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 several potential causes of fatigue and these can vary from patient to patient.
Signs and Symptoms
- 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
Causes
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.
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
Expected Outcomes
- 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 for 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.
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 for 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.
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.
References and Sources
- Cleveland Clinic (2020). Fatigue. https://my.clevelandclinic.org/health/symptoms/21206-fatigue
- Mayo Clinic. (2020). Fatigue. https://www.mayoclinic.org/symptoms/fatigue/basics/causes/sym-20050894
- O’Connell, K. (2020). Causes of fatigue and how to manage it. https://www.healthline.com/health/fatigue
