Activity Intolerance

nursing intervention for activity intolerance

Introduction/Pathophysiology [1,3]

Activity intolerance can be described as insufficient physiological or psychological energy to complete required or desired daily activities. Activity intolerance is a common side effect of heart failure and can be related to generalized weakness and difficulty resting and sleeping. A contributing factor is often tissue hypoxia caused by decreased cardiac output.  The International Journal of Nursing identified activity intolerance in 100% of clients with NYHA classes I-IV congestive heart failure as well as activity intolerance is one of the most common diagnoses identified by nurses. Nursing intervention for activity intolerance is an important part of wholesome client care.

Causes[1,2]

  • coronary disease
  • decreased cardiac output
  • hypertension
  • congenital problems
  • congestive heart failure
  • cardiac arrhythmias/dysrhythmias
  • structural abnormalities
  • myocardial ischemia and myocardial infarction

Symptoms[1,2]

Subjective (client may report)

  • fatigue
  • abnormal heart rate or blood pressure in response to activity
  • exertional discomfort
  • dysrhythmias
  • dyspnea with exertion
  • chest pain

Objective[1]:

  • Abnormal blood pressure response to activity
    • excessive rise in blood pressure-systolic>180 or diastolic >110 mmHg
    • excessive hypotension-drop in blood pressure of 10 mm Hg from from baseline blood pressure
  • Abnormal heart rate in response to activity
    • Inappropriate bradycardia- drop in heart rate 10 beats per minute
    • Increased heart rate > 100 beats per minute
  • EKG changes reflecting arrhythmias or ischemia
  • Excess fluid volume/edema-provide nursing intervention for fluid volume excess

Risk factors[1]:

  • History of hypertension
  • Recent/acute MI
  • Previous episodes of HF
  • Valvular heart disease, cardiac surgery
  • Smoking
  • Presence of respiratory disease
  • Inexperience with activity

Intervention[1]

Assessment[1]

Collect client history, including risk factors and symptoms (objective and subjective data)

Cardiac Function:

  • Chest pain
  • Abnormal heart rate in response to activity
  • Increase in rate of 20 BPM above resting rate
  • Rate not returning to baseline level within 3 minutes after stopping activity

Respiratory function

  • Wheezing
  • Cough
  • Tachypnea

Neurologic/Sensory function

  • Fatigue
  • Asthenia

Visual appearance/labs

  • Fatigue
  • Asthenia
  • Diaphoresis
  • Edema

Nursing diagnosis[1]

Assessment of client response to activity

  • note pulse rate more than 20 beats/min faster than resting rate; marked increase in BP during/after activity (systolic increase of 40 mm Hg or diastolic pressure increase of 20 mm Hg); dyspnea or chest pain; excessive fatigue and weakness; diaphoresis; dizziness or syncope.

Rationale:

  • The stated parameters are helpful in assessing physiological responses to the stress of activity and, if present, are indicators of overexertion.

Planning[1,2]

  • Improve myocardial contractility/systemic perfusion
  • Reduce fluid volume overload
  • Prevent complications
  • Provide information about disease/prognosis, therapy needs, and prevention of recurrences
  • Provide activity intolerance care plan for client
  • Improve edema-provide nursing interventions for fluid volume excess

Activity Intolerance Nursing Care plan[1,2]

Perform:

  • Actions to maintain adequate cardiac output

Provide:

  • Support with Vagal maneuvers
  • Assistance with cardioversion or defibrillation if performed
  • Calm environment-limit number of visitors
  • Tips for energy saving techniques (e.g., using chair when showering, brushing teeth, combing hair)

Administer:

  • Supplemental oxygen
  • Antidysrhythmic agents, Anticholinergic agents, pain medications if needed

Monitor:

  • Oxygen levels
  • Blood pressure
  • Heart rate

Encourage:

  • Gradual increase in activity as allowed and tolerated
  • Measures to promote sleep

Goals and Outcomes[1,2]

  • Ability to participate in activities of daily living with decreased incidence of dyspnea, chest pain, diaphoresis, dizziness and changes in vital signs
  • Client reported increase in activity tolerance
  • Client demonstrates decrease in physiological signs of intolerance
  • Plan in place to meet needs after discharge
  • Provide activity intolerance care plan for home/discharge

Post-Nursing intervention for activity intolerance evaluation/monitoring [1]

Monitor[1]

  • Cardiac rate and BP

Future goals [1]

  • Dysrhythmia controlled or absent
  • Pulse oximetry within acceptable range/ free of signs of respiratory distress
  • Client meets all self-care needs
  • Client demonstrates increase in activity tolerance

Prevention[1,2,3]

  • Promote healthy lifestyle
  • Encourage smoking cessation
  • Educate about tips to conserve energy
  • Provide activity intolerance nursing care plan

Supplemental material

Client case

Client presents to the ambulatory clinic with the chief complain of constant tiredness, shortness of breath when engaging in activities of daily living and mild-moderate chest pain when having to climb the stairs at home. Client also reports trouble sleeping and waking up restless. Client’s current blood pressure is 135/75 and heartbeat is 68 bpm. Client has a history of asthma, is overweight and currently smokes ½ ppd.

Questions:

Based on the client case, what are the symptoms predictive of activity intolerance?

Answer: tiredness, shortness of breath when engaging in AODL, trouble sleeping, chest pain, restlessness

Changes in what value during exercise is indicative of activity intolerance?

  1. diastolic pressure increase of 10 mm Hg from baseline
  2. pulse rate more than 5 beats/min faster than resting rate
  3. rise in systolic BP >140
  4. systolic pressure increases of 40 mm Hg from baseline

What medications are appropriate to treat acute symptoms of activity intolerance with chest pain?

  1. Antidysrhythmic agents
  2. Anticholinergic agents
  3. pain medications
  4. A and C
  5. C and B
  6. All of the above

The International Journal of Nursing identified that activity intolerance is present in what percentage of clients with NYHA classes I-IV congestive heart failure?

  1. 20%
  2. 40%
  3. 60%
  4. 80%
  5. 100%

List at least 3 tips for conserving energy during AODL

  1. Using chair when showering
  2. Using the elevator when possible
  3. Using an electric shopping card
  4. Taking advantage of delivery services
  5. Using a wheeling card when moving items

References:

  1. Doenges, Marilynn E., et al. Nursing Care Plans: Guidelines for Individualizing Client Care. F.A. Davis, 2006.
  2. Haugen, Nancy, et al. Ulrich & Canale’s Nursing Care Planning Guides: Prioritization, Delegation, and Critical Reasoning. Elsevier, 2020.
  3. Assis, Cinthia Calsinski de, and Alba Botura Leite de Barros. “Nursing Diagnoses in Clients With Congestive Heart Failure.” Wiley Online Library, John Wiley & Sons, Ltd, 25 July 2008, onlinelibrary.wiley.com/doi/abs/10.1111/j.1744-618X.2003.001.x.