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Activity Intolerance related to generalized weakness secondary to side

effects of chemotherapy for advanced stage of cervical cancer


Independent Nsg Interventions
(i) Determine patient's perception of causes of fatigue or activity intolerance.
May be temporary or permanent, physical, or psychological. Assessment guides
treatment.
(i) Assess patient's level of mobility.
Aids in defining what patient is capable of, which is necessary before setting realistic
goals.
(i) Assess nutritional status.
Adequate energy reserves are required for activity.
(i) Assess potential for physical injury with activity.
Injury may be related to falls or overexertion.
(i) Assess need for ambulation aids: bracing, cane, walker, equipment modification for
activities of daily living (ADLs).
Some aids may require more energy expenditure (walking with crutches) for patients who
have reduced upper arm strength. Adequate assessment of energy requirements is
indicated.
(i) Assess patient's cardiopulmonary status before activity using the following measures:
Heart rate
o Heart rate should not increase greater than 20 to 30 beats above resting with
routine activities. This number will change depending on the intensity of exercise
the patient is attempting (climbing four flights of stairs versus shoveling snow).
Orthostatic BP changes
o Elderly patients are more prone to drops in blood pressure with position changes.
Need for oxygen with increased activity
o Portable pulse oximetry can be used to assess for oxygen desaturation.
Supplemental oxygen may help compensate for the increased oxygen demands.
How Valsalva's maneuver affects heart rate when patient moves in bed
o Valsalva's maneuver, which requires breath holding and bearing down, can cause
bradycardia and related reduced cardiac output.
(i) 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.
(i) Observe and document response to activity.
Close monitoring serves as a guide for optimal progression of activity.
Report any of the following:
Rapid pulse (20 beats over resting rate or 120 beats per minute [BPM])
Palpitations
Significant increase in systolic BP (20 mm Hg)
Significant decrease in systolic BP (drop of 20 mm Hg)
Dyspnea, labored breathing, wheezing
Weakness, fatigue
Lightheadedness, dizziness, pallor, diaphoresis
(i) Assess emotional response to change in physical status.
Depression over inability to perform required activities can further aggravate the activity
intolerance.
(i) Establish guidelines and goals of activity with the patient and caregiver.
Motivation is enhanced if the patient participates in goal setting. Depending on the
etiologic factors of the activity intolerance, some patients may be able to live
independently and work outside the home. Other patients with chronic debilitating
disease may remain homebound.
(i) Encourage adequate rest periods, especially before meals, other activities of daily living,
exercise sessions, and ambulation.
To reduce cardiac workload.
(i) Refrain from performing nonessential procedures.
To promote rest. Patients with limited activity tolerance need to prioritize tasks.
(i) Anticipate patient's needs (e.g., keep telephone and tissues within reach).
(i) Assist with ADLs as indicated.
To reduce energy expenditure.
However, avoid doing for patient what he or she can do for self.
To optimize patient's self-esteem.
(i) Provide bedside commode as indicated.
To reduce energy expenditure. NOTE: Bedpans require more energy than commode.

(i) Encourage physical activity consistent with patient's energy resources.

(i) Assist patient to plan activities for times when he or she has the most energy.
Not all self-care and hygiene activities need to be completed in the morning. Likewise,
not all housecleaning needs to be completed in one day.

(i) Encourage verbalization of feelings regarding limitations.
Acknowledgment that living with activity intolerance is both physically and emotionally
difficult aids coping.

(i) Progress activity gradually.
To prevent overexerting the heart and promote attainment of short-range goals, as with
the following:
Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing.
Dangling 10 to 15 minutes three times daily
Deep breathing exercises three times daily
Sitting up in chair 30 minutes three times daily
Walking in room 1 to 2 minutes three times daily
Walking in hall 25 feet or walking around the house, then slowly progressing, saving
energy for return trip.
(i) Encourage active ROM exercises three times daily. If further reconditioning is needed,
confer with rehabilitation personnel.
To maintain muscle strength and joint range of motion.
(i) Provide emotional support while increasing activity. Promote a positive attitude
regarding abilities.
(i) Encourage patient to choose activities that gradually build endurance.
(i) Improvise in adapting ADL equipment or environment.
Appropriate aids will enable the patient to achieve optimal independence for self-care.
(i) Teach patient/caregivers to recognize signs of physical overactivity.
Promotes awareness of when to reduce activity.
(i) Involve patient and caregivers in goal setting and care planning.
Setting small attainable goals can increase self-confidence and self-esteem.
(i) When hospitalized, encourage significant others to bring ambulation aid: walker or
cane.
(i) Teach the importance of continued activity at home.
To maintain strength, ROM, and endurance gain.
(i) Assist in assigning priority to activities to accommodate energy levels.
(i) Teach energy conservation techniques.
They reduce oxygen consumption, allowing more prolonged activity.
Some examples include the following:
Sitting to do tasks.
o Standing requires more work.
Changing positions often.
o Distributes work to different muscles to avoid fatigue.
Pushing rather than pulling.
Sliding rather than lifting.
Working at an even pace.
o Allows enough time so not all work is completed in a short period of time.
Storing frequently used items within easy reach.
o To avoid bending and reaching.
Resting for at least 1 hour after meals before starting a new activity.
o Because energy is needed to digest food.
Using wheeled carts for laundry, shopping, and cleaning needs.
Organizing a work-rest-work schedule.
(i) Teach appropriate use of environmental aids (e.g., bed rails, elevation of head of bed
while patient gets out of bed, chair in bathroom, hall rails).
To conserve energy and prevent injury from fall.
(i) Teach ROM and strengthening exercises.
(i) Encourage patient to verbalize concerns about discharge and home environment
To reduce feelings of anxiety and fear.

Dependent Nsg Interventions
Check physicians order then administer drugs
Rationale: To prevent any errors. Only privileged physicians and residents under their
supervision can order medications.
Provide/monitor response to supplemental oxygen and medications and changes in
treatment regimen
Monitor any abnormal sign and symptoms
Rationale: To prevent further complications
Monitor laboratory studies, Hb or Hct and RBC count, arterial blood gas (ABGs)
Rationale: Identifies deficiencies in RBC components affecting oxygen transport and
treatment needs or response to therapy

Collaborative Nsg Interventions
Receive/transfer client from the O.R. (if applicable)
Provide referral to other disciplines like physical or occupational therapists
Rationale: To develop individually appropriate therapeutic regimens