Activity intolerance is a nursing diagnosis that is defined by NANDA as a state in which an individual has insufficient physiological or psychological energy to endure or complete necessary or desired daily activities.
Factors that can lead to activity intolerance may include side effects of medication, extended bed rest, living a sedentary lifestyle, regular restrictions to healthy activity levels, improper oxygen supply / demand balance, pain, deprived or low-quality sleep, depression, lack of motivation and severe stress.
Activity intolerance may also be caused by age related conditions, especially among elderly patients.
Here is a list of some factors that may be related to activity intolerance:
- Generalized weakness / age
- Sedentary lifestyle / deconditioned state
- Inadequate sleep / insufficient rest
- Extended bed rest / muscular decline/ immobility
- Imposed activity restriction
- Imbalance between oxygen supply and demand
- Lack of motivation
- Severe stress
- Cognitive deficiency
Activity intolerance may be characterized by a number of symptoms or signs such as:
- Early signs of fatigue, dizziness and/or weakness
- Abnormal discomfort or dyspnea during activity
- Inability to perform basic activities
- Abnormal blood pressure or heart rate level in response to activity level
The goal or expected outcome of a proper care plan is to restore the patients ability to perform regular activities in a healthy manner without experiencing any signs or symptoms of activity intolerance.
The expected outcome of a successful care plan may include:
- Patient is able to provide positive verbal feedback in response to activity level
- Patient is able to display and use effective energy management/conservation techniques
- Patient is able to perform basic activities without excessive exhaustion or loss of energy
- Patient is able to display physiological improvements over time
- Patient is able to maintain regular cardiovascular and respiratory functions during activities
The following part of the discussion will focus on assessment techniques and intervention strategies that can be applied to patients in order to help assist them in reducing and/or recovering from their activity intolerance.
Prior to and throughout a patients intervention plan it is important to perform regular assessments in order to identify potential problems that may have led to activity intolerance as well as identify any issues that may arise throughout the intervention.
When performing an assessment there are a number of techniques, strategies and practices that can be implemented including the following:
1. Assess physical health level and potential injuries and/or illnesses. Identify if the health condition is severe or minor and short-term or long-term.
1. Measure and evaluate patients cardiopulmonary status prior to and following scheduled activities to identify primary concerns and track the status of improvement / decline.
2. Regularly interview, communicate and discuss with the patient concerns related to their activity intolerance in order to address problems and determine the route cause of their activity intolerance.
3. Monitor and evaluate sleep quality, length and patterns. Identify and address potential sleep deficiencies in order to maximize recovery / activity progress while reducing the opportunities for errors to occur.
4. Observe and assess emotional responses to performed activities in order to identify and address potential stress responses, depression or mental / emotional conflicts.
5. Assess mobility level prior to exercise, stretching or other interventions to ensure the patient does not injure or over-stress him / herself.
5. Assess and evaluate nutritional health habits to identify dietary needs and food related concerns.
6. When first waking or performing demanding tasks observe patients for symptoms related to activity intolerance such as dizziness, impaired cognitive function and physical pain/stress as well as abnormal changes in vital signs i.e. blood pressure and heart-rate.
7. Monitor and record patient health regularly and refer to the data in order to identify abnormalities, performance improvements or performance declines.
8. Observe and record skin integrity throughout the day to check for symptoms and health status.
9. Observe and assess pain level prior to and upon completion of activities. If the patient is experiencing an uncomfortable amount of pain reassesses the activity and determine whether or not the pain can be treated prior to the activity being performed.
Intervention plans or treatments are designed to help patients improve their condition and reduce or eliminate their activity intolerance.
Interventions may either be independent (managed by the patient alone) or collaborative (managed with the aide of a medical professional).
Some interventions that may be performed to assist patients dealing with activity intolerance may include:
1. Encourage physical activity, develop proper patient exercise programs and ensure they are followed regularly to help prevent muscle atrophy and strengthen the patients cardiovascular system. Physical activity can also have a positive effect on the patients psychological status.
2. Evaluate patient recovery speed between sessions in order to ensure proper scheduling and prevent additional overload or stress while the patient is still recovering from their previous sessions.
3. Allow and encourage proper rest periods in between individual exercises to ensure optimal performance during sessions.
4. Eliminate nonessential activities or procedures to conserve energy output, conserve strength for important activities and ensure adequate rest.
4. Assist patients with planning and scheduling activities and provide direct feedback on performance and improvements.
5. Help patient develop a proper diet plan and eating habits to help them improve their overall health status.
6. Minimize cardiovascular deconditioning through proper resting positions and postural exercises.
7. Assist with ADLs (activities of daily living) regularly as indicated by the physician or supervisor.
8. If appropriate maintain gradual progression of activities to improve performance overtime.
9. Educate patients on lifestyle choices, healthy habits and the importance of regular physical activity in daily life.
10. If patients are feeling symptoms of activity intolerance such as dizziness or their condition has worsened encourage them to stop their activity until they recover and reevaluate their exercise program.
11. Encourage patient to develop good breathing habits in order to improve cardiovascular functions and reduce stress levels.
12. Observe and address restrictive clothing and items that may impact proper blood flow, oxygen levels and physical comfort.