Understanding Activity Intolerance in Nursing
In nursing, Activity Intolerance is recognized as a significant nursing diagnosis, describing a state where an individual has insufficient physical or psychological energy to perform or complete their necessary or desired daily activities. This condition spans across all age groups, from children to the elderly, and is particularly relevant for individuals with a history of reduced activity or previous episodes of intolerance. A variety of underlying health issues can elevate a person’s susceptibility to activity intolerance, with generalized weakness being a prominent factor.
It’s important to note that while this nursing diagnosis was previously termed “Activity Intolerance,” it has been updated to “Decreased Activity Tolerance” by NANDA International. However, for clarity and broader understanding, this article will continue to use “Activity Intolerance.”
This guide aims to provide a comprehensive understanding of activity intolerance, especially when linked to general weakness, and to equip nurses and nursing students with the knowledge to develop effective nursing care plans.
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Alt text: Nurse assisting patient with ambulation, demonstrating activity intolerance nursing care.
Common Causes of Activity Intolerance
Several factors can contribute to activity intolerance. Identifying these causes is crucial for developing targeted nursing interventions and care plans. Common related factors include:
- Respiratory Conditions: Conditions like COPD significantly impact oxygen intake and utilization, leading to decreased activity tolerance.
- Anemia: Reduced red blood cell count lowers oxygen-carrying capacity, resulting in fatigue and weakness.
- Malnutrition: Inadequate nutrient intake deprives the body of the energy needed for activities.
- Depression: Mental health conditions like depression can cause fatigue and lack of motivation, affecting physical activity.
- Pain: Both acute and chronic pain can limit movement and reduce the willingness to engage in activities.
- Decreased Mobility: Post-surgery limitations or conditions affecting mobility directly hinder physical activity.
- Inadequate Sleep: Lack of sufficient rest reduces overall energy levels and the ability to perform activities.
- Cognitive Impairment: Conditions affecting cognitive function can impact the ability to plan and execute activities.
- Generalized Weakness: Muscle weakness from various causes directly reduces physical endurance and activity tolerance. This is a key factor in many cases and often requires a tailored nursing care plan for general weakness.
Recognizing Signs and Symptoms
Identifying the signs and symptoms of activity intolerance is essential for accurate diagnosis and effective nursing care. 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 or weakness: This is a primary indicator, often described as general weakness that limits their ability to perform daily tasks.
- Shortness of breath with exertion: Dyspnea or difficulty breathing during activity.
- Fatigue: Feeling unusually tired or exhausted, even after minimal activity.
- Exertional discomfort: Pain, chest discomfort, or other unpleasant sensations experienced during activity.
Objective Signs (Nurse Assesses):
- Abnormal blood pressure and heart rate response to activity: Significant increases or decreases in vital signs during or after activity.
- Changes to ECG: Irregular heart rhythms or other cardiac abnormalities detected by electrocardiogram.
- Signs of pain with movement or activity: Observable signs of discomfort, such as grimacing or guarding.
- Difficulty engaging in activity: Struggling to initiate or continue physical activities.
- Increased oxygen demands: Evidenced by increased respiratory rate or desaturation during activity.
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Alt text: Nurse measuring blood pressure, an objective sign assessment in nursing diagnosis.
Expected Outcomes and Nursing Goals
Setting clear goals and expected outcomes is vital for guiding nursing care and measuring progress. For patients with activity intolerance, particularly due to general weakness, typical expected outcomes include:
- Normalized vital signs with activity: Patient’s heart rate, blood pressure, and respiratory rate will remain within acceptable limits during and after activity.
- Participation in therapy sessions: Patient will be able to engage in prescribed physical therapy (PT) and occupational therapy (OT) sessions.
- Return to baseline activity level: Patient will gradually regain their previous level of activity tolerance.
- Independent completion of ADLs: Patient will be able to perform activities of daily living (ADLs) independently or with minimal assistance.
- Stable heart rhythm during activity: Patient’s cardiac rhythm will remain regular and stable throughout physical activity.
- Understanding of gradual activity increase: Patient will verbalize understanding of the importance of gradually increasing activity levels and strategies to achieve this safely at home, which is a key component of my nursing care plan.
Nursing Assessment for Activity Intolerance
A comprehensive nursing assessment is the first step in developing an effective nursing care plan. It involves gathering both subjective and objective data to understand the patient’s condition fully.
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Assess current activity level and tolerance: Determine the patient’s baseline activity level and how much activity they can currently tolerate. This forms the basis for a personalized activity plan and helps track progress.
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Monitor vital signs: Establish baseline vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation). Regular monitoring during activity is crucial to detect abnormal responses.
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Identify underlying causes: Investigate potential causes of activity intolerance, such as respiratory conditions, anemia, general weakness, or medication side effects. Addressing the root cause is essential for long-term improvement.
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Review medications: Examine the patient’s medication list for drugs that may contribute to fatigue or weakness. Consider timing adjustments or alternative medications if appropriate, in consultation with the physician.
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Evaluate nutritional status: Assess the patient’s nutritional intake and identify any deficiencies that might impact energy levels and activity tolerance. Nutritional support is often a critical part of the nursing care plan for general weakness.
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Determine need for assistive devices: Assess if the patient requires assistive devices (walkers, canes, etc.) to enhance mobility and activity levels. Ensure these devices are readily available and properly used.
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Frequent skin integrity assessment: Patients with decreased activity are at higher risk for pressure ulcers. Regular skin assessments are vital to prevent skin breakdown.
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Alt text: Nurse assessing skin for pressure ulcers, a key nursing assessment for immobile patients.
Nursing Interventions to Improve Activity Tolerance
Nursing interventions are crucial in managing activity intolerance and promoting patient recovery. These interventions should be tailored to the individual patient and their specific needs, especially when dealing with general weakness.
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Initiate ROM exercises (if bed-rest is required): Begin with range of motion exercises to maintain joint flexibility and muscle strength, especially for patients on bed rest. Gradually progress activities based on tolerance.
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Monitor vital signs during activity: Continuously monitor vital signs before, during, and after activity to ensure cardiovascular stability and detect any adverse reactions.
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Administer supplemental oxygen as needed: Provide oxygen therapy to patients who experience shortness of breath or desaturation during activity, maintaining adequate oxygen saturation levels.
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Ensure frequent position changes: For patients with limited mobility, frequent position changes are essential to prevent pressure ulcers and respiratory complications.
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Provide nutritional support: Address any nutritional deficiencies with appropriate supplements and dietary modifications to support energy production and muscle strength, particularly vital for patients with general weakness.
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Utilize assistive devices: Ensure patients have access to and use appropriate assistive devices to enhance mobility and safety during activities.
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Manage pain effectively: Address pain prior to activity to improve patient comfort and willingness to participate. Effective pain management is crucial for enhancing activity tolerance, especially post-operatively or in chronic pain conditions.
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Consult PT/OT: Collaborate with physical and occupational therapists to develop structured therapy plans and exercises to gradually build endurance and activity tolerance.
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Provide emotional support and encouragement: Address patient discouragement and frustration related to activity limitations. Offer consistent encouragement and positive reinforcement to motivate gradual progress.
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Educate on safe activity increase at home: Provide patients with clear instructions and strategies on how to safely and progressively increase their activity levels at home. This empowers patients to take control of their recovery and is a key component of my nursing care plan for discharge.
Nursing Care Plan Examples for Activity Intolerance
Nursing care plans are essential tools for organizing and prioritizing patient care. Here are examples of nursing care plans for activity intolerance, focusing on different related factors.
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 during activity, evidenced by:
- Heart rate within normal limits.
- Systolic BP increase less than 20mmHg over resting.
- Respiratory rate less than 20 breaths/min.
- Patient will report a perceived exertion rate of 0 or decreased rating using the Rate of Perceived Exertion (RPE) Scale after activity.
- Patient will report a reduction in fatigue levels.
- Patient will participate in activities of daily living.
Assessment:
- Identify precipitating factors: Assess for underlying conditions contributing to generalized weakness, such as chronic diseases, anemia, or endocrine disorders.
- Monitor cardiopulmonary status: Regularly assess heart rate, rhythm, orthostatic blood pressure changes, respiratory rate, level of consciousness, skin color, and chest discomfort to monitor tolerance to activity.
Interventions:
- Assist with ADLs: Provide assistance with activities of daily living while encouraging independence and avoiding over-assistance to prevent dependency.
- Promote rest periods: Encourage adequate rest periods, especially before meals, ADLs, and planned exercise, to conserve energy.
- Schedule activities for peak energy levels: Plan activities for times when the patient reports having the most energy.
- Encourage endurance-enhancing exercises: Promote physical activity, focusing on exercises that improve endurance and muscle strength.
- Gradual activity progression: Implement a gradual progression of activities, starting with ROM exercises in bed, advancing to sitting, dangling, standing, and ambulation, to prevent overexertion.
- Assistive devices: Provide and encourage the 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 exhibit improved respiratory status, evidenced by:
- Respiratory rate less than 20 breaths/min.
- Absence of dyspnea.
- Pinkish skin and nails.
- Absence of accessory muscle use.
- Absence of clubbing.
- O2 saturation >95%.
- Patient will utilize energy-conservation techniques.
Assessment:
- Assess for atelectasis signs and symptoms: Monitor for decreased breath sounds, crackles, cough, sputum production, dyspnea, tachypnea, diminished chest expansion, and cyanosis.
- Monitor laboratory findings: Review chest x-ray, arterial blood gases (ABGs), and chest CT results to confirm atelectasis and assess respiratory function.
Interventions:
- Administer medications: Administer prescribed mucolytics or other medications to address atelectasis and underlying conditions.
- Encourage deep breathing and incentive spirometry: Promote lung expansion through deep breathing exercises and incentive spirometry.
- Teach energy conservation techniques: Educate the patient on energy-saving techniques like pacing activities, sitting for tasks, and work-rest schedules.
- Refer to respiratory therapy: Refer the patient to a respiratory therapist for pulmonary rehabilitation to improve respiratory function and activity tolerance.
- Provide supplemental oxygen: Administer oxygen therapy to improve oxygen saturation and support lung re-expansion.
Care Plan #3: Activity Intolerance related to Physical Deconditioning
Diagnostic statement:
Activity intolerance related to physical deconditioning or immobility as evidenced by dyspnea on exertion and abnormal heart rate or blood pressure response to activity.
Expected outcomes:
- Patient will demonstrate increased tolerance to activity.
- Patient will participate in prescribed physical activity with appropriate vital sign responses (heart rate, blood pressure, breathing rate).
Assessment:
- Assess activity and mobility level: Determine the patient’s current level of physical activity and mobility to establish a baseline.
- Identify cause of intolerance: Determine if activity intolerance is due to physical deconditioning, psychological factors, or motivational issues.
- Monitor activity tolerance: Record vital signs and signs of cardiac decompensation (dyspnea, palpitations, chest discomfort, hypotension/hypertension, tachycardia, desaturation, lightheadedness) before, during, and after activity to assess tolerance.
Interventions:
- Upright positioning (if bed rest): Position the patient upright to minimize cardiovascular deconditioning during bed rest.
- Assist with self-care and gradual activity increase: Assist with self-care activities and gradually increase activity levels from sitting to ambulating, monitoring for postural hypotension.
- Perform ROM exercises: Implement range-of-motion exercises for immobile patients to maintain joint mobility and prevent stiffness.
- Refer to physical therapy: Consult physical therapy for a structured activity plan to improve strength and activity tolerance.
- Emotional support and goal setting: Provide emotional support and encouragement to gradually increase activity, setting mutual, achievable goals.
- Provide assistive devices: Obtain and ensure the use of necessary assistive devices (walkers, canes, portable oxygen) to support increased physical activity.
References
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th 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
