Nursing Care Plan (NCP) for Activity Intolerance

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Outline

Pathophysiology

Activity Intolerance is the insufficient physiological or psychological energy to continue or complete necessary or desired tasks. Activity intolerance is a common side effect of heart failure and can be related to generalized weakness and difficulty resting and sleeping. A contributing factor is often tissue hypoxia caused by decreased cardiac output.

Etiology

Activity intolerance is a common side effect of heart failure and can be related to generalized weakness and difficulty resting and sleeping. This could also be related to a number of other cardiac diseases such as cardiomyopathy, stenosis, or Myocardial Infarction (MI).

Desired Outcome

The patient will demonstrate the ability to participate in normal life activities with decreased occurrence of dyspnea, chest pain, diaphoresis, dizziness and changes in vital signs. The patient will  report an increase in activity tolerance.

Subjective Data

  • Fatigue
  • Dyspnea with mild exertion
  • Chest pain
  • Weakness

Objective Data

  • ↑HR, ↑BP in response to activity
  • Dysrhythmias
  • Edema
  • Signs of Heart failure
  • Decreased Oxygen Saturation
  • Increased Respiratory Rate

Nursing Interventions

Intervention

Rationale

Assess cardiac and respiratory status

↓Cardiac Output, Low ejection fraction or CHF are reasons a person would have intolerance. Respiratory conditions such as COPD, asthma can contribute to this.

Monitor vital signs

↑HR, ↑BP in response to activity. If O2 SATs decline, stop activity and apply supplemental oxygen.

Coordinate rest periods before straining activities such as eating, bathing, and ambulating.

Rest periods allow the patient to conserve energy. It allows for heart rate and breathing to normalize.

Gradually increase activity with active range-of-motion exercises in bed, increasing to sitting and then standing.

Gradual progression of the activity prevents overexertion.

Assess for the cause of the activity intolerance. 

Referral to Cardiologist

Many patients with activity intolerance may have some underlying cardiac issues. Refer to a cardiologist for further diagnosis.

Lesson Details

Writing a Nursing Care Plan (NCP) for Activity Intolerance

A Nursing Care Plan (NCP) for Activity Intolerance starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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Transcript

This is the nursing care plan for activity intolerance. Activity tolerance is the insufficient, physiological or psychological energy to continue or complete necessary or desired tasks. Activity Intolerance is a common side effect of heart failure and can be related to generalized weakness and difficulty resting and sleeping. A contributing factor is often tissue hypoxia caused by decreased cardiac output. Some nursing considerations that we want to keep in mind are that we want to monitor vital signs. We want to assess the respiratory and cardiac status. We want to obtain an EKG for cardiac involvement, and we may need to refer the patient to a cardiologist. The desired outcome is that the patient is going to, uh, demonstrate the ability to participate in normal life activities with decreased occurrence of dyspnea, chest pain, diaphoresis, dizziness, and changes in vital signs. The patient will also report an increase in activity tolerance. 

So, the patient with activity intolerance is someone who is going to come in very similar to someone looking like a heart failure patient. So, some of the things that they are going to, uh, let us know the subjective data is, they are going to complain of some fatigue. They’re going to be tired. They’re always tired. Um, very minimal or small activities, kind of take all of their energy. They also have some dyspnea or shortness of breath on exertion. Again, it doesn’t take much exertion, but when they exert themselves, they are typically very short of breath. Again, they may complain of some chest pain and weakness. 

Now, when we observe these patients, there’s going to be a few things that we see once again, it’s going to mimic heart failure. So, the first thing we’re going to notice with our objective data is we are going to notice that they have signs of heart failure. These patients are going to have signs of heart failure. Some of those things that mimic heart failure are, they are going to have an increased heart rate, increased blood pressure, and that’s going to be in response to activity. So walking down the hall, if they walk too far too fast, they’re going to have that tachycardia. That’s not going to resolve itself. They may also have some edema and they’re going to have, uh, some dysrhythmias. 

Okay. So what are we going to do? What are interventions that we’re going to do with this patient? Well, the first thing is we’re going to get us a good cardiac and a good respiratory assessment. We want to assess the status. Remember, low cardiac output. Decreased cardiac output. Um, they can also have a low ejection fraction. They can also have CHF. These are the reasons why a person would have activity intolerance, respiratory conditions, such as COPD, or Asthma can also contribute to this activity tolerance. Remember we always want to assess to gather our data. The next thing is we want to monitor their vital signs. Remember this person looks like a patient in heart failure. So we want to monitor vital signs. Some of the vital signs we may see on the monitor again, is increased heart rate. That’s going to be in relation to any activity that they have. They may also have increased blood pressure. Um, some patients will also see a decrease in their o2 saturations. And if that is the case, we want to make sure that we stop the activity and we administer any supplemental o2 that they need. It’s very important for us as nurses to coordinate with the patient, we want to coordinate rest periods. We want to give the patient enough time to take those grueling activities. Remember rest periods allow a patient to conserve energy. It allows for the heart rate and breathing to normalize. So we want to conserve energy. That’s number one. The next thing we want to do is we want to gradually increase activity. So we want these patients to be conditioned. We want to condition them to tolerate activity, but we can’t go from zero to 100. In one week, we have to gradually increase their activity. So, we are going to gradually increase activity as tolerated. Remember, we want to make sure that we’re going to do some range of motion exercises, and then we’ll increase those from sitting then standing. Gradual progression of the activities, prevent overexertion. And that’s our goal. We want to preserve the little energy that they’re able to give us. We want to make sure that we assess the cause of the activity tolerance. So, we want to, uh, find the root cause. We may also need to refer to cardiologists. Remember many patients with activity intolerance may have some underlying cardiac issues. We want to refer to a cardiologist for further diagnosis. This is the complete care plan. Now let’s take a look at the key points. Remember the pathophysiology, activity intolerance is just what it is, it  is insufficient, physiological or psychological energy to continue or complete necessary or desired tasks. These people just don’t have the steam in the engine to go. The subjective data that we want to do. Remember, this patient is going to complain about being fatigued. They’re going to have some dyspnea or shortness of breath with mild exertion. It’s not going to take much to knock them out. It’s also going to have some chest pain and some weakness. When we assess this patient, when this patient comes in to see us, we are going to see a few things. We’re going to see an increased heart rate, tachycardia, you’re going to see an increased blood pressure. That’s going to be all in response to just normal activity. These patients may also have some edema and they may also show signs and symptoms of heart failure. The first thing we want to do with these patients remember, is we want to find the root cause. It’s very important to find the root cause. Remember a cardiologist may be consulted. And the next thing we want to do is we want to improve the baseline. We want to make sure that they can eventually tolerate activity in order to do that, we want to do gradual progression of the activity. So that way we can prevent overexertion. 

We love you guys. Go out and be your best self today. And that’s always happy nursing.

 

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