The nursing diagnosis of activity intolerance is defined as a person having insufficient physiologic or psychological energy to endure or complete their required or desired daily activities. This can include a wide spectrum of individuals from a pediatric patient to the elderly patient. Individuals that have experienced a decrease in activity in the past or previous intolerance are much more likely to experience this again. A variety of underlying conditions and causes can put a person at an increased risk of activity intolerance.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are revised, added, or retired by the NANDA International Diagnosis Development Committee (DDC) to coincide with shifts in language standardization. “Activity Intolerance” has been renamed to “Decreased Activity Tolerance”. Students and seasoned nurses alike may be unfamiliar with this change, and thus NurseTogether has chosen to continue to use the diagnostic label “Activity Intolerance” in this article until the recent relabeling receives wider adoption.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are the common causes of activity intolerance:
- Respiratory Conditions (i.e. COPD)
- Anemia
- Malnutrition
- Depression
- Acute pain or chronic pain
- Decreased mobility due to surgery
- Inadequate sleep
- Cognitive impairment
- Generalized weakness
Signs and Symptoms (As evidenced by)
The following are the common signs and symptoms of activity intolerance. They are categorized into subjective and objective data based on patient reports and the assessment by the nurse.
Subjective (Patient reports)
- Patient’s report of decreased activity/weakness
- Shortness of breath with exertion
- Fatigue
- Exertional discomfort
Objective (Nurse assesses)
- Abnormal blood pressure and heart rate response to activity
- Changes to ECG
- Signs of pain with movement/activity
- Difficulty engaging in activity
- Increased oxygen demands
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for activity intolerance:
- Patient’s vital signs will normalize with activity.
- Patient will be able to participate in PT and OT sessions.
- Patient’s activity will return to baseline activity level.
- Patient will be able to independently complete activities of daily living.
- Patient’s heart rhythm will remain stable throughout activity.
- Patient will verbalize understanding of the need to gradually increase activity level and how to accomplish this.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to activity intolerance.
1. Assess the patient’s present level of activity and tolerance to activity.
This will allow the nurse to evaluate where the patient is beginning and then develop a patient specific activity plan. This will allow the nurse to track progress.
2. Assess the patient’s vital signs.
This gives the nurse a baseline and way to gauge potential changes and fluctuations in vital signs when active.
3. Assess the underlying cause of activity intolerance.
This will allow the nurse to appropriately treat any underlying causes of decreased activity.
4. Review medication list.
Some medications and the side effects may contribute to decreased activity intolerance due to tiredness and fatigue. Identifying these medications will then allow for substitution of an alternative medication when appropriate. If this is not possible, sometimes it is possible to take the medication at a different time of day to reduce the side effects.
5. Assess nutritional status.
The patient’s body requires certain nutritional needs in order to be active. It is important to ensure the patient’s nutritional needs are being met.
6. Assess potential need for assistive devices with activity.
Activity level may be decreased due to the patient not having appropriate assistive devices readily available to them. Assessing if these are needed and then making them available can increase a patient’s activity level/tolerance.
7. Assess skin integrity frequently.
Patients with decreased activity level or intolerance to activity are at an increased risk of developing pressure ulcers. Assess skin frequently to prevent skin breakdown.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section you’ll learn more about possible nursing interventions for a patient with activity intolerance.
1. If the patient is limited to bed-rest, begin with range of motion (ROM) exercises.
It is important to adapt activity exercises to the patient’s current tolerance level and build from there.
2. Monitor vital signs throughout activity.
This ensures the patient is remaining in a stable state throughout activity.
3. Provide supplemental oxygen therapy as needed.
Patients with decreased activity tolerance may become short of breath with activity and require additional oxygen therapy in order to maintain appropriate oxygen saturation levels.
4. Provide frequent position changes.
Patients that may be on bed-rest or chair-rest should be repositioned frequently to decrease risk of skin breakdown.
5. Provide appropriate nutritional supplements when indicated.
If malnourished, it will be more difficult for the patient to increase activity level therefore, ensuring appropriate nutrition is vital.
6. Utilize appropriate assistive devices if needed.
Patients may have decreased activity due to needing assistive devices (i.e. walker, cane, etc.) that are not readily available to them. Ensure these devices are available and used when needed.
7. Treat pain as needed.
Patients may be limited in their ability to endure activity due to pain (i.e. following a surgery). Ensure the patient receives appropriate pain medication in advance of activity.
8. Discuss order for PT/OT with MD.
Patients benefit from set therapy schedules and exercises. PT and OT will also be able to assist with gradually building patient’s endurance.
9. Provide emotional support to the patient.
Patients can become discouraged with decreased activity level that can further hinder their ability and desire to be active. Encourage patients to continue gradual increases in activity as they are able to tolerate.
10. Educate the patient on how to safely increase activity level at home.
This allows patients independence and the ability to take control of their own health and improvement. It further helps to give them a sense of empowerment.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for activity intolerance.
Care Plan #1
Diagnostic statement:
Activity intolerance related to generalized weakness as evidenced by verbal reports of fatigue and exertional discomfort.
Expected outcomes:
- Patient will exhibit a stable cardiopulmonary status as evidenced by the following:
- Heart rate <120 beats per min
- Systolic BP within 20mmHg increase over resting systolic BP
- Respiratory rate less than 20 breaths/min
- Using the Rate of Perceived Exertion (RPE) Scale from 0 to 10, the patient will report 0 or a decreased rating of perceived exertion after a physical activity.
- Patient will report the absence of fatigue.
- Patient will perform activities of daily living.
Assessment:
1. Assess precipitating factors.
Generalized weakness, fatigue, and exertional discomfort are nonspecific subjective complaints that may be traced from several chronic diseases such as pulmonary diseases, anemias, malignancy, hypothyroidism, etc.
2. Monitor the patient’s cardiopulmonary status such as:
- Heart rate and rhythm
- Orthostatic BP changes
- Rate of breathing
- Level of consciousness
- Skin color
- Chest discomfort
Changes in cardiopulmonary status provide a guide on the progression of planned activity.
Interventions:
1. Assist with ADLs as indicated, but not to the extent of promoting dependency.
Assisting the patient with ADLs allows for the conservation of energy. However, the nurse must remember that this intervention must enhance the patient’s activity tolerance and self-esteem and not increase patient dependency. There should be a balance between providing assistance and facilitating endurance.
2. Encourage adequate rest periods, especially before meals, other ADLs, and exercise.
Rest between activities provides adequate time for energy conservation.
3. Assist the patient with planning activities when they have the most energy.
Activities should be planned according to the patient’s peak energy level.
4. Encourage physical activity, especially exercises that enhance endurance.
Exercise maintains muscle strength, joint ROM, and exercise tolerance. Strength training is valuable in enhancing endurance.
5. Progress activities gradually as follows:
- Active ROM exercises in bed, progressing to sitting and standing
- Dangling legs 10 to 15 minutes daily
- Deep breathing exercises at least 3x daily
- Walking in room 1 to 2 minutes 3x daily
- Walking outside the house
These activities help in deconditioning the heart. Appropriate progression prevents over-exerting the heart.
6. Encourage or assist the patient in using assistive devices if necessary (i.e., transfer chairs/wheelchairs, bath benches, etc.).
Assistive devices help in easing fatigue and discomfort.
Care Plan #2
Diagnostic statement:
Activity Intolerance related to compromised oxygen transport system secondary to atelectasis as evidenced by increased respiratory rate and cyanosis.
Expected outcomes:
- After the nursing interventions, the patient will not exhibit signs of respiratory distress brought by atelectasis as evidenced by:
- Respiratory rate less than 20 breaths/min
- Absence of dyspnea
- Pinkish skin and nails
- Absence of use of accessory muscles
- Absence of clubbing
- O2 saturation >95%
- The patient will use energy-conservation techniques.
Assessment:
1. Assess for signs and symptoms of atelectasis:
- Decreased or absent breath sounds
- Crackles
- Cough
- Sputum production
- Dyspnea
- Tachypnea
- Diminished chest expansion
- Cyanosis
Atelectasis is typically asymptomatic. But these signs and symptoms indicating lung collapse may already suggest a pulmonary complication that must be promptly addressed.
2. Monitor laboratory findings including:
- Chest x-ray results will reveal a tracheal shift toward the affected side, pulmonary opacities, and displacement of interlobar fissures.
- Arterial Blood Gasses will reveal arterial hypoxemia and respiratory alkalosis.
- Chest CT will reveal lung densities at the peripheries and a lung volume reduction on the affected side.
Interventions:
1. Administer medications as indicated.
Mucolytics such as acetylcysteine benefit patients with atelectasis experiencing mucous plugging in the airways. Other medications may be used to treat the underlying cause of atelectasis or inhaled medications may be used to open airways.
2. Encourage the patient to take deep breaths or use incentive spirometry.
These activities allow the reexpansion of a collapsed lung.
3. Teach energy conservation techniques such as:
- Changing positions often
- Pushing rather than pulling
- Sitting to do tasks
- Resting at least 1 hour after meals before starting a new activity
- Organizing a work-rest-work schedule
Energy conservation techniques decrease oxygen consumption allowing more prolonged activity.
4. Refer the patient to a respiratory therapist for pulmonary rehabilitation.
Pulmonary rehabilitation will help alleviate pulmonary symptoms, prevent further disability, encourage participation in physical and social activities, and enhance the quality of life for patients with pulmonary diseases.
5. Provide supplemental oxygenation.
Oxygenation helps in lung reexpansion and increases arterial oxygen saturation to more than 90%.
Care Plan #3
Diagnostic statement:
Activity intolerance related to physical deconditioning or immobility as evidenced by dyspnea on exertion and abnormal heart rate or blood pressure response to activity.
Expected outcomes:
- Patient will demonstrate increased tolerance to activity.
- Patient will participate in prescribed physical activity with appropriate changes in heart rate, blood pressure, and breathing rate.
Assessment:
1. Assess the level of physical activity and mobility.
This will provide information on the baseline functional capacity of the patient and the level of assistance necessary to improve activity tolerance.
2. Determine the cause of activity intolerance, whether physical, psychological, or motivational.
Identifying the cause will help the nurse plan and implement evidence-based nursing care strategies to reduce deconditioning.
3. Monitor and record the patient’s ability to tolerate activity.
Noting the vital signs (i.e., pulse rate, blood pressure, respiratory pattern) and work of breathing before, during, and after the activity will provide information on the patient’s tolerance to the activity. Signs and symptoms of cardiac decompensation (i.e., dyspnea, palpitations, chest discomfort, hypotension/hypertension, tachycardia, decreased oxygen saturation, lightheadedness) are indications to stop the activity immediately.
Interventions:
1. If the patient is on bed rest, position the patient upright to minimize cardiovascular deconditioning.
During bed rest, gravitational stress is lost, causing fluids to shift from the extremities to the thoracic cavity. An upright position helps maintain optimal fluid distribution and orthostatic tolerance.
2. Assist the patient with self-care activities, positioning, and transferring. When appropriate, gradually increase activity as able.
Progress the patient from sitting in bed to dangling, standing, and ambulating. Always have the client dangle at the bedside before standing to evaluate for postural hypotension. A reduction in plasma volume associated with bed rest impacts the physiological responses of autonomic control of circulation.
3. Perform range-of-motion (ROM) exercises if the patient is immobile and cannot tolerate activity.
ROM exercises increase joint movement, improve joint integrity, decrease pain, and promote independence.
4. Refer to physical therapy.
Physical therapists are experts who can provide a physical activity plan to help increase activity levels and strength.
5. Provide emotional support and encouragement to gradually increase activity by setting mutual goals that increase activity levels.
Fear of breathlessness, pain, or falling may decrease willingness to increase activity. Emotional support prevents a decline in function, improves the patient’s feeling with exercise, and promotes the belief that exercise is beneficial.
6. Obtain any necessary assistive devices or equipment (e.g., walkers, canes, crutches, portable oxygen) before ambulating the patient.
Assistive devices may be used to support patients in increasing physical activity.
References
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Grott, K., Chauhan, S.& Dunlap, J.D. (2022). Atelectasis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK545316/
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Sharma, S. (2023). Pulmonary rehabilitation. MedScape. https://emedicine.medscape.com/article/319885-overview
