Desired Outcomes/Evaluation
Criteria—Client Will:
• Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible.
• Use identified techniques to enhance activity tolerance.
• Participate willingly in necessary/desired activities.
• Report measurable increase in activity tolerance.
• Demonstrate a decrease in physiological signs of intolerance (e.g., pulse, respirations, and blood pressure remain within client’s normal range).
Actions/Interventions
NURSING PRIORITY NO. 1. To identify causative/precipitating factors:
• Note presence of factors contributing to fatigue (e.g., acute or chronic illness, heart failure, hypothyroidism, cancer, and cancer therapies).
• Evaluate current limitations/degree of deficit in light of usual status. (Provides comparative baseline.)
• Note client reports of weakness, fatigue, pain, difficulty accomplishing tasks, and/or insomnia.
• Assess cardiopulmonary response to physical activity, including vital signs before, during, and after activity. Note progression/ accelerating degree of fatigue.
• Ascertain ability to stand and move about and degree of assistance necessary/use of equipment.
• Identify activity needs versus desires (e.g., is barely able to walk upstairs but would like to play racquetball).
• Assess emotional/psychological factors affecting the current situation (e.g., stress and/or depression may be increasing the effects of an illness, or depression might be the result of being forced into inactivity).
• Note treatment-related factors, such as side effects/interactions of medications.
NURSING PRIORITY NO. 2. To assist client to deal with contributing factors and manage activities within individual limits:
• Monitor vital/cognitive signs, watching for changes in blood pressure, heart and respiratory rate; note skin pallor and/or cyanosis, and presence of confusion.
• Adjust activities to prevent overexertion. Reduce intensity level or discontinue activities that cause undesired physiological changes.
• Provide/monitor response to supplemental oxygen and medications and changes in treatment regimen.
• Increase exercise/activity levels gradually; teach methods to conserve energy, such as stopping to rest for 3 minutes during a 10-minute walk, sitting down instead of standing to brush hair.
• Plan care with rest periods between activities to reduce fatigue.
• Provide positive atmosphere, while acknowledging difficulty of the situation for the client. (Helps to minimize frustration, rechannel energy.)
• Encourage expression of feelings contributing to/resulting from condition.
• Involve client/SO(s) in planning of activities as much as possible.
• Assist with activities and provide/monitor client’s use of assistive devices (crutches, walker, wheelchair, oxygen tank, etc.) to protect client from injury.
• Promote comfort measures and provide for relief of pain to enhance ability to participate in activities. (Refer to NDs acute or chronic Pain.)
• Provide referral to other disciplines as indicated (e.g., exercise physiologist, psychological counseling/therapy, occupational/ physical therapists, and recreation/leisure specialists) to develop individually appropriate therapeutic regimens.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Plan for maximal activity within the client’s ability.
• Review expectations of client/SO(s)/providers to establish individual goals. Explore conflicts/differences to reach agreement for the most effective plan.
• Instruct client/SO(s) in monitoring response to activity and in recognizing signs/symptoms that indicate need to alter activity level.
• Plan for progressive increase of activity level as client tolerates.
• Give client information that provides evidence of daily/ weekly progress to sustain motivation.
• Assist client in learning and demonstrating appropriate safety measures to prevent injuries.
• Provide information about the effect of lifestyle and overall health factors on activity tolerance (e.g., nutrition, adequate fluid intake, mental health status).
• Encourage client to maintain positive attitude; suggest use of relaxation techniques, such as visualization/guided imagery as appropriate, to enhance sense of well-being.
• Encourage participation in recreation/social activities and hobbies appropriate for situation. (Refer to ND deficient Diversional Activity.)
source : Nurse’s Pocket Guide : Diagnoses, Prioritized Interventions, and Rationales
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