT) and Occupational Therapy (OT) sessions. This participation is crucial for regaining strength, endurance, and functional abilities.
- Return to Baseline Activity Level: The ultimate goal is to help patients return to their pre-illness or baseline activity level. This may involve gradual progression and tailored interventions to rebuild activity tolerance.
- Independent Completion of Activities of Daily Living (ADLs): Achieving independence in ADLs, such as bathing, dressing, and eating, is a significant outcome. This signifies improved functional capacity and quality of life.
- Stable Heart Rhythm Throughout Activity: For patients with cardiac concerns, maintaining a stable heart rhythm during physical activity is a critical outcome. This ensures cardiovascular safety and tolerance to exertion.
- Verbalized Understanding of Gradual Activity Increase: Patient education is key. Patients should understand the importance of gradually increasing activity levels and be able to articulate how to safely progress their activity at home. This promotes self-management and long-term recovery.
Comprehensive Nursing Assessment for Activity Intolerance
A thorough nursing assessment is the foundation of an effective diagnosis weakness care plan. It involves gathering subjective and objective data across physical, psychosocial, emotional, and diagnostic domains.
1. Assess Current Activity Level and Tolerance: This initial assessment establishes a baseline. It helps understand the patient’s starting point and guides the development of a personalized activity plan. Tracking progress against this baseline is crucial.
2. Evaluate Vital Signs: Assessing baseline vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) provides a reference point. It allows nurses to monitor for any abnormal responses or fluctuations during activity and identify potential risks.
3. Identify Underlying Causes of Activity Intolerance: Determining the root cause is paramount. Whether it’s respiratory conditions, anemia, pain, or other factors, identifying the underlying cause directs appropriate treatment and targeted interventions.
4. Review Medication List: Certain medications and their side effects can contribute to fatigue and decreased activity tolerance. Reviewing the medication list helps identify potential medication-related causes and allows for discussions about possible alternatives or timing adjustments.
5. Evaluate Nutritional Status: Adequate nutrition is essential for energy production and physical function. Assessing nutritional status ensures that any nutritional deficiencies contributing to weakness and activity intolerance are addressed.
6. Determine Need for Assistive Devices: Lack of appropriate assistive devices can hinder activity levels. Assessing the need for devices like walkers, canes, or orthotics and ensuring their availability can significantly improve a patient’s ability to be active.
7. Frequent Skin Integrity Assessment: Patients with decreased activity are at higher risk for pressure ulcers. Regular skin assessments, especially in areas prone to pressure, are vital for preventing skin breakdown and complications.
Essential Nursing Interventions for Managing Activity Intolerance
Nursing interventions are critical components of a diagnosis weakness care plan, aimed at improving activity tolerance and facilitating patient recovery.
1. Initiate Range of Motion (ROM) Exercises for Bed-Rest Patients: For patients confined to bed rest, starting with ROM exercises is crucial. These exercises help maintain joint mobility, prevent muscle stiffness, and prepare the body for increased activity. It’s important to tailor exercises to the patient’s current tolerance and gradually increase intensity.
2. Continuous Vital Signs Monitoring During Activity: Monitoring vital signs throughout activity sessions is essential for patient safety. It ensures that patients remain stable and allows for immediate adjustments if adverse responses occur.
3. Provide Supplemental Oxygen Therapy as Needed: Patients with activity intolerance, especially those with respiratory conditions, may experience shortness of breath during activity. Supplemental oxygen can help maintain adequate oxygen saturation levels and improve tolerance for exercise.
4. Implement Frequent Position Changes: For patients with limited mobility, frequent position changes are crucial. This intervention prevents pressure ulcers, promotes circulation, and enhances respiratory function, indirectly improving activity tolerance.
5. Administer Appropriate Nutritional Supplements: Addressing nutritional deficits is key to improving energy levels. Providing nutritional supplements when indicated, especially for malnourished patients, supports muscle strength and overall physical capacity needed for increased activity.
6. Utilize Assistive Devices as Necessary: Ensuring patients have and use appropriate assistive devices is vital. Walkers, canes, wheelchairs, and other devices can provide support and stability, enabling patients to engage in more activity safely and comfortably.
7. Manage Pain Effectively: Pain can be a significant barrier to activity. Addressing pain with appropriate medication or non-pharmacological measures before activity sessions can significantly improve a patient’s ability to participate and progress.
8. Consult with Physician Regarding Physical/Occupational Therapy Orders: PT and OT are invaluable resources for patients with activity intolerance. Discussing therapy orders with the physician ensures patients receive structured exercise programs and expert guidance to gradually build endurance and functional skills.
9. Offer Emotional Support and Encouragement: Decreased activity levels can be discouraging. Providing emotional support, encouragement, and positive reinforcement helps patients maintain motivation and adhere to their activity plans.
10. Educate Patients on Safe Activity Increase at Home: Patient education empowers individuals to take control of their recovery. Teaching patients how to safely and gradually increase their activity levels at home promotes independence and long-term improvement. This education should include guidelines on monitoring symptoms, pacing activities, and recognizing signs of overexertion.
Nursing Care Plans: Examples for Activity Intolerance
Nursing care plans are structured frameworks that prioritize assessments and interventions to achieve both short-term and long-term care goals. Here are examples of care plans for activity intolerance, illustrating how to implement a diagnosis weakness care plan approach.
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 demonstrate stable cardiopulmonary status, indicated by:
- Heart rate within patient’s normal range.
- Systolic blood pressure increase within 20mmHg over resting systolic BP.
- Respiratory rate less than 20 breaths per minute.
- 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 hindering daily activities.
- Patient will successfully perform activities of daily living (ADLs) with minimal assistance.
Assessment:
- Identify Precipitating Factors: Assess for underlying conditions contributing to generalized weakness, such as chronic diseases (pulmonary disease, anemia, malignancy, hypothyroidism), as these conditions directly impact activity tolerance.
- Monitor Cardiopulmonary Status: Regularly monitor heart rate and rhythm, orthostatic blood pressure changes, respiratory rate, level of consciousness, skin color, and reports of chest discomfort. Changes in these parameters guide activity progression and indicate tolerance levels.
Interventions:
- Assist with ADLs: Provide assistance with ADLs as needed, but avoid promoting dependency. Encourage patient participation to conserve energy while maintaining self-esteem and promoting gradual independence.
- Encourage Rest Periods: Ensure adequate rest periods, especially before meals, ADLs, and planned exercise. Rest between activities conserves energy and prevents overexertion.
- Plan Activities around Peak Energy Levels: Schedule activities when the patient reports having the most energy. This optimizes participation and success in physical activities.
- Promote Endurance-Enhancing Physical Activity: Encourage appropriate physical activity, focusing on exercises that build endurance. Strength training and aerobic exercises maintain muscle strength, joint range of motion, and overall exercise tolerance.
- Gradually Progress Activities: Implement a gradual progression of activities:
- Begin with active ROM exercises in bed, progress to sitting and standing.
- Encourage dangling legs for 10-15 minutes daily to improve orthostatic tolerance.
- Implement deep breathing exercises at least 3 times daily to enhance respiratory function.
- Start with walking in the room for 1-2 minutes, 3 times daily, gradually increasing duration and distance.
- Progress to walking outside the house as tolerated.
This staged approach prevents cardiac overexertion and promotes safe deconditioning.
- Utilize Assistive Devices: Encourage or assist with the use of assistive devices (transfer chairs, wheelchairs, bath benches) to reduce fatigue and discomfort during activities, enhancing safety and independence.
Care Plan #2: Activity Intolerance related to Compromised Oxygen Transport System
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 exhibit no signs of respiratory distress from atelectasis post-nursing interventions, evidenced by:
- Respiratory rate less than 20 breaths per minute.
- Absence of dyspnea (shortness of breath).
- Pinkish skin and nail beds, indicating adequate oxygenation.
- Absence of accessory muscle use during breathing.
- Absence of digital clubbing.
- Oxygen saturation (SpO2) greater than 95%.
- Patient will effectively utilize energy-conservation techniques to manage activity levels.
Assessment:
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Assess for Atelectasis Signs and Symptoms: Monitor for indicators of atelectasis, including:
- Decreased or absent breath sounds in affected lung areas.
- Crackles (abnormal lung sounds).
- Cough (may be present or absent).
- Sputum production (note color and consistency).
- Dyspnea or increased work of breathing.
- Tachypnea (rapid breathing).
- Diminished chest expansion on the affected side.
- Cyanosis (bluish discoloration of skin and mucous membranes).
Atelectasis can be initially asymptomatic, but these signs suggest potential lung collapse requiring immediate attention.
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Monitor Laboratory and Diagnostic Findings: Review relevant results:
- Chest X-ray: Assess for tracheal shift, pulmonary opacities, and displacement of interlobar fissures, indicative of atelectasis.
- Arterial Blood Gases (ABGs): Evaluate for arterial hypoxemia (low blood oxygen) and respiratory alkalosis.
- Chest CT Scan: Check for lung densities at the peripheries and lung volume reduction on the affected side for detailed assessment.
Interventions:
- Administer Medications as Prescribed: Administer medications as indicated, such as mucolytics like acetylcysteine to help clear mucous plugs in airways. Other medications may target underlying causes or include inhaled bronchodilators to open airways.
- Encourage Deep Breathing and Incentive Spirometry: Promote deep breathing exercises and use of incentive spirometry to encourage lung re-expansion and prevent further collapse.
- Teach Energy Conservation Techniques: Educate the patient in energy-saving methods:
- Frequent position changes to improve lung expansion and prevent fatigue.
- Pushing objects rather than pulling to reduce exertion.
- Sitting down to perform tasks whenever possible.
- Resting for at least one hour after meals before resuming activity.
- Organizing a work-rest-work schedule to balance activity and recovery.
These techniques reduce oxygen consumption and enable more sustained activity.
- Refer to Respiratory Therapist for Pulmonary Rehabilitation: Recommend referral to a respiratory therapist for pulmonary rehabilitation. This specialized program helps manage symptoms, prevent disability progression, encourages physical and social participation, and enhances quality of life for patients with pulmonary conditions.
- Provide Supplemental Oxygenation: Administer supplemental oxygen as prescribed to aid in lung re-expansion and maintain arterial oxygen saturation above 90%, supporting oxygen transport and reducing hypoxemia.
Care Plan #3: Activity Intolerance related to Physical Deconditioning or 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 measurable increased tolerance to physical activity over time.
- Patient will participate in prescribed physical activity routines with appropriate physiological responses: heart rate, blood pressure, and breathing rate within acceptable limits.
Assessment:
- Assess Level of Physical Activity and Mobility: Evaluate the patient’s current functional capacity and mobility level to establish a baseline. Determine the extent of assistance needed to improve activity tolerance and mobility.
- Determine Cause of Activity Intolerance: Identify whether the primary cause is physical deconditioning, psychological factors (like fear or anxiety), motivational issues, or a combination. Understanding the cause directs targeted nursing care strategies to reduce deconditioning effectively.
- Monitor Activity Tolerance: Continuously monitor and record the patient’s ability to tolerate activity. Track vital signs (pulse rate, blood pressure, respiratory rate, oxygen saturation) and observe work of breathing before, during, and after activity sessions. Recognize signs of cardiac decompensation (dyspnea, palpitations, chest discomfort, hypo/hypertension, tachycardia, decreased SpO2, lightheadedness) which necessitate immediate cessation of activity.
Interventions:
- Upright Positioning During Bed Rest: If the patient is on bed rest, position them upright when possible to minimize cardiovascular deconditioning. Upright positions help maintain optimal fluid distribution and orthostatic tolerance by counteracting fluid shifts from extremities to the thoracic cavity during bed rest.
- Assist with Gradual Activity Progression: Assist with self-care activities, positioning, and transferring. Gradually increase activity as tolerated, progressing from sitting in bed to dangling, standing, and ambulating. Always ensure the patient dangles at the bedside before standing to assess for postural hypotension. Bed rest-related plasma volume reduction impacts autonomic circulatory control.
- Implement Range-of-Motion (ROM) Exercises: Perform ROM exercises if the patient is immobile or unable to tolerate active movement. ROM exercises enhance joint mobility, improve joint integrity, reduce stiffness and pain, and promote functional independence.
- Refer to Physical Therapy: Refer the patient to physical therapy for expert assessment and a tailored physical activity plan. Physical therapists specialize in designing programs to increase activity levels, build strength, and improve mobility safely and effectively.
- Provide Emotional Support and Encouragement: Offer consistent emotional support and encouragement to gradually increase activity. Set mutual, realistic goals to enhance activity levels incrementally. Address fears of breathlessness, pain, or falling that may hinder willingness to increase activity. Emotional support helps prevent functional decline, improves patient feelings about exercise, and reinforces the benefits of physical activity.
- Obtain and Utilize Assistive Devices: Secure necessary assistive devices or equipment (walkers, canes, crutches, portable oxygen) before ambulating the patient. Ensure devices are properly fitted and used to support increased physical activity safely and effectively. Assistive devices aid in stability, reduce strain, and promote confidence in movement.
By implementing these comprehensive nursing care plans, healthcare providers can effectively address activity intolerance, promote patient recovery, and enhance their quality of life. The focus on accurate diagnosis, tailored interventions, and continuous assessment ensures that patients receive the optimal support to regain and maintain their desired activity levels.
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
