Sunday, February 26, 2012

Nursing Interventions for Activity Intolerance

Activity Intolerance

Activity Intolerance Definition : Insufficient physiological or psychological energy to endure or complete required or desired daily activities

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 satisfactory lifestyle.

Related Factors:
  • Generalized weakness
  • Deconditioned state
  • Sedentary lifestyle
  • Insufficient sleep or rest periods
  • Depression or lack of motivation
  • Prolonged bed rest
  • Imposed activity restriction
  • Imbalance between oxygen supply and demand
  • Pain
  • Side effects of medications

Nursing Interventions for Activity Intolerance

1. Assess patient's level of mobility. This aids in defining what patient is capable of, which is necessary before setting realistic goals.

2. Assess nutritional status. Adequate energy reserves are required for activity.

3. Assess potential for physical injury with activity. Injury may be related to falls or overexertion.

4. Assess patient's cardiopulmonary status before activity using the following measures:
  • Heart rate Heart rate should not increase more than 20 to 30 beats/min above resting with routine activities. This number will change depending on the intensity of exercise the patient is attempting (e.g., 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 demands.
  • How Valsalva maneuver affects heart rate when patient moves in bed Valsalva maneuver, which requires breath holding and bearing down, can cause bradycardia and related reduced cardiac output.
5. Assess need for ambulation aids: bracing, cane, walker, equipment modification for activities of daily living (ADLs). Some aids may require more energy expenditure for patients who have reduced upper arm strength (e.g., walking with crutches). Adequate assessment of energy requirements is indicated.

6. Determine patient's perception of causes of fatigue or activity intolerance. These may be temporary or permanent, physical or psychological. Assessment guides treatment.
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.

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