00298 Decreased Activity Tolerance

Domain 4: activity/rest
Class 2: activity/exercise
Diagnostic Code: 00298
Nanda label: decreased activity tolerance
Diagnostic focus: activity Tolerance
approved 2020 • Evidence level 3.2

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « decreased activity tolerance is defined as: insufficient resistance to complete the required activities of daily life.

Definite characteristics

  • Abnormal blood pressure in response to activity
  • Abnormal heart rate in response to activity
  • Anxiety when activity is required
  • Electrocardiographic changes
  • Mounted for effort
  • Effort dyspnea
  • Express fatigue
  • generalized weakness

Related factors

  • Decrease in muscle strength
  • Depressive symptoms
  • Fear of pain
  • Oxygen contribution and demand imbalance
  • deterioration of physical mobility
  • Inexperience in an activity
  • Insufficient muscle mass
  • Malnutrition
  • Pain
  • Loss of physical condition
  • Sedentary lifestyle

Note : These factors are taken from Nanda-I. They are secondary to a wide variety of physiological alterations and psychopathologies such as depression, heart disease (for example, congestive heart failure), lung diseases (such as an emphysema), nephropathies, cancer, anemia, obesity, infections (for example, mononucleosis), and stay Bed prolonged.

Risk population

  • People with a history of decreased activity tolerance
  • Older adults

Associated problems

  • Neoplasms
  • Neurodegenerative diseases
  • Respiratory disorders
  • Cerebral traumatic injuries
  • Vitamin D

Suggestions of use

  • This diagnosis should not be used unless it is possible to increase patient resistance.
  • Activity intolerance should only be used if the patient refers to fatigue or weakness due to the activity. Many medical diseases (for example, heart disease or arteriopathies) usually cause intolerance to activity. Nursing staff cannot treat medical diseases independently, so that a diagnosis of intolerance to the activity “with reference to a coronaryopathy” is not useful.
  • Often, activity intolerance causes other problems such as self -care deficit, social isolation or ineffective breastfeeding, and can be better used as the etiology of these other problems.
  • In the intolerance to the activity, the level of resistance must be specified, as follows (Gordon, 1994, p. 110):
    • Level I: Normally walks on flat ground, but the air is missing earlier than normal by climbing one or more staircases
    • Level II: travel a block of 150 meters on flat floor or climb a stairs floor slowly without stopping
    • Level III: Walk no more than 15 meters on flat floor without stopping and is unable to climb a stairs floor without stopping
    • Level IV: Dyspnea and Fatigue at rest
  • The following is an example of such a diagnosis: self -care deficit (total) related to activity intolerance (level IV)

Suggested alternative diagnostics

  • Fatigue (activity intolerance improves with rest, but not fatigue)
  • Self -care deficit, analysis

NOC Results

  • Self -care: basic activities of daily life (AVD): Ability to independent
  • Self -care: Instrumental activities of daily life (AIVD): Ability to carry out the necessary activities to function at home or in the community independently, with or without auxiliary devices
  • Energy Conservation: Personal actions aimed at handling the necessary energy to initiate and carry out activities
  • Psychomotor energy: personal desire and energy to carry out the activities of daily life, nutrition and personal security
  • Fatigue level: gravity reported or observed of generalized and prolonged fatigue
  • Rest: pattern and quantity of decreased activity for mental and physical recovery
  • Resistance: Ability to maintain an activity
  • Activity tolerance: Physiological response to movements that consume energy during everyday activities

Evaluation objectives and criteria

  • Tolerates the usual activity, revealed by activity tolerance, resistance, energy conservation, fatigue level, psychomotor energy, rest and self -care: AVD (and aivd)
  • It presents tolerance to the activity, manifested by the following indicators (specify from 1 to 5: severely, substantially, moderately, slightly or not affected):
    • Oxygen saturation in the activity
    • Respiratory rate in activity
    • Ability to speak when performing a physical activity
  • Presents energy conservation, manifested by the following indicators (specify from 1 to 5: never, rarely, sometimes, often, usually):
    • Recognize energy limitations
    • Balance activity and rest
    • Organize activities to conserve energy
  • Other examples

    The patient will be able to:

    • Identify anxiety -generating activities or situations that can contribute to the intolerance to the activity
    • Participate in necessary physical activities with an adequate increase in heart and respiratory rate, as well as blood pressure, and monitor that the patterns are within normal limits
    • Achieve for (established date) a level of activity of (specify the desired degree according to the list of “use suggestions”)
    • Verbalize that you know the need to administer oxygen, medicines and/or equipment that can increase your tolerance to activities
    • Make the AVDs with some support (how to use the toilet if you are helped to reach the bathroom)
    • Do basic domestic tasks with a little help (for example, you need help with cleaning once a week)

    NIC Interventions

    • Help in self -care: to help another to perform the avd
    • Help in self -care: AIVD: Help and teach a person to carry out the instrumental activities of daily life (AIVD) necessary to have a good functioning at home or in the community
    • Help in the maintenance of the home: help the patient and his family to keep their home clean and safe, so that it is a pleasant place to live
    • Cardiac care: Rehabilitation: Promote a higher level of functional activity for a patient who has experienced an episode of alteration of heart functioning as a result of an imbalance between the contribution and demand for oxygen to the myocardium
    • Energy management: regulate the use of energy to treat or prevent fatigue and optimize operation
    • Management of the environment: manipulate the patient’s environment seeking a therapeutic and aesthetic benefit, while psychological well -being
    • mood management: provide safety, stability, recovery and maintenance to a patient who has a depressed or hypertimic spirit.
    • Sleep improvement: facilitate regular sleep-vigilia cycles
    • Exercise promotion: Stretch: Facilitate regular resistance muscle training to maintain or increase muscle strength
    • Exercise therapy: Muscle control: Use of specific protocols for activities or exercises to improve or restore controlled body movement
    • Exercise therapy: joint mobility: use of active or liabilities body movements to maintain or restore joint flexibility
    • Activity therapy: prescribe and help in the realization of specific physical, social and spiritual activities to increase the range, frequency or duration of an individual’s activity (or a group)

    Nursing Activities

    Valuations

    • Assess the patient’s mobility in bed, if he can stand up, wander, and perform avd and am)
    • Assess the emotional, social and spiritual response to the activity
    • Evaluate the patient’s motivation and desire to increase the activity
    • (NIC) Energy management:
      • Determine the causes of fatigue (for example, treatments, pain and medications)
      • Monitor the cardiorespiratory response to the activity (such as tachycardia, other alterations of the heart rate, dyspnea, diaphoresis, paleness, hemodynamic pressures and respiratory rate)
      • Monitor the patient’s reaction to oxygen (for example, pulse, heart rate and respiratory rate) with self -care or nursing activities
      • Monitor food to ensure that energy resources are appropriate
      • Monitor and record the patient’s sleep pattern and the number of hours that sleep

    Patient and family education

    instruct the patient and the family about:

    • Use of controlled breathing during the activity, when appropriate
    • Recognition of signs and symptoms of activity intolerance including those who need to call the doctor
    • Importance of adequate nutrition
    • Use of accessory equipment, such as oxygen, during activities
    • Use of relaxation techniques (for example, distraction, visualization) during activities
    • Consequences of the intolerance to the activity for the family and the responsibilities of the work role
    • Measures to conserve energy, for example: have within reach the objects of common use
    • (NIC) Energy management:
      • Teach the patient, and the relatives closest to him, self -care techniques that decrease oxygen consumption (for example, highway and techniques to perform AVD in several steps)
      • Teach techniques to organize activities and to manage time in order to avoid fatigue

    Collaboration activities

    • Administer analgesics before the activity, if there is pain
    • Collaborate with occupational therapists, physiotherapists (for example, for resistance training) and recreational therapists to plan and supervise a program of activities, if necessary
    • Channel patients with psychiatric diseases to household mental health services
    • Refer to home care to obtain help for domestic tasks, as required
    • Send the dietitian to plan meals and increase the intake of energy food
    • Channel to cardiac rehabilitation if the problem is due to heart disease

    Others

    • Do not plan nursing care during rest periods
    • Help the patient gradually change position, to join, sit, stand up and wander, if tolerate it
    • Watch the vital signs before, during and after the activity: interrupting the activity if the vital signs are not within the normal limits for the patient, or if signs appear that the activity is not tolerating (for example, pain In the chest, paleness, vertigo, dyspnea)
    • Plan with the patient and his family activities that promote independence and resistance, for example:
      • Encourage them to alternate periods of activity and rest
      • Set modest, realistic and attainable objectives to increase the patient’s independence and self -esteem
    • (NIC) Energy management:
      • Help the patient identify their preferences regarding the activity
      • Plan activities for the periods in which the patient has the greatest energy
      • Help in the usual physical activities (wandering, transfers, postural changes in bed and personal care), if necessary
      • Limit environmental stimuli (such as light and noise) to facilitate relaxation
      • Help the patient to highlight through the elaboration and use of a written record of the intake of calories and energy expenditure, if necessary

    Home attention

    • Evaluate the characteristics of the address that can contribute to the intolerance to the activity (stairs, placement of the furniture, location of the bathroom)
    • Evaluate the need for auxiliary devices (elevators, electric beds), oxygen, etc., at home

    Babies and Children

    • Plan the care of the baby or the child to minimize the demand for oxygen of the organism:
      • Anticipate food, water, comfort, be in arms and stimulation, to avoid unnecessary crying
      • Avoid low oxygen concentration environments (altitude, non -pressurized aircraft)
      • Minimize anxiety and stress
      • Avoid hyperthermia and hypothermia
      • Prevent infections
      • Provide proper rest

    Older people

    • Provide more time for treatments and avd
    • Monitor the possible appearance of orthostatic hypotension, dizziness and syncopes during the activity (Tinetti, Mcavay and Claus, 2003)