The nursing diagnosis of activity intolerance is defined as a person having insufficient physiologic or psychologic 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. Some of these are listed below.
Potential Underlying Causes
- Respiratory Conditions (i.e. COPD)
- Acute pain or chronic pain
- Decreased mobility due to surgery
- Inadequate sleep
- Cognitive impairment
- Generalized weakness
- Patient’s report of decreased activity/weakness
- Abnormal blood pressure and heart rate response to activity
- Changes to ECG
- Shortness of breath with exertion
- Exertional discomfort
- Signs of pain with movement/activity
- Difficulty engaging in activity
- Increased oxygen demands
- The patient’s vital signs will normalize with activity.
- The patient will be able to activity participate in PT and OT sessions.
- The patient will return to baseline activity level.
- The patient will be able to independently complete activities of daily living.
- The patient’s heart rhythm will remain stable throughout activity.
- The patient will verbalize understanding of need to gradually increase activity level and how to accomplish this.
Nursing Assessment for Activity Intolerance
1. Assess 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.
2. Assess 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 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.
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 patient not having appropriate assistive devices readily available to them. Assessing if these are needed and then making them available can increase 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 for Activity Intolerance
1. If patient is limited to bed-rest, begin with range of motion (ROM) exercises.
It is important to adapt activity exercises to patient’s current tolerance level and build from there.
2. Monitor vital signs throughout activity.
This ensures 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 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 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 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 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.
Many types of patients can face activity intolerance from the young adult who is recovering from surgery to an elderly patient suffering from chronic conditions. It is vital the nurse assess each patient individually and tailors the treatment plan to increase activity level according to each specific patients’ needs. First and foremost, always assess for the patient’s overall safety in completing any level of activity.
References and Sources
- 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.
- Nanda Nursing Diagnosis List (2020). Activity intolerance nursing diagnosis. https://nanda-nursingdiagnosislist.com/activity-intolerance-nursing-diagnosis/