Nursing Diagnosis: Generalized Weakness and Activity Intolerance

The nursing diagnosis of activity intolerance, now often referred to as Decreased Activity Tolerance, is defined as a state where an individual has insufficient physiologic or psychological energy to engage in or complete their desired or necessary daily activities. This condition affects a diverse population, spanning from pediatric to geriatric patients. Individuals with a history of reduced activity or previous activity intolerance are at a heightened risk of experiencing it again. Numerous underlying health issues and factors can predispose a person to activity intolerance. One significant factor contributing to activity intolerance is generalized weakness.

It’s important to note the terminology update: While officially renamed to “Decreased Activity Tolerance” by the NANDA International Diagnosis Development Committee (DDC), this article will primarily use “Activity Intolerance” for broader recognition, acknowledging the ongoing transition in terminology within the nursing field.

Exploring the Root Causes of Activity Intolerance

Identifying the underlying causes of activity intolerance is crucial for effective nursing care. Several factors can contribute to this diagnosis, with generalized weakness being a prominent one. Other common related factors include:

Respiratory Conditions: Conditions like Chronic Obstructive Pulmonary Disease (COPD) significantly impact respiratory function, leading to decreased oxygen availability and subsequent activity intolerance.
Anemia: A deficiency in red blood cells or hemoglobin reduces the oxygen-carrying capacity of the blood, resulting in fatigue and reduced tolerance for activity.
Malnutrition: Inadequate nutrient intake deprives the body of the energy and building blocks needed for physical activity, contributing to weakness and intolerance.
Depression: Mental health conditions like depression can lead to decreased energy levels, motivation, and overall physical activity.
Pain (Acute or Chronic): Pain, whether short-term or persistent, can severely limit movement and willingness to engage in activities, leading to decreased activity tolerance.
Reduced Mobility Post-Surgery: Surgical procedures often result in temporary or prolonged limitations in mobility, directly impacting activity levels.
Sleep Deprivation: Insufficient or poor-quality sleep impairs physical and cognitive function, contributing to fatigue and reduced activity tolerance.
Cognitive Impairment: Conditions affecting cognitive function can impact an individual’s ability to plan, initiate, and safely execute daily activities.
Generalized Weakness: This broad category encompasses muscle weakness from various origins, such as deconditioning, neurological conditions, or systemic illnesses.

Recognizing the Signs and Symptoms of Activity Intolerance

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

Subjective Symptoms (Patient-Reported)

Patient reports of generalized weakness: Individuals may describe a pervasive feeling of weakness throughout their body, making activities feel more challenging.
Verbalizes decreased activity level: Patients may acknowledge a noticeable reduction in their usual activity levels, often linking it to feelings of weakness or fatigue.
Shortness of breath with exertion (Dyspnea): Experiencing breathlessness with minimal physical effort is a common complaint.
Fatigue: Persistent and overwhelming tiredness that is not relieved by rest.
Exertional discomfort: Unpleasant sensations, such as pain, heaviness, or discomfort, experienced during or after activity.

Objective Signs (Nurse-Observed)

Abnormal blood pressure and heart rate response to activity: An exaggerated increase or decrease in blood pressure or heart rate beyond normal physiological responses to activity.
Changes in ECG: Electrocardiogram abnormalities indicating cardiac stress or dysfunction during activity.
Observable signs of pain with movement/activity: Facial grimacing, guarding, or verbalizations of pain during activity.
Difficulty initiating or sustaining activity: Hesitation, slowness, or inability to continue an activity due to physical limitations.
Increased oxygen demand: Evidenced by increased respiratory rate, use of accessory muscles, or decreased oxygen saturation during activity.

Setting Expected Outcomes for Patients with Activity Intolerance

Establishing clear and measurable expected outcomes is vital for guiding nursing care and evaluating progress. Common goals for patients diagnosed with activity intolerance, particularly related to generalized weakness, include:

Normalization of vital signs with activity: The patient will demonstrate a stable cardiovascular response to activity, with vital signs returning to within normal limits post-exertion.
Active participation in physical and occupational therapy: The patient will engage in prescribed therapy sessions aimed at improving strength and activity tolerance.
Return to baseline activity level: The patient will gradually regain their pre-diagnosis level of physical activity and functional capacity.
Independent completion of Activities of Daily Living (ADLs): The patient will be able to perform essential self-care tasks, such as bathing, dressing, and eating, independently or with minimal assistance.
Stable heart rhythm during activity: The patient will maintain a regular and stable heart rhythm throughout physical activity.
Verbalized understanding of gradual activity progression: The patient will demonstrate knowledge of the importance of gradually increasing activity levels and strategies for safe progression at home.

Comprehensive Nursing Assessment for Activity Intolerance

A thorough nursing assessment is the foundation of effective care planning. When assessing a patient for activity intolerance, especially in the context of generalized weakness, the nurse should gather both subjective and objective data, focusing on:

Current Activity Level and Tolerance: Evaluate the patient’s baseline activity level and their ability to perform various activities. This establishes a starting point for care planning and progress tracking.
Vital Signs Assessment: Obtain baseline vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation) to monitor physiological responses to activity and identify any abnormalities.
Identify Underlying Causes: Investigate potential contributing factors to activity intolerance, including medical history, current health conditions, and specifically explore the reasons behind generalized weakness.
Medication Review: Analyze the patient’s medication list to identify any medications or side effects that may contribute to fatigue, weakness, or decreased activity tolerance.
Nutritional Status Evaluation: Assess the patient’s nutritional intake and status, as inadequate nutrition can lead to weakness and reduced energy levels.
Need for Assistive Devices: Determine if the patient requires assistive devices (e.g., walkers, canes) to support mobility and enhance activity levels.
Skin Integrity Assessment: Regularly assess skin integrity, particularly in patients with reduced mobility, to prevent pressure ulcers, a significant risk associated with decreased activity.

Targeted Nursing Interventions for Activity Intolerance

Nursing interventions are crucial for addressing activity intolerance and promoting patient recovery. For patients experiencing activity intolerance related to generalized weakness, key interventions include:

Initiate Range of Motion (ROM) Exercises: For patients with limited mobility, begin with passive or active ROM exercises to maintain joint flexibility and muscle function. Gradually progress as tolerated.
Continuous Vital Sign Monitoring: Monitor vital signs before, during, and after activity to ensure cardiovascular stability and identify any adverse responses.
Supplemental Oxygen Administration: Provide supplemental oxygen as needed to maintain adequate oxygen saturation levels, particularly during activity, for patients experiencing dyspnea or desaturation.
Frequent Position Changes: Implement frequent position changes for patients with limited mobility to prevent skin breakdown and respiratory complications.
Nutritional Support: Provide appropriate nutritional supplements or dietary modifications to address any nutritional deficiencies contributing to weakness and activity intolerance.
Assistive Device Provision and Training: Ensure patients have access to and are properly trained in the use of necessary assistive devices to enhance mobility and independence.
Pain Management Strategies: Address pain effectively with appropriate analgesia to minimize pain-related limitations to activity.
Physical and Occupational Therapy Consultations: Collaborate with physical and occupational therapists to develop individualized exercise programs and strategies for gradually increasing activity tolerance.
Emotional Support and Encouragement: Provide emotional support and encouragement to address patient discouragement and promote motivation for gradual activity progression.
Patient Education on Safe Activity Progression at Home: Educate patients and caregivers on safe methods for gradually increasing activity levels at home, fostering independence and self-management.

Nursing Care Plans for Activity Intolerance: Examples

Nursing care plans provide structured frameworks for organizing assessments and interventions to achieve patient-centered goals. Here are examples of care plan approaches for activity intolerance, including one specifically addressing generalized weakness.

Care Plan #1: Activity Intolerance Related to Generalized Weakness

Diagnostic Statement:

Activity intolerance related to generalized weakness as evidenced by patient reports of fatigue and exertional discomfort.

Expected Outcomes:

Patient will demonstrate stable cardiopulmonary function during activity, indicated by:
- Heart rate within patient’s normal range or with expected increase during activity.
- Systolic blood pressure increase within 20mmHg over resting levels.
- Respiratory rate remaining below 20 breaths per minute.
Patient will report a perceived exertion level of 0 or a decreased rating on the Rate of Perceived Exertion (RPE) scale (0-10) following physical activity.
Patient will report a reduction in fatigue levels.
Patient will successfully perform activities of daily living (ADLs) with minimal assistance.

Assessments:

Identify Precipitating Factors: Investigate potential underlying medical conditions contributing to generalized weakness, such as chronic diseases (pulmonary disease, anemia, malignancy, hypothyroidism).
Monitor Cardiopulmonary Status: Regularly assess and document:
- Heart rate and rhythm.
- Orthostatic blood pressure changes.
- Respiratory rate and pattern.
- Level of consciousness.
- Skin color and temperature.
- Presence of chest discomfort.
  Changes in these parameters provide crucial indicators of activity tolerance and guide activity progression.

Interventions:

Provide ADL Assistance While Promoting Independence: Assist with ADLs as needed to conserve energy, but encourage patient participation to maintain self-esteem and prevent dependence. Balance assistance with fostering endurance.
Encourage Rest Periods: Schedule adequate rest periods, particularly before meals, ADLs, and planned exercise sessions, to allow for energy restoration.
Activity Planning During Peak Energy: Collaborate with the patient to plan activities for times when their energy levels are typically highest.
Promote Endurance-Enhancing Physical Activity: Encourage appropriate physical activity, focusing on exercises that build endurance and improve muscle strength and joint range of motion. Strength training is particularly beneficial for enhancing endurance.
Gradual Activity Progression: Implement a staged activity progression:
- Begin with active ROM exercises in bed, progress to sitting and standing.
- Encourage dangling legs at bedside for 10-15 minutes daily.
- Implement deep breathing exercises at least three times daily.
- Progress to short walks within the room (1-2 minutes, three times daily).
- Gradually increase ambulation distance and activity level, including walking outside the home as tolerated.
  This stepwise approach prevents cardiac overexertion and facilitates deconditioning.
Assistive Devices Utilization: Encourage and assist the patient in using assistive devices (e.g., transfer chairs, wheelchairs, bath benches) as needed to minimize fatigue and discomfort during activities.

Care Plan #2 & #3 (Examples from Original Article – Briefly Mentioned for Completeness):

The original article also includes care plans focused on:

Activity Intolerance related to compromised oxygen transport (atelectasis).
Activity Intolerance related to physical deconditioning or immobility.

These plans provide tailored assessments and interventions specific to those underlying causes of activity intolerance.

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