Activity Intolerance - Weakness; deconditioned; sedentary
Meg Gulanick, RN, PhD
NANDA: A state in which an individual has insufficient
physiological or psychological energy to endure or complete required or desired
Most activity intolerance is related to generalized weakness and
debilitation secondary to acute or chronic illness and disease. This is
especially apparent in elderly patients with a history of orthopedic,
cardiopulmonary, diabetic, or pulmonary-related problems. The aging process
itself causes reduction in muscle strength and function, which can impair the
ability to maintain activity. Activity intolerance may also be related to
factors such as obesity, malnourishment, side effects of medications (e.g.,
beta-blockers), or emotional states such as depression or lack of confidence to
exert one's self. Nursing goals are to reduce the effects of inactivity,
promote optimal physical activity, and assist the patient to maintain a
- Generalized weakness
- Deconditioned state
- Sedentary lifestyle
- Insufficient sleep or rest periods
- Lack of motivation or depression
- Prolonged bedrest
- Imposed activity restriction
- Imbalance between O2 supply and demand
- Side effects of medications
- Verbal report of fatigue or weakness
- Inability to begin or perform activity
- Abnormal heart rate or blood pressure (BP) response to activity
- Exertional discomfort or dyspnea
Patient maintains activity level within capabilities, as evidenced
by normal heart rate and blood pressure during activity, as well as absence of
shortness of breath, weakness, and fatigue.
Patient verbalizes and uses
Ongoing Assessment Actions/Interventions/Rationale
- (i) independent
- (i) Determine patient's perception of causes of
fatigue or activity intolerance.
- May be temporary or permanent, physical, or psychological.
Assessment guides treatment.
- (i) Assess patient's level of mobility.
- Aids in defining what patient is capable of, which is
necessary before setting realistic goals.
- (i) Assess nutritional status.
- Adequate energy reserves are required for activity.
- (i) Assess potential for physical injury with
- Injury may be related to falls or overexertion.
- (i) Assess need for ambulation aids: bracing,
cane, walker, equipment modification for activities of daily living
- Some aids may require more energy expenditure (walking with
crutches) for patients who have reduced upper arm strength. Adequate assessment
of energy requirements is indicated.
- (i) Assess patient's cardiopulmonary status
before activity using the following measures:
- Heart rate
- Heart rate should not increase greater than 20 to 30
beats above resting with routine activities. This number will change depending
on the intensity of exercise the patient is attempting (climbing four flights
of stairs versus shoveling snow).
- Orthostatic BP changes
- Elderly patients are more prone to drops in blood
pressure with position changes.
- Need for oxygen with increased activity
- Portable pulse oximetry can be used to assess for oxygen
desaturation. Supplemental oxygen may help compensate for the increased oxygen
- How Valsalva's maneuver affects heart rate when patient moves in
- Valsalva's maneuver, which requires breath holding and
bearing down, can cause bradycardia and related reduced cardiac
- (i) Monitor patient's sleep pattern and amount
of sleep achieved over past few days.
- Difficulties sleeping need to be addressed before activity
progression can be achieved.
- (i) Observe and document response to
- Close monitoring serves as a guide for optimal progression of
Report any of the following:
- Rapid pulse (20 beats over resting rate or 120 beats per minute
- Significant increase in systolic BP (20 mm Hg)
- Significant decrease in systolic BP (drop of 20 mm Hg)
- Dyspnea, labored breathing, wheezing
- Weakness, fatigue
- Lightheadedness, dizziness, pallor, diaphoresis
- (i) Assess emotional response to change in
- Depression over inability to perform required activities can
further aggravate the activity intolerance.
- (i) independent
- (i) Establish guidelines and goals of activity
with the patient and caregiver.
- Motivation is enhanced if the patient participates in goal
setting. Depending on the etiologic factors of the activity intolerance, some
patients may be able to live independently and work outside the home. Other
patients with chronic debilitating disease may remain homebound.
- (i) Encourage adequate rest periods, especially
before meals, other activities of daily living, exercise sessions, and
- To reduce cardiac workload.
- (i) Refrain from performing nonessential
- To promote rest. Patients with limited activity tolerance
need to prioritize tasks.
- (i) Anticipate patient's needs (e.g., keep
telephone and tissues within reach).
- (i) Assist with ADLs as indicated.
- To reduce energy expenditure.
- However, avoid doing for patient what he or she can do for
- To optimize patient's self-esteem.
- (i) Provide bedside commode as indicated.
- To reduce energy expenditure. NOTE: Bedpans require more
energy than commode.
(i) Encourage physical activity consistent
with patient's energy resources.
(i) Assist patient to plan activities for
times when he or she has the most energy.
- Not all self-care and hygiene activities need to be completed
in the morning. Likewise, not all housecleaning needs to be completed in one
(i) Encourage verbalization of feelings
- Acknowledgment that living with activity intolerance is both
physically and emotionally difficult aids coping.
(i) Progress activity gradually.
- To prevent overexerting the heart and promote attainment of
short-range goals, as with the following:
- Active range-of-motion (ROM) exercises in bed, progressing to
sitting and standing.
- Dangling 10 to 15 minutes three times daily
- Deep breathing exercises three times daily
- Sitting up in chair 30 minutes three times daily
- Walking in room 1 to 2 minutes three times daily
- Walking in hall 25 feet or walking around the house, then
slowly progressing, saving energy for return trip.
- (i) Encourage active ROM exercises three times
daily. If further reconditioning is needed, confer with rehabilitation
- To maintain muscle strength and joint range of
- (i) Provide emotional support while
increasing activity. Promote a positive attitude regarding abilities.
- (i) Encourage patient to choose activities
that gradually build endurance.
- (i) Improvise in adapting ADL equipment or
- Appropriate aids will enable the patient to achieve optimal
independence for self-care.
Education/Continuity of Care
- (i) independent
- (i) Teach patient/caregivers to recognize signs
of physical overactivity.
- Promotes awareness of when to reduce activity.
- (i) Involve patient and caregivers in goal
setting and care planning.
- Setting small attainable goals can increase self-confidence
- (i) When hospitalized, encourage
significant others to bring ambulation aid: walker or cane.
- (i) Teach the importance of continued
activity at home.
- To maintain strength, ROM, and endurance gain.
- (i) Assist in assigning priority to
activities to accommodate energy levels.
- (i) Teach energy conservation
- They reduce oxygen consumption, allowing more prolonged
Some examples include the following:
- Sitting to do tasks.
- Standing requires more work.
- Changing positions often.
- Distributes work to different muscles to avoid
- Pushing rather than pulling.
- Sliding rather than lifting.
- Working at an even pace.
- Allows enough time so not all work is completed in a
short period of time.
- Storing frequently used items within easy reach.
- To avoid bending and reaching.
- Resting for at least 1 hour after meals before starting a new
- Because energy is needed to digest food.
- Using wheeled carts for laundry, shopping, and cleaning
- Organizing a work-rest-work schedule.
- (i) Teach appropriate use of environmental
aids (e.g., bed rails, elevation of head of bed while patient gets out of bed,
chair in bathroom, hall rails).
- To conserve energy and prevent injury from fall.
- (i) Teach ROM and strengthening
- (i) Encourage patient to verbalize concerns
about discharge and home environment
- To reduce feelings of anxiety and fear.
- (i) Refer to community resources as indicated.
Energy Management; Teaching: Prescribed Activity/Exercise
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