risk for Activity Intolerance
Definition: At risk of experiencing insufficient physiological or psychological energy to endure or complete required or desired daily activities
RISK FACTORS
History of previous intolerance
Presence of circulatory/respiratory problems, [dysrhythmias]
Deconditioned status; [aging]
Inexperience with the activity
[Diagnosis of progressive disease state/debilitating condition, anemia]
[Verbalized reluctance/inability to perform expected activity]
NOTE: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred; rather, nursing interventions are directed at prevention.
Sample Clinical Applications: Anemias, angina aortic stenosis, bronchitis, emphysema, dysmenorrhea, heart failure, HIV/AIDS, labor/preterm labor, leukemias, mitral stenosis, obesity, pain, pericarditis, peripheral vascular disease, rheumatic fever, thrombocytopenia, tuberculosis, uterine bleeding
RISK FACTORS
History of previous intolerance
Presence of circulatory/respiratory problems, [dysrhythmias]
Deconditioned status; [aging]
Inexperience with the activity
[Diagnosis of progressive disease state/debilitating condition, anemia]
[Verbalized reluctance/inability to perform expected activity]
NOTE: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred; rather, nursing interventions are directed at prevention.
Sample Clinical Applications: Anemias, angina aortic stenosis, bronchitis, emphysema, dysmenorrhea, heart failure, HIV/AIDS, labor/preterm labor, leukemias, mitral stenosis, obesity, pain, pericarditis, peripheral vascular disease, rheumatic fever, thrombocytopenia, tuberculosis, uterine bleeding
Client Will (Include Specific Time Frame)
• Verbalize understanding of potential loss of ability in relation to existing condition.
• Participate in conditioning/rehabilitation program to enhance ability to perform.
• Verbalize understanding of potential loss of ability in relation to existing condition.
• Participate in conditioning/rehabilitation program to enhance ability to perform.
• Identify alternative ways to maintain desired activity level (e.g., if weather is bad, walking in a shopping mall could be an option).
• Identify conditions/symptoms that require medical reevaluation.
• Identify conditions/symptoms that require medical reevaluation.
NURSING PRIORITY NO.1 To assess factors affecting current situation:
• Note presence of medical diagnosis and/or therapeutic regimens (e.g., AIDS, COPD, cancer, heart failure/other cardiac problems, anemia, multiple medications/treatment modalities, extensive surgical interventions, musculoskeletal trauma, neurological disorders) that have potential for interfering with client’s ability to perform at a desired level of activity.
Note: Many factors cause or contribute to fatigue, but activity intolerance implies that the individual cannot endure or adapt to increased energy or oxygen demands caused by an actvity.
• Ask client/SO about usual level of energy to identify potential problems and/or client’s/SO’s perception of client’s energy and ability to perform needed/desired activities.
• Identify factors (e.g., age, functional decline, painful conditions, breathing problems, client resistive to efforts; vision or hearing impairments, climate, or weather; unsafe areas to exercise; need for mobility assistance, etc.) that could block/affect desired level of activity.
• Determine current activity level and physical condition with observation, exercise tolerance testing, use of functional level classification system (e.g., Gordon’s), as appropriate. Provides baseline for comparison and opportunity to track changes.
• Note presence of medical diagnosis and/or therapeutic regimens (e.g., AIDS, COPD, cancer, heart failure/other cardiac problems, anemia, multiple medications/treatment modalities, extensive surgical interventions, musculoskeletal trauma, neurological disorders) that have potential for interfering with client’s ability to perform at a desired level of activity.
Note: Many factors cause or contribute to fatigue, but activity intolerance implies that the individual cannot endure or adapt to increased energy or oxygen demands caused by an actvity.
• Ask client/SO about usual level of energy to identify potential problems and/or client’s/SO’s perception of client’s energy and ability to perform needed/desired activities.
• Identify factors (e.g., age, functional decline, painful conditions, breathing problems, client resistive to efforts; vision or hearing impairments, climate, or weather; unsafe areas to exercise; need for mobility assistance, etc.) that could block/affect desired level of activity.
• Determine current activity level and physical condition with observation, exercise tolerance testing, use of functional level classification system (e.g., Gordon’s), as appropriate. Provides baseline for comparison and opportunity to track changes.
NURSING PRIORITY NO.2 To develop/investigate alternative ways to remain active within the limits of the disabling condition/situation:
• Implement physical therapy/exercise program in conjunction with the client and other team members such as a physical and/or occupational therapist, exercise/rehabilitation physiologist. Collaborative program with short-term achievable goals enhances likelihood of success and may motivate client to adopt a lifestyle of physical exercise for enhancement of health.
• Promote/implement conditioning program and support inclusion in exercise/activity groups to prevent/limit deterioration.
• Instruct client in proper performance of unfamiliar activities and/or alternate ways of doing familiar activities to learn methods of conserving energy and promote safety in performing activities.
• Implement physical therapy/exercise program in conjunction with the client and other team members such as a physical and/or occupational therapist, exercise/rehabilitation physiologist. Collaborative program with short-term achievable goals enhances likelihood of success and may motivate client to adopt a lifestyle of physical exercise for enhancement of health.
• Promote/implement conditioning program and support inclusion in exercise/activity groups to prevent/limit deterioration.
• Instruct client in proper performance of unfamiliar activities and/or alternate ways of doing familiar activities to learn methods of conserving energy and promote safety in performing activities.
NURSING PRIORITY NO.3 To promote wellness (Teaching/Discharge Considerations):
• Discuss with client/SO relationship of illness/debilitating condition to inability to perform desired activity(ies). Understanding these relationships can help with acceptance of limitations or reveal opportunity for changes of practical value.
• Discuss with client/SO relationship of illness/debilitating condition to inability to perform desired activity(ies). Understanding these relationships can help with acceptance of limitations or reveal opportunity for changes of practical value.
• Provide information regarding factors, such as smoking when one has respiratory problems, weight management, lack of motivation/interest in exercise. Education is essential to encourage modification of potential interferences to activity.
• Assist client/SO(s) with planning for changes that may become necessary (e.g., shifting of family responsibilities, use of supplemental oxygen to improve client’s ability to participate in desired activities). Anticipatory guidance facilitates adaptation if symptoms occur. (Refer to ND Activity Intolerance.)
• Identify and discuss symptoms for which client needs to seek medical assistance/ evaluation, providing for timely intervention.
• Refer to appropriate sources for assistance (e.g., smoking cessation, dietary counseling) and/or equipment, as needed, to sustain or improve activity level and to promote client safety.
• Assist client/SO(s) with planning for changes that may become necessary (e.g., shifting of family responsibilities, use of supplemental oxygen to improve client’s ability to participate in desired activities). Anticipatory guidance facilitates adaptation if symptoms occur. (Refer to ND Activity Intolerance.)
• Identify and discuss symptoms for which client needs to seek medical assistance/ evaluation, providing for timely intervention.
• Refer to appropriate sources for assistance (e.g., smoking cessation, dietary counseling) and/or equipment, as needed, to sustain or improve activity level and to promote client safety.
DOCUMENTATION FOCUS
Assessment/Reassessment
• Identified/potential risk factors for individual.
• Current level of activity tolerance and blocks to activity.
Planning
• Treatment options, including physical therapy/exercise program, other assistive therapies
and devices.
• Lifestyle changes that are planned, who is to be responsible for each action, and monitoring
methods.
Implementation/Evaluation
• Responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modification of plan of care.
Discharge Planning
• Referrals for medical assistance/evaluation.
Assessment/Reassessment
• Identified/potential risk factors for individual.
• Current level of activity tolerance and blocks to activity.
Planning
• Treatment options, including physical therapy/exercise program, other assistive therapies
and devices.
• Lifestyle changes that are planned, who is to be responsible for each action, and monitoring
methods.
Implementation/Evaluation
• Responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modification of plan of care.
Discharge Planning
• Referrals for medical assistance/evaluation.
Tags: nursing diagnoses, risk for Activity Intolerance
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2 Respones to "risk for Activity Intolerance"
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June 21, 2019 at 7:16 AM
Activity Intolerance is often mixed with fatigue, but these are two different terms having separate goals. Fatigue can cause tiredness in the patient, but the objective of activity tolerance is to enhance the tolerance and endurance of activity.
June 30, 2019 at 11:27 PM
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