Fatigue Nursing Diagnosis & Care Plans

Fatigue is a feeling of being extremely overtired that makes it challenging for the individual to carry out their regular activity and normal daily routines. It can cause individuals to feel as if they have no energy to complete their tasks. It also makes some feel that they need to sleep much more often, but upon waking they still feel tired and not refreshed. There are a variety of signs to look for in an individual that may be fatigued. Likewise, there are a multitude of potential causes of fatigue and these can vary from patient to patient.

Causes (Related to)

The cause of fatigue can be multifactorial. It can be related to other medical conditions one has or medications. Likewise, it can be related to certain lifestyle habits. The following are common causes of fatigue:

Lifestyle Causes

• Poor diet
• Poor exercise
• Excessive alcohol intake
• Drug use
• Excessive stress

Medical Causes

• Sleep disorders  
• Infections  
• Cancers  
• Kidney disease
• Multiple sclerosis  
• Autoimmune diseases  
• Hormonal imbalances  
• Anemia  
• Vitamin deficiencies
• Eating disorders  
• Chronic cardiac conditions (i.e. congestive heart failure) 
• Chronic respiratory conditions (i.e. COPD) 

Medications

• Antidepressants  
• Chemotherapies  
• Pain medications
• Blood pressure medications
• Allergy medications
• Muscle relaxants
• Seizure or epilepsy medications

Signs and Symptoms (As evidenced by)

The following are common signs and symptoms of fatigue:

• Sleepiness
• Impatience
• Malaise/general discomfort
• Lack of motivation
• Tired legs/muscle weakness
• Depression or lack of desire to do activities that were once enjoyable
• Difficulty concentrating
• Low energy
• Nervousness, anxiousness

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for fatigue:

• Patient will verbalize reduction in fatigue.  
• Patient will be able to engage in daily activities independently.   
• Patient will be able to display adequate energy levels in order to complete activities.  
• Patient’s vital signs and lab values will remain stable as they relate to any potential underlying chronic conditions.

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 fatigue.

1. Assess current level of activity as it compares to patient’s normal baseline activity.
This allows the nurse to gauge the difference in patient’s current energy level and how the fatigue is currently impacting patient. The nurse can also assess for when the fatigue started and how long it lasted.

2. Assess vital signs.
Abnormal vital signs such as tachycardia, hypotension, or fever may cause patient to fatigue quickly with any level of activity.

3. Assess lab values.
This will allow the nurse to determine if any lab values are out of range as a result of an underlying condition which could be attributing to the patient’s fatigue (i.e. anemia).

4. Assess full medical and surgical history.
Patient may be fatigued due to a chronic condition or recent procedure. Identifying this will assist nurse in tailoring care and activity to meet the patient’s needs.

5. Assess any imaging or cardiac studies (i.e. echocardiogram).
These studies can also direct the nurse to any potential underlying conditions or causes of fatigue.

6. Review complete medication list.
Some medications may be the cause of patient’s fatigue and alternatives may be available and need to be discussed between patient and provider.

7. Assess need for assistive devices for activity.
Patients may be able to tolerate more activity if using the appropriate assistive device.

Nursing Interventions

Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with fatigue.

1. Monitor vital signs and treat abnormal vital signs as needed.
Vital signs out of the normal range may fatigue the patient quickly when completing any level of activity. Be aware of abnormal readings and treat as appropriate (i.e. fever, tachycardia, hypotension).

2. Administer supplemental oxygen therapy as needed.
Patient may be fatigued due to shortness of breath with activity and decreased oxygen saturation. Additional oxygen may be necessary when engaging in activity and assist patient with completing more activity.

3. Monitor lab work and treat abnormal values as ordered by provider.
Abnormal lab values may further fatigue an individual. For example, a patient with a history of anemia and low hemoglobin and hematocrit may be very fatigued with activity and require a blood transfusion. Routine monitoring of labs will allow the nurse to be aware of this and treat as needed.

4. Provide appropriate assistive devices for activity.
Patient may be able to tolerate more activity if using appropriate devices such as a walker.

5. Develop activity plan.
This will allow the nurse and patient to have a plan that will gradually increase the patient’s activity level and strength. The nurse can also educate the patient about techiniques such as activity clustering and scheduling rests throughout the day.

6. Discuss with ordering provider the potential need for physical therapy and/or a cardiac rehab program as appropriate.
This will further help the patient to regain strength and improve endurance and decrease fatigue.

7. Treat underlying causes of fatigue as appropriate.
Appropriate treatment of underlying causes can improve and increase patient’s activity level thereby decreasing the fatigue the patient is experiencing.

8. Educate patient on lifestyle habits to improve activity and lessen fatigue.
This will allow the patient to become more independent upon discharge and be able to have a plan in place for how to provide appropriate self-care once home and fully independent.

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 fatigue.

Care Plan #1

Diagnostic statement:

Fatigue related to caregiving responsibilities as evidenced by daytime sleepiness.

Expected outcomes:

• Patient will verbalize the reduction of fatigue, as evidenced by reports of increased energy in the morning.
• Patient will utilize energy-conservation techniques.

Assessment:

1. Assess the description of fatigue, including timing, severity, and relationship to activities/alleviating factors.
Knowing the specific experience of fatigue will help the nurse to develop an individualized activity plan.

2. Assess the patient’s feelings of fatigue brought on by the caring responsibilities.
The patient is experiencing caregiver burnout. Anxiety and depression are common emotional responses associated with fatigue that could aggravate the fatigue level felt by the patient.

Interventions:

1. Encourage the patient to keep a weekly 24-hour fatigue and activity log.
Identifying specific activities that cause excessive energy expenditure will aid in scheduling daily activity plans.

2. Assist in developing a daily schedule of rest and activity.
An activity plan that balances work and rest is crucial to perform responsibilities without causing too much fatigue.

3. Minimize environmental stimuli, especially during rest and sleep.
Interrupted sleep or rest aggravates the feeling of fatigue. Bright lighting, noise, visitors, frequent distractions, and clutter in the patient’s physical environment can inhibit relaxation or interrupt rest/sleep.

4. Teach energy conservation skills.
Patients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use the available energy to complete desired activities. Organization and time management can help the patient conserve energy and reduce fatigue. The occupational therapist can reinforce energy-conservation techniques and provide the patient with assistive devices.

Care Plan #2

Diagnostic statement:

Fatigue related to iron deficiency anemia, as evidenced by an inability to maintain usual routines.

Expected outcomes:

Patient will verbalize the reduction of fatigue as evidence of the ability to perform usual routines.
Patient will have a normalized complete blood count (CBC), hemoglobin levels, blood iron levels, and ferritin levels.

Assessment:

1. Assess the patient’s ability to perform ADLs.
Fatigue limits the ability to perform ADLs and roles. Knowing the capability of the patient will help to identify areas needing assistance.

2. Assess the precipitating factors of anemia.
Correcting anemia will correct the patient’s fatigue. Addressing the root causes of the patient’s anemia is vital for symptom relief. Some other medical conditions can precipitate iron deficiency anemia such as celiac disease, ulcerative colitis, kidney disease or obesity among others. Obtain a detailed medical history.

3. Obtain diet history.
Iron deficiency anemia is a nutrition problem that could be reversed by balanced nutrition. A diet history will help the nurse identify nutrient deficiencies and develop an appropriate meal plan.

Interventions:

1. Plan a balanced meal with the patient.
Though, the patient mainly lacks iron. A properly balanced intake of fats, carbohydrates, protein, vitamins, and minerals is needed to provide energy resources.

2. Administration of ferrous sulfate/iron supplements.
Iron helps in producing hemoglobin–a protein in red blood cells that carries oxygen from the lungs to the tissues. Iron supplements help in managing iron-deficiency anemia. Depending on the severity of the iron deficiency anemia, the patient may be able to take oral iron supplements or may require IV iron infusions.

3. Encourage appropriate exercise programs.
Exercise can help the patient build endurance for physical activity and subsequently reduce fatigue. However it should also be noted that extreme endurance sports can worsen iron deficiency anemia.

4. Educate the patient about energy conservation and time management strategies.
Organization and time management can help the patient conserve energy and prevent fatigue.

References

1. Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
2. Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
3. Cleveland Clinic (2020). Fatigue. https://my.clevelandclinic.org/health/symptoms/21206-fatigue
4. 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.
5. Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
6. Mayo Clinic. (2020). Fatigue. https://www.mayoclinic.org/symptoms/fatigue/basics/causes/sym-20050894
7. O’Connell, K. (2020). Causes of fatigue and how to manage it. https://www.healthline.com/health/fatigue
8. Turner, J., Parsi, M.& Badireddy, M. (2022). Anemia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499994/