Nursing Diagnosis: Activity Intolerance – Comprehensive Guide for Nurses

Activity intolerance as a nursing diagnosis is defined as a state in which an individual has insufficient physiological or psychological energy to perform or complete their desired or necessary daily activities. This condition affects a diverse population, ranging from children to older adults. Individuals with a history of reduced physical activity or previous experiences of activity intolerance are at a higher risk of recurrence. Numerous underlying health conditions and factors can elevate a person’s susceptibility to activity intolerance.

It’s important to note that while this nursing diagnosis was previously termed “Activity Intolerance,” it has been updated to “Decreased Activity Tolerance” by the NANDA International Diagnosis Development Committee (DDC) to align with current language standards. Although the official label has changed, “Activity Intolerance” remains widely recognized and used in clinical practice. For clarity and broader understanding, this article will continue to use “Activity Intolerance.”

Common Causes of Activity Intolerance

Several factors can contribute to activity intolerance. Identifying these causes is crucial for developing effective nursing interventions.

• Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD) significantly impact respiratory function, leading to decreased oxygenation and increased fatigue, both of which contribute to activity intolerance. These conditions impair the lungs’ ability to efficiently exchange oxygen and carbon dioxide, essential for energy production during physical activity.
• Anemia: Anemia, characterized by a deficiency of red blood cells or hemoglobin, reduces the blood’s oxygen-carrying capacity. This results in insufficient oxygen delivery to tissues and muscles, causing fatigue and activity intolerance. Different types of anemia, such as iron-deficiency anemia or vitamin B12 deficiency, can all lead to this issue.
• Malnutrition: Inadequate nutrition deprives the body of essential nutrients needed for energy production and muscle function. Malnutrition can manifest in various forms, including deficiencies in macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins, minerals), all of which are vital for maintaining energy levels and physical endurance.
• Depression: Depression is not just a mental health condition; it also has significant physical manifestations. It often leads to decreased energy levels, fatigue, and loss of interest in activities. The neurochemical imbalances in depression can directly impact energy regulation and motivation to engage in physical activities.
• Acute or Chronic Pain: Pain, whether acute (sudden and short-term) or chronic (long-lasting), can severely limit a person’s ability to move and participate in activities. Pain can be physically debilitating and also psychologically draining, leading to avoidance of movement and subsequent activity intolerance.
• Decreased Mobility due to Surgery: Post-surgical immobility, whether due to the surgical procedure itself, pain, or required recovery protocols, inevitably leads to muscle weakness and reduced physical capacity. Prolonged periods of inactivity after surgery contribute to deconditioning, making it harder to resume normal activity levels.
• Inadequate Sleep: Sleep is essential for physical and mental restoration. Insufficient or poor-quality sleep leads to fatigue, reduced energy levels, and impaired cognitive function, all of which contribute to activity intolerance. Chronic sleep deprivation can have a cumulative negative impact on overall physical endurance and tolerance to activity.
• Cognitive Impairment: Cognitive impairments, such as dementia or delirium, can affect a person’s ability to understand and follow instructions for physical activity, plan and execute movements, and maintain safety during activities. These impairments can indirectly lead to decreased activity levels and intolerance due to safety concerns and reduced self-efficacy.
• Generalized Weakness: Generalized weakness, which can stem from various underlying medical conditions, muscle atrophy due to disuse, or age-related changes, directly reduces physical strength and endurance. This overall lack of muscle power makes it difficult to perform even routine daily tasks, leading to activity intolerance.

This image illustrates the distinction between subjective and objective data in nursing assessments, crucial for identifying activity intolerance symptoms.

Signs and Symptoms of Activity Intolerance

Recognizing the signs and symptoms of activity intolerance is vital for accurate diagnosis and intervention. These symptoms can be categorized as subjective (reported by the patient) and objective (observed by the nurse).

Subjective Symptoms (Patient Reports)

• Patient’s Report of Decreased Activity/Weakness: This is a primary indicator. Patients may verbally express feeling weaker than usual, having less energy, or noticing a decline in their ability to perform activities they previously managed without difficulty. This subjective feeling of reduced capacity is a key starting point in assessing activity intolerance.
• Shortness of Breath with Exertion: Dyspnea, or shortness of breath, that occurs or worsens with physical activity is a significant subjective symptom. Patients may report feeling winded or struggling to breathe during or after activities that should not normally cause such distress. This symptom often points to underlying respiratory or cardiovascular issues contributing to activity intolerance.
• Fatigue: Fatigue in the context of activity intolerance is more than just ordinary tiredness. It is a persistent and overwhelming sense of exhaustion that is not relieved by rest. Patients may describe feeling constantly drained, lacking energy even after sleep, and finding it difficult to initiate or sustain physical activity.
• Exertional Discomfort: This encompasses various unpleasant sensations experienced during or after physical exertion, such as chest pain, muscle aches, or general discomfort. Patients may report feeling pain, heaviness, or tightness in their chest, muscles, or joints when attempting to be active. This discomfort acts as a barrier to continuing activity and indicates activity intolerance.

Objective Symptoms (Nurse Assesses)

• Abnormal Blood Pressure and Heart Rate Response to Activity: An abnormal physiological response to activity is a key objective sign. This can manifest as an exaggerated increase in heart rate, a significant rise or drop in blood pressure, or a slow recovery of vital signs to baseline levels after activity. These responses indicate that the cardiovascular system is struggling to cope with the demands of physical exertion.
• Changes to ECG: Electrocardiogram (ECG) changes during or after activity can reveal underlying cardiac issues contributing to activity intolerance. These changes might include arrhythmias, ST-segment depression or elevation, or other abnormalities indicating myocardial ischemia or electrical instability in response to activity.
• Signs of Pain with Movement/Activity: Observable signs of pain, such as grimacing, guarding, or reluctance to move a body part during activity, are objective indicators of pain-related activity intolerance. Nurses may observe patients wincing, protecting a specific area of their body, or hesitating to perform movements that appear to cause discomfort.
• Difficulty Engaging in Activity: Observable difficulty in initiating or sustaining physical activity, such as struggling to get out of bed, needing frequent rests while walking short distances, or appearing physically strained during simple tasks, is an objective sign of activity intolerance. This can be seen in a patient’s hesitant movements, slow pace, or need for assistance with activities they should be able to perform independently.
• Increased Oxygen Demands: Objective signs of increased oxygen demand during activity include increased respiratory rate (tachypnea), use of accessory muscles for breathing, nasal flaring, or decreased oxygen saturation levels (SpO2). These signs indicate that the body is working harder to obtain sufficient oxygen during physical exertion, suggesting activity intolerance related to respiratory or cardiovascular limitations.

This image represents a nursing care plan, highlighting the structured approach nurses take in addressing patient needs like activity intolerance.

Expected Outcomes for Activity Intolerance

Setting realistic and measurable expected outcomes is essential for effective nursing care planning. For patients with activity intolerance, common expected outcomes include:

• Patient’s Vital Signs Will Normalize with Activity: This outcome focuses on physiological stability during activity. Normalization means that the patient’s heart rate, blood pressure, and respiratory rate will remain within acceptable limits or return to baseline promptly after activity. This indicates improved cardiovascular and respiratory response to exertion.
• Patient Will Be Able to Participate in PT and OT Sessions: This outcome highlights the patient’s ability to engage in therapeutic activities. Successful participation in Physical Therapy (PT) and Occupational Therapy (OT) sessions demonstrates improved physical capacity and willingness to engage in rehabilitation, contributing to increased activity tolerance.
• Patient’s Activity Will Return to Baseline Activity Level: The goal here is to restore the patient’s functional capacity to their pre-illness or pre-injury level of activity. This outcome aims to improve the patient’s ability to perform their usual daily activities without undue fatigue or distress, indicating a significant improvement in activity tolerance.
• Patient Will Be Able to Independently Complete Activities of Daily Living (ADLs): Achieving independence in ADLs, such as bathing, dressing, eating, and toileting, is a crucial outcome for patients with activity intolerance. This outcome reflects a significant improvement in functional status and quality of life, as it allows patients to care for themselves without assistance.
• 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. This indicates that the patient’s heart is tolerating physical exertion without developing arrhythmias or other rhythm disturbances, ensuring cardiovascular safety during activity.
• Patient Will Verbalize Understanding of the Need to Gradually Increase Activity Level and How to Accomplish This: Patient education is a key component of managing activity intolerance. This outcome focuses on the patient’s cognitive understanding and self-management skills. Verbalizing understanding of the importance of gradual activity progression and the methods to achieve this empowers patients to take an active role in their recovery and prevent setbacks.

Nursing Assessment for Activity Intolerance

A thorough nursing assessment is the foundation for addressing activity intolerance. It involves gathering both subjective and objective data to understand the patient’s condition comprehensively.

1. Assess the Patient’s Present Level of Activity and Tolerance to Activity:

• This initial assessment establishes a baseline. Understanding the patient’s current activity level, what activities they can perform, and how well they tolerate them is crucial. This includes inquiring about their daily routines, any limitations they experience, and their perception of their activity level compared to their usual state. This baseline helps in tracking progress and tailoring interventions.

2. Assess the Patient’s Vital Signs:

• Vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) provide objective data on the patient’s physiological status at rest and during activity. Monitoring these parameters helps to identify any abnormal responses to exertion, such as tachycardia, hypertension, hypotension, or desaturation. Baseline vital signs are essential for comparison and detecting changes.

3. Assess the Underlying Cause of Activity Intolerance:

• Identifying the root cause is crucial for targeted interventions. This involves reviewing the patient’s medical history, current medical conditions, medications, and recent events that could contribute to activity intolerance. Common causes include respiratory diseases, cardiac conditions, anemia, pain, and deconditioning. Addressing the underlying cause is often necessary to improve activity tolerance.

4. Review Medication List:

• Certain medications and their side effects can contribute to fatigue and decreased activity tolerance. Sedatives, beta-blockers, and some pain medications are examples. Reviewing the medication list helps identify potential medication-related causes of activity intolerance. If medications are implicated, collaboration with the physician to explore alternative medications or timing of administration may be beneficial.

5. Assess Nutritional Status:

• Adequate nutrition is essential for energy production and muscle function. Assessing nutritional status includes evaluating dietary intake, appetite, weight changes, and any signs of malnutrition. Nutritional deficiencies can directly impact energy levels and contribute to activity intolerance. Nutritional support and dietary modifications may be necessary interventions.

6. Assess Potential Need for Assistive Devices with Activity:

• Lack of appropriate assistive devices can be a barrier to activity. Assess if the patient requires devices such as walkers, canes, crutches, or wheelchairs to enhance their mobility and activity level. Providing necessary assistive devices can significantly improve a patient’s ability to engage in activities safely and independently.

7. Assess Skin Integrity Frequently:

• Patients with decreased activity levels or intolerance are at increased risk of pressure ulcers. Regular skin assessments, especially over bony prominences, are essential to prevent skin breakdown. Immobility and reduced weight shifting contribute to pressure ulcer development. Frequent skin assessments and preventive measures, such as repositioning and pressure-relieving devices, are crucial.

This image represents nursing interventions, the actions nurses take to address patient diagnoses and improve their health outcomes, including activity intolerance.

Nursing Interventions for Activity Intolerance

Nursing interventions are targeted actions designed to address the identified causes and symptoms of activity intolerance and promote improved functional capacity.

1. If the Patient is Limited to Bed-Rest, Begin with Range of Motion (ROM) Exercises:

• For patients on bed rest, initiating Range of Motion (ROM) exercises is crucial to prevent muscle atrophy, joint stiffness, and circulatory complications associated with immobility. ROM exercises can be passive (nurse assists) or active (patient performs). Starting with ROM exercises helps maintain joint flexibility and muscle tone, preparing the patient for increased activity levels as tolerated.

2. Monitor Vital Signs Throughout Activity:

• Monitoring vital signs before, during, and after activity is essential to ensure patient safety and assess physiological response to exertion. This helps detect any adverse reactions such as abnormal heart rate or blood pressure changes, shortness of breath, or decreased oxygen saturation. Continuous monitoring allows for timely adjustments to activity levels and interventions.

3. Provide Supplemental Oxygen Therapy as Needed:

• Patients with decreased activity tolerance, especially those with respiratory or cardiac conditions, may experience oxygen desaturation during activity. Supplemental oxygen therapy can help maintain adequate oxygen saturation levels, reducing shortness of breath and improving tolerance to activity. Oxygen administration should be guided by physician orders and patient assessment.

4. Provide Frequent Position Changes:

• For patients on bed rest or chair rest, frequent position changes are vital to prevent pressure ulcers and promote circulation. Repositioning at least every two hours, or more frequently as needed, helps redistribute pressure and prevent skin breakdown. Position changes also help improve respiratory function and comfort.

5. Provide Appropriate Nutritional Supplements When Indicated:

• Nutritional deficiencies can exacerbate activity intolerance. If malnutrition is identified, providing appropriate nutritional supplements, as prescribed by a physician or dietitian, can help improve energy levels and muscle strength. Nutritional support may include oral supplements, enteral nutrition, or parenteral nutrition, depending on the patient’s needs and ability to tolerate oral intake.

6. Utilize Appropriate Assistive Devices if Needed:

• Providing and ensuring the proper use of assistive devices, such as walkers, canes, crutches, or wheelchairs, can significantly enhance a patient’s mobility and activity level. These devices provide support, stability, and reduce the energy expenditure required for ambulation. Proper fitting and patient education on device usage are essential.

7. Treat Pain as Needed:

• Pain is a major barrier to activity. Effective pain management is crucial to improve activity tolerance. Administering pain medication as prescribed, and utilizing non-pharmacological pain management techniques, can help reduce pain and enable patients to participate more comfortably in activities. Pain should be assessed regularly, and pain management strategies should be tailored to the patient’s needs.

8. Discuss Order for PT/OT with MD:

• Physical Therapy (PT) and Occupational Therapy (OT) are essential resources for patients with activity intolerance. Consulting with the physician to obtain orders for PT and OT services allows for specialized assessment and intervention to improve mobility, strength, endurance, and functional skills. PT and OT professionals can develop individualized exercise programs and strategies to enhance activity tolerance.

9. Provide Emotional Support to the Patient:

• Activity intolerance can be discouraging and frustrating for patients. Providing emotional support, encouragement, and positive reinforcement is crucial. Patients may experience feelings of helplessness, sadness, or anxiety related to their limitations. Emotional support helps patients cope with these feelings, maintain motivation, and adhere to activity plans.

10. Educate the Patient on How to Safely Increase Activity Level at Home:

• Patient education is vital for long-term management of activity intolerance. Educating patients on safe and gradual methods to increase activity levels at home empowers them to take control of their health and promote recovery. This includes teaching principles of pacing activities, monitoring symptoms, recognizing signs of overexertion, and strategies for energy conservation. Home exercise programs and written instructions can enhance patient understanding and adherence.

Nursing Care Plans for Activity Intolerance

Nursing care plans provide a structured approach to patient care, outlining diagnoses, expected outcomes, assessments, and interventions. Here are examples of nursing 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 a stable cardiopulmonary status as evidenced by:
  • Heart rate within normal limits for age and condition.
  • Systolic BP within 20mmHg increase over resting systolic BP during activity.
  • Respiratory rate less than 20 breaths/min at rest and during activity.
• Using the Rate of Perceived Exertion (RPE) Scale from 0 to 10, the patient will report 0 or a decreased rating of perceived exertion after physical activity.
• Patient will report the absence of fatigue or a reduction in fatigue levels.
• Patient will perform activities of daily living with minimal assistance.

Assessment:

1. Assess precipitating factors:

• Generalized weakness, fatigue, and exertional discomfort can be nonspecific symptoms related to various underlying conditions such as chronic diseases (pulmonary, cardiac, endocrine), anemia, malignancy, or deconditioning. Identifying potential underlying causes guides further diagnostic evaluation and targeted interventions.

2. Monitor the patient’s cardiopulmonary status:

• Heart rate and rhythm, orthostatic BP changes, rate of breathing, level of consciousness, skin color, and chest discomfort are key indicators of cardiopulmonary function and tolerance to activity. Changes in these parameters during activity provide crucial information about the patient’s physiological response and help determine activity progression.

Interventions:

1. Assist with ADLs as indicated, but not to the extent of promoting dependency:

• Providing assistance with Activities of Daily Living (ADLs) conserves the patient’s energy, reducing fatigue and allowing energy to be used for therapeutic activities. However, it is vital to balance assistance with encouraging independence and self-care to prevent learned helplessness and promote self-esteem. The goal is to facilitate endurance and functional recovery, not to create dependency.

2. Encourage adequate rest periods, especially before meals, other ADLs, and exercise:

• Rest periods between activities allow for energy restoration and prevent overexertion. Scheduling rest before energy-demanding activities like meals, ADLs, and planned exercise sessions optimizes energy levels and improves activity tolerance. Planned rest is as important as planned activity.

3. Assist the patient with planning activities when they have the most energy:

• Activities should be scheduled to coincide with the patient’s peak energy levels. This requires assessing the patient’s diurnal energy patterns and planning activities for times when they feel most energetic. Individualizing activity scheduling based on energy patterns improves participation and success.

4. Encourage physical activity, especially exercises that enhance endurance:

• Regular physical activity and endurance-building exercises are essential to improve muscle strength, joint range of motion (ROM), and overall exercise tolerance. Strength training and aerobic exercises, tailored to the patient’s abilities and limitations, are valuable in enhancing endurance and functional capacity.

5. Progress activities gradually:

• A gradual and progressive approach to increasing activity is crucial to prevent overexertion and cardiac strain. Starting with simple activities and progressively increasing intensity and duration is recommended. Examples include:
• Active ROM exercises in bed, progressing to sitting and standing.
• Dangling legs for 10 to 15 minutes daily to improve orthostatic tolerance.
• Deep breathing exercises at least 3 times daily to improve respiratory function.
• Walking in room for 1 to 2 minutes 3 times daily, gradually increasing distance and duration.
• Progressing to walking outside the house as tolerated.
• This step-wise progression helps the heart adapt to increased demands and prevents deconditioning without overwhelming the patient.

6. Encourage or assist the patient in using assistive devices if necessary:

• Assistive devices such as transfer chairs, wheelchairs, bath benches, walkers, or canes can reduce fatigue and discomfort during activities. These devices provide support and stability, conserving energy and improving safety. Proper selection and fitting of assistive devices are essential to maximize their benefit.

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:

• After nursing interventions, the patient will not exhibit signs of respiratory distress brought by atelectasis as evidenced by:
  • Respiratory rate less than 20 breaths/min.
  • Absence of dyspnea at rest and with mild activity.
  • Pinkish skin and nails, indicating adequate oxygenation.
  • Absence of use of accessory muscles of respiration.
  • Absence of finger clubbing.
  • O2 saturation >95% on room air or baseline.
• The patient will utilize energy-conservation techniques to manage activity levels.

Assessment:

1. Assess for signs and symptoms of atelectasis:

• Atelectasis, or lung collapse, can significantly impair oxygen transport and lead to activity intolerance. Signs and symptoms to assess include:
• Decreased or absent breath sounds in affected lung areas.
• Crackles (rales) upon auscultation.
• Cough, which may be productive or non-productive.
• Sputum production, noting color and consistency.
• Dyspnea (shortness of breath), especially with exertion.
• Tachypnea (increased respiratory rate).
• Diminished chest expansion on the affected side.
• Cyanosis (bluish discoloration of skin and mucous membranes), indicating hypoxemia.
• Atelectasis may be initially asymptomatic, but these signs and symptoms indicate a pulmonary complication requiring prompt intervention.

2. Monitor laboratory findings including:

• Diagnostic tests confirm atelectasis and its severity:
• Chest x-ray results may reveal tracheal shift toward the affected side, pulmonary opacities, and displacement of interlobar fissures, indicating lung collapse.
• Arterial Blood Gases (ABGs) may reveal arterial hypoxemia (low PaO2) and respiratory alkalosis (low PaCO2 due to hyperventilation).
• Chest CT scan provides detailed imaging and can reveal lung densities at the peripheries and lung volume reduction on the affected side, confirming the extent and location of atelectasis.

Interventions:

1. Administer medications as indicated:

• Medications may be prescribed to address the underlying cause of atelectasis or to facilitate airway clearance:
• Mucolytics such as acetylcysteine (Mucomyst) help to break down and thin thick mucous secretions, beneficial for patients with mucous plugging contributing to atelectasis.
• Bronchodilators may be used to open airways and improve airflow, especially if bronchospasm is a contributing factor.
• Antibiotics may be indicated if infection is the underlying cause of atelectasis.
• Inhaled medications, such as bronchodilators or mucolytics, may be administered via nebulizer or metered-dose inhaler to deliver medication directly to the airways.

2. Encourage the patient to take deep breaths or use incentive spirometry:

• Deep breathing exercises and incentive spirometry are crucial to promote lung re-expansion and prevent further atelectasis. These activities encourage full lung inflation, improve alveolar ventilation, and help clear secretions. Incentive spirometry provides visual feedback and encourages sustained maximal inspiration.

3. Teach energy conservation techniques:

• Energy conservation techniques reduce oxygen consumption and fatigue, allowing for more prolonged activity and improved tolerance. Examples include:
• Changing positions often to prevent prolonged pressure on one area and improve ventilation.
• Pushing rather than pulling objects to reduce muscle strain.
• Sitting to perform tasks whenever possible to decrease energy expenditure.
• Resting for at least 1 hour after meals before starting a new activity to allow for digestion and energy conservation.
• Organizing a work-rest-work schedule to balance activity with rest periods and prevent overexertion.

4. Refer the patient to a respiratory therapist for pulmonary rehabilitation:

• Pulmonary rehabilitation programs, led by respiratory therapists, provide comprehensive care to improve respiratory function and activity tolerance in patients with pulmonary diseases, including those with atelectasis and chronic lung conditions. Pulmonary rehabilitation aims to:
• Alleviate pulmonary symptoms such as dyspnea and cough.
• Prevent further disability and disease progression.
• Encourage participation in physical and social activities.
• Enhance overall quality of life.
• Pulmonary rehabilitation programs typically include exercise training, breathing techniques, education, and psychosocial support.

5. Provide supplemental oxygenation:

• Supplemental oxygen therapy helps improve oxygenation and increase arterial oxygen saturation, essential for lung re-expansion and tissue oxygen delivery. Oxygen administration is typically titrated to maintain SpO2 >90% or as prescribed by the physician. Adequate oxygenation reduces hypoxemia-related symptoms and improves activity tolerance.

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, progressing towards pre-deconditioning activity levels.
• Patient will participate in prescribed physical activity with appropriate physiological responses, including heart rate, blood pressure, and breathing rate within acceptable limits for activity level.

Assessment:

1. Assess the level of physical activity and mobility:

• A thorough assessment of the patient’s current level of physical activity and mobility provides baseline data on functional capacity. This includes evaluating:
• Types of activities the patient can perform (e.g., walking, ADLs, exercise).
• Duration and intensity of activity.
• Level of assistance required for mobility and activities.
• Patient’s subjective perception of their activity level and limitations.
• This baseline assessment helps determine the extent of deconditioning and guides the development of an individualized activity plan.

2. Determine the cause of activity intolerance:

• Identifying the underlying cause of activity intolerance is crucial for effective intervention planning. Causes can be:
• Physical: Prolonged bed rest, sedentary lifestyle, musculoskeletal impairments, chronic illnesses.
• Psychological: Depression, anxiety, fear of falling or injury, lack of motivation.
• Motivational: Lack of interest in activity, perceived lack of benefits, low self-efficacy.
• Understanding the contributing factors allows the nurse to address specific barriers and implement evidence-based strategies to reduce deconditioning.

3. Monitor and record the patient’s ability to tolerate activity:

• Systematic monitoring of activity tolerance is essential to guide activity progression and ensure patient safety. This includes:
• Measuring and recording vital signs (pulse rate, blood pressure, respiratory rate) and oxygen saturation (SpO2) before, during, and after activity.
• Observing and documenting the patient’s subjective symptoms, such as dyspnea, chest pain, fatigue, dizziness, or palpitations.
• Monitoring for objective signs of cardiac decompensation (e.g., dyspnea, palpitations, chest discomfort, hypotension/hypertension, tachycardia, decreased oxygen saturation, lightheadedness).
• If signs and symptoms of cardiac decompensation occur, the activity should be stopped immediately, and the patient’s condition should be further evaluated.

Interventions:

1. If the patient is on bed rest, position the patient upright to minimize cardiovascular deconditioning:

• During prolonged bed rest, gravitational stress is lost, causing fluid shifts from the extremities to the thoracic cavity, leading to cardiovascular deconditioning and orthostatic intolerance. Positioning the patient upright, such as in a semi-Fowler’s or high-Fowler’s position, helps:
• Maintain optimal fluid distribution.
• Improve orthostatic tolerance.
• Reduce cardiovascular deconditioning effects.
• Upright positioning should be implemented as tolerated and in accordance with the patient’s medical condition.

2. Assist the patient with self-care activities, positioning, and transferring. Gradually increase activity as able:

• Providing assistance with self-care activities, positioning, and transfers conserves the patient’s energy initially and prevents overexertion. As the patient’s tolerance improves, gradually increase activity levels in a progressive manner:
• Progress from sitting in bed to dangling legs at the bedside.
• Advance to standing at the bedside, with support if needed.
• Progress to ambulating short distances in the room, gradually increasing distance and duration.
• Always have the patient dangle at the bedside before standing and ambulating to assess for postural hypotension and prevent falls. Plasma volume reduction associated with bed rest affects autonomic control of circulation, increasing the risk of orthostatic hypotension.

3. Perform range-of-motion (ROM) exercises if the patient is immobile and cannot tolerate activity:

• For patients who are immobile or have very limited activity tolerance, passive or active-assistive Range of Motion (ROM) exercises are essential to:
• Increase joint movement and flexibility.
• Improve joint integrity.
• Decrease pain and stiffness.
• Promote muscle strength and circulation.
• Maintain functional independence.
• ROM exercises should be performed regularly, at least 2-3 times daily, focusing on all major joints.

4. Refer to physical therapy:

• Physical therapists are experts in exercise prescription and rehabilitation. Referral to physical therapy is crucial for patients with activity intolerance due to deconditioning. Physical therapists can:
• Conduct comprehensive assessments of physical function and mobility.
• Develop individualized physical activity plans tailored to the patient’s needs and abilities.
• Provide supervised exercise sessions to improve strength, endurance, balance, and coordination.
• Educate patients on safe exercise techniques and progression.
• Physical therapy intervention is essential for optimizing functional recovery and increasing activity tolerance.

5. Provide emotional support and encouragement to gradually increase activity:

• Fear of breathlessness, pain, falling, or symptom exacerbation can decrease a patient’s willingness to increase activity levels. Providing emotional support, encouragement, and positive reinforcement is crucial to address these fears and promote motivation. Strategies include:
• Setting mutual, realistic goals for activity progression with the patient.
• Providing positive feedback and acknowledging progress.
• Addressing patient concerns and anxieties related to activity.
• Educating the patient on the benefits of exercise and activity.
• Emotional support helps prevent functional decline, improves the patient’s experience with exercise, and promotes a belief in the benefits of increased activity.

6. Obtain any necessary assistive devices or equipment before ambulating the patient:

• Assistive devices and equipment can provide support and safety during ambulation and activity progression. Ensure necessary devices are readily available and properly fitted before mobilizing the patient:
• Walkers, canes, crutches provide stability and reduce weight-bearing on lower extremities.
• Portable oxygen can be used to supplement oxygen needs during activity for patients with oxygen desaturation.
• Appropriate footwear should be provided to prevent falls.
• Using assistive devices appropriately supports patients in safely increasing physical activity and improving mobility.

References

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2. Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
3. 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.
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