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* Activity Tolerance
* Energy Conservation
* Knowledge: Treatment Regimen
* Energy Management
* Teaching: Prescribed Activity/Exercise
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.
Ongoing Assessment
Therapeutic Interventions
* Establish guidelines and goals of activity with the patient and caregiver. Motivation is
enhanced if the patient participates in goal setting. Depending on the etiological 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.
* Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and
ambulation. Rest between activities provides time for energy conservation and recovery. Heart
rate recovery following activity is greatest at the beginning of a rest period.
* Refrain from performing nonessential procedures. Patients with limited activity tolerance need
to prioritize tasks.
* Anticipate patient's needs (e.g., keep telephone and tissues within reach).
* Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self.
Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance
providing assistance with facilitating progressive endurance that will ultimately enhance the
patient's activity tolerance and self-esteem.
* Provide bedside commode as indicated. This reduces energy expenditure. NOTE: A bedpan
requires more energy than a commode.
* Encourage physical activity consistent with patient's energy resources.
* 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 1 day.
* Encourage verbalization of feelings regarding limitations. Acknowledgment that living with
activity intolerance is both physically and emotionally difficult aids coping.
* Progress activity gradually, as with the following:
o Active range-of-motion (ROM) exercises in bed, progressing to sitting and standing
o Dangling 10 to 15 minutes three times daily
o Deep breathing exercises three times daily
o Sitting up in chair 30 minutes three times daily
o Walking in room 1 to 2 minutes three times daily
o Walking in hall 25 feet or walking around the house, then slowly progressing, saving energy
for return trip
This prevents overexerting the heart and promotes attainment of short-range goals.
* Encourage active ROM exercises three times daily. If further reconditioning is needed, confer
with rehabilitation personnel. Exercises maintain muscle strength and joint ROM.
* Provide emotional support while increasing activity. Promote a positive attitude regarding
abilities.
* Encourage patient to choose activities that gradually build endurance.
* Improvise in adapting ADL equipment or environment. Appropriate aids will enable the patient
to achieve optimal independence for self-care.
Education/Continuity of Care