Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions

Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions

This guide is on activity intolerance, activity intolerance nursing assessment, and activity intolerance nursing interventions. It can be used to develop activity intolerance nursing care plans for educational purposes.

Activity Intolerance

What does activity intolerance mean?

Activity intolerance occurs when a person has difficulty completing activities due to fatigue, pain, or breathlessness. Activity intolerance may also occur when an individual has difficulty mobilizing due to weakness or stiffness.

Nanda nursing diagnosis defines activity intolerance as a state in which a person is unable to produce enough physical or mental energy to complete one or more activities of daily living (ADLs).

Related Factors to Activity Intolerance

Can activity intolerance be related to pain?

There are several factors that may affect an individual’s tolerance to activity. These include:

  • Advanced age
  • Mental status such as depression, lack of motivation, cognitive deficiency, severe stress
  • Generalized weakness
  • Sedentary lifestyle
  • Deconditioned state
  • Inadequate sleep/rest
  • Immobility
  • Extended bed rest or imposed activity restriction
  • Muscular problems
  • More oxygen demand than supply
  • Pain

Signs and Symptoms of Activity Intolerance

What are signs of activity intolerance?

Activity Intolerance can be characterized by the following signs and symptoms:

  • Generalized body weakness
  • Dizziness
  • Shortness of breath upon exertion or during activity
  • Verbalization of unusual discomfort when doing ADLs
  • Inability to perform basic activities such as brushing teeth and going to the toilet
  • Blood pressure and/or heart rate changes during activity

 

Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions
Activity Intolerance

Activity Intolerance Nursing Assessment

How should you assess for activity intolerance?

Ongoing assessment is essential in order to identify potential problems that may have led to Activity Intolerance as well as identify any issues that may arise during nursing care. Monitoring the individual’s responses to activity are cue points in performing an assessment related to activity intolerance:

Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions
Activity Intolerance Nursing Assessment
Assessment Rationales
Assess the physical activity level and mobility of the patient. 

  • Take the resting pulse, blood pressure, and respirations.
  • Consider the rate, rhythm, and quality of the pulse.
  • If the signs are normal, have the patient perform the activity.
  • Obtain the vital signs immediately after activity
  • Have the patient rest for 3 minutes and then take the vital signs again.
Provides baseline information for formulating nursing goals during goal setting. 

Discontinue the activity if the patient responds with:

  • chest pain, vertigo, and/or dizziness
  • decreased pulse rate, systemic blood pressure, respiratory response

Reduce the duration and intensity of the activity if:

  • Pulse takes longer than 3 to 4 minutes to return to within 6-7 beats of the resting pulse.
  • RR increase is excessive after the activity.
Investigate the patient’s perception of causes of activity intolerance. Causative factors may be temporary or permanent as well as physical or psychological. Determining the cause can help guide the nurse during the nursing intervention.
Assess the patient’s nutritional status. Adequate energy reserves are needed during activity.
Observe and monitor the patient’s sleep pattern and the amount of sleep achieved over the past few days. Sleep deprivation and difficulties during sleep can affect the activity level of the patient – these needs to be addressed before successful activity progression can be achieved.
Determine the patient’s daily routine and over-the-counter medication. Fatigue can limit the patient’s ability to perform needed activity. It can also be a medication side effect. Pay attention to the patient’s use of beta-blockers, calcium channel blockers, tranquilizers, antihistamines, relaxants, alcohol, and sedatives.
Assess the need for ambulation aids (e.g., cane, walker) for ADLs. Assistive devices enhance the mobility of the patient by helping him overcome limitations.
Use portable pulse oximetry to assess for oxygen desaturation during activity. May determine the use of supplemental oxygen to help compensate for the increased oxygen demands during physical activity.
Assess the patient’s baseline cardiopulmonary status (e.g., heart rate, orthostatic BP) before initiating activity. In normal adults, HR should not increase more than 20 to 30 beats/min above resting with routine activities. Older patients are more susceptible to orthostatic drops in BP with position changes.
Observe and document response to activity. Close monitoring will serve as a guide for optimal progression of activity.
Assess emotional response to limitations in physical activity. Depression over the inability to perform activities can be a source of stress and frustration.

Activity Intolerance Nursing Interventions

What are the nursing interventions to promote activity and exercise?

The following are the therapeutic nursing interventions for patients with activity intolerance:

Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions
Activity Intolerance Nursing Interventions
Interventions Rationales
Establish guidelines and goals of activity with the patient and/or SO. Motivation and cooperation are enhanced if the patient participates in goal setting.
Evaluate the need for additional help at home. Coordinated efforts are more meaningful and effective in assisting the patient in conserving energy.
Have the patient perform the activity more slowly, in a longer time with more rest or pauses, or with assistance if necessary. Helps in increasing the tolerance for the activity.
Gradually increase activity with active range-of-motion exercises in bed, increasing to sitting and then standing. Gradual progression of the activity prevents overexertion.
Dangle the legs from the bed side for 10 to 15 minutes. Prevents orthostatic hypotension.
Refrain from performing nonessential activities or procedures. Patient with limited activity tolerance need to prioritize important taks first.
Assist with ADLs while avoiding patient dependency. Assisting the patient with ADLs allows conservation of energy. Carefully balance provision of assistance; facilitating progressive endurance will ultimately enhance the patient’s activity tolerance and self-esteem.
Provide bedside commode as indicated. Use of commode requires less energy expenditure than using a bedpan or ambulating to the bathroom.
Encourage physical activity consistent with the patient’s energy levels. Helps promote a sense of autonomy while being realistic about capabilities.
Instruct patient to plan activities for times when they have the most energy. Activities should be planned ahead to coincide with the patient’s peak energy level. If the goal is too low, negotiate.
Encourage verbalization of feelings regarding limitations. This helps the patient to cope. Acknowledgment that living with activity intolerance is both physically and emotionally difficult.
Gradually progress patient activity with the following: 

  • Range-of-motion (ROM) exercises in bed, gradually increasing duration and frequency (then intensity) to sitting and then standing.
  • Deep-breathing exercises three or more times daily.
  • Sitting up in a chair 30 minutes three times daily.
  • Walking in room 1 to 2 minutes TID.
  • Walking down the hall 20 feet or walking through the house, then slowly progressing walking outside the house, saving energy for the return trip.
Duration and frequency should be increased before intensity.
Encourage active ROM exercises. Encourage the patient to participate in planning activities that gradually build endurance. Exercise maintains muscle strength, joint ROM, and exercise tolerance. Physical inactive patients need to improve functional capacity through repetitive exercises over a long period of time. Strength training is valuable in enhancing endurance of many ADLs.
Provide emotional support and positive attitude regarding abilities. Patient may be fearful of overexertion and potential damage to the heart. Appropriate supervision during early efforts can enhance confidence.
Provide the patient with the adaptive equipment needed for completing ADLs. Appropriate aids will enable the patient to achieve optimal independence for self-care and reduce energy consumption during activity.
Teach the patient and/or SO to recognize signs of physical overactivity or overexertion. Knowledge promotes awareness to prevent the complication of overexertion.
Teach energy conservation techniques, such as: 

  • Sitting to do tasks
  • Frequent position changes
  • Pushing rather than pulling
  • Sliding rather than lifting
  • Working at an even pace
  • Placing frequently used items within easy reach
  • Resting for at least 1 hour after meals before starting a new activity
  • Using wheeled carts for laundry, shopping, and cleaning needs
  • Organizing a work-rest-work schedule
These techniques reduce oxygen consumption, allowing a more prolonged activity.
For patients with pulmonary insufficiency:
Encourage conscious-controlled breathing techniques (e.g., pursed-lip breathing and diaphragmatic breathing) during increased activity and times of emotional or physical stress. 

Pursed-lip breathing

  • Have the client breathe in through the nose, then breathe slowly out through partially closed lips while counting to seven and making a “puuu” sound.

Diaphragmatic-breathing or abdominal breathing: 

  • Have the patient sit comfortably with knees bent and shoulders, head, neck relaxed.
  • Breath in slowly through the nose so that the stomach moves out against your hand.
  • The hand on the chest should remain as still as possible.
  • Place one hand in the upper chest and the other just below the rib cage to allow the palpation of the movement of the diaphragm during breathing.
  • Tighten the stomach muscles, letting them fall inward during exhalation through pursed-lip.
  • The hand on the upper chest must remain as still as possible
Helps in performing efficient breathing by maxi

Activity Intolerance Nursing Care Plans

Activity Intolerance Nursing Care Plan 1

Infective Endocarditis

Nursing Diagnosis: Activity intolerance related to pulmonary insufficiency secondary to infective endocarditis as evidenced by fatigue during activity, shortness of breath upon exertion, generalized body weakness, and oxygen desaturation to less than 94% after activity

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.

Activity Intolerance Nursing Interventions Rationales
Assess and monitor the cardiopulmonary status of the patient by checking the vital signs before and after and activity. Include monitoring of orthostatic blood pressure. Normally, the adult heart rate does not increase more than 20 – 30 beats per minute on top of the resting heart rate. Elderly patients may have orthostatic hypotension when changing positions or doing activities, which can be evidenced by dizziness or increased weakness.
Assess the patient’s oxygen saturation during activity using a portable pulse oximeter. A portable pulse oximeter is helpful in determining the body’s need for supplemental oxygen to help the patient cope with increased oxygen demand when performing activities of daily living or exercise.
Observe the patient’s response to activity and document in an Activity Chart. An Activity chart can help show trends on a patient’s tolerance to performing ADLs or exercise, such as duration, need for supplemental oxygenation, support from staff, or pain medication.
Teach the patient to gradually do more active range of motion (ROM) exercises while in bed. Start with sitting from the bed into the chair for 30 mins, standing and walking for a minute or two, and sitting again. It is important to promote ROM exercises to prevent muscular decline and improve energy levels. However, this must be done gradually to prevent overexertion.
Encourage the patient to perform deep breathing exercise at least 3 times a day. Deep breathing exercises, also known as thoracic expansion exercises, help in increasing lung volumes and moving any phlegm from the lower lobes of the lungs upwards to be effectively coughed out.

Activity Intolerance Nursing Care Plan 2

Fracture

Nursing Diagnosis: Activity intolerance related to neuromuscular skeletal impairment and limb immobilization secondary to hip fracture as evidenced by limited range of motion (ROM), decreased muscular strength, pain upon movement, and imposed restrictions due to the required restrictive therapy.

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

Activity Intolerance Nursing Interventions Rationales
Assess the patient’s degree of immobility due to the restrictive therapy for the fracture. Monitor for other factors that affect activity intolerance such as pain and muscular weakness, during activity. Immobility due to the therapy is the main reason for the patient’s activity intolerance, but he/she might also require pain medications or support from nursing staff to perform ADLs.
Encourage the patient to perform active and passive ROM exercises for all muscle groups. Assist the patient as needed. ROM exercises help increase blood flow to bones and muscles. In turn, this improves muscular tone and preserves joint mobility while preventing muscular atrophy and contracture formation.
Teach the patient about isometric exercises to be done with the unaffected limbs. Isometric exercises work by contracting muscles without having to move the whole limb or bend the joints. Isometrics help in maintaining muscular mass and strength. It is important to note not to perform them on the affected limb or any area with acute bleeding or edema.
Encourage the patient to use the trapeze and post position as needed. The trapeze can help the patient move on the bed during skin care, hygiene, or linen changes.
Refer the patient to physical therapy/ occupational therapy/ rehabilitation team. A physical therapist can work with the patient and the rest of the team in creating a customized exercise regimen to help the patient gradually progress in tolerating daily activities. An occupational therapist and rehabilitation specialist can help the patient get back to his/her normal activities of daily living, or at least achieve the optimal performance of such activities, depending on the degree of injury and result of treatments.

Activity Intolerance Nursing Care Plan 3

Chronic Obstructive Pulmonary Disease (COPD)

Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand secondary to COPD as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

Activity Intolerance Nursing Interventions Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest. To gradually increase the patient’s tolerance to physical activity. To prevent exacerbation of COPD by allowing the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required. To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.
Educate the patient on energy conservation techniques, which include:Working or moving at an even pacePushing rather than pullingSliding rather than pullingSitting to perform some tasksUsing aids such as wheeled carts for shopping, laundry, and carrying thingsPositioning frequently used items within reachResting for about an hour or two post-meals before doing an activity Energy conservation techniques help reduce the body’s demand for oxygen, which allows the patient to accomplish more ADLs.

Activity Intolerance Nursing Care Plan 4

Alzheimer’s Disease

Nursing Diagnosis: Activity intolerance related to cognitive and perceptual impairment as evidenced by inability to move at will, inability to bear weight, muscular weakness, gait disturbances, moments of immobility, decreased fine and gross motor movement, and balance and coordination deficits.

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

Activity Intolerance Nursing Interventions Rationales
Assess the patient’s functional ability in terms of mobility and tolerance to activity. Assess for cognitive impairment that affects activity intolerance. Monitor for other factors that affect activity intolerance such as pain and muscular weakness, during activity. Immobility due to the progression of Alzheimer’s disease is the main reason for the patient’s activity intolerance, but he/she might also require pain medications or support from nursing staff to perform ADLs.
Encourage the patient to perform active and passive ROM exercises for all muscle groups. Assist the patient as needed. ROM exercises help increase blood flow to bones and muscles. In turn, this improves muscular tone and preserves joint mobility while preventing muscular atrophy and contracture formation.
Assist the patient in performing ADLs by providing simple and easy-to-understand instructions. Simple instructions can help the patient with AD to perform a task successfully with little to no help from a carer. There might be a need to repeat instructions.
Provide enough time for the patient to perform each activity. It is important not to rush the patient to avoid triggering disturbed thought or confusion.
Refer the patient to physical therapy/ occupational therapy/ rehabilitation team. A physical therapist can work with the patient and the rest of the team in creating a customized exercise regimen to help the patient gradually progress in tolerating daily activities. An occupational therapist can help the patient to achieve the optimal performance of such activities.

Activity Intolerance Nursing Care Plan 5

Cerebrovascular Accident (CVA) or Stroke

Nursing Diagnosis: Activity intolerance related to neuromuscular skeletal impairment secondary to stroke as evidenced by limited range of motion (ROM), and decreased muscular strength.

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

Activity Intolerance Nursing Interventions Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage the patient to perform active and passive ROM exercises for all muscle groups. Assist the patient as needed. ROM exercises help increase blood flow to bones and muscles. In turn, this improves muscular tone and preserves joint mobility while preventing muscular atrophy and contracture formation.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Provide adaptive equipment for the patient to use in performing ADLs. Stroke patients can benefit from using adaptive aids to help them gain independence in performing self-care tasks and reducing energy consumed while doing ADLs.
Encourage progressive activity through self-care and exercise as tolerated. Alternate periods of physical activity with 60-90 minutes of undisturbed rest. To gradually increase the patient’s tolerance to physical activity.
Refer the patient to physical therapy/ occupational therapy/ rehabilitation team. A physical therapist can work with the patient and the rest of the team in creating a customized exercise regimen to help the patient gradually progress in tolerating daily activities. An occupational therapist and rehabilitation specialist can help the patient to achieve the optimal performance of such activities.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

Activity Intolerance, Activity Intolerance Nursing Assessment, and Activity Intolerance Nursing Interventions

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