An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at the usual level
Altered attention
Apathy
Decreased aerobic capacity
Decreased gait velocity
Difficulty maintaining usual physical activity
Difficulty maintaining usual routines
Disinterested in surroundings
Drowsiness
Expresses altered libido
Expresses demoralization
Expresses frustration
Expresses lack of energy
Expresses nonrelief through usual energy-recovery strategies
Expresses tiredness
Expresses weakness
Inadequate role performance
Increased physical symptoms
Increased rest requirement
Insufficient physical endurance
Introspection
Lethargy
Tiredness
NANDA-I approved*
Many factors can cause fatigue; combining related factors may be useful (e.g., Related to muscle weakness, accumulated waste products, inflammation, and infections secondary to hepatitis).
Biopathophysiological
Related to malnutrition*
Related to hypermetabolic state secondary to:
Viruses (e.g., Epstein-Barr)
Fever
Pregnancy
Related to inadequate tissue oxygenation secondary to:
Chronic obstructive lung disease
Heart failure
Anemia
Peripheral vascular disease
Related to biochemical changes secondary to:
Endocrine/metabolic disorders
Diabetes mellitus
Pituitary disorders
Acquired immunodeficiency syndrome (AIDS)
Hypothyroidism
Addison's disease
Chronic diseases
Renal failure
Cirrhosis
Lyme disease
Related to physical deconditioning* secondary to:
Myasthenia gravis
Parkinson's disease
Multiple sclerosis
AIDS
Amyotrophic lateral sclerosis
Related to hypermetabolic state, competition between body and tumor for nutrients, anemia, and stressors associated with cancer
Related to malnutrition
Related to nutritional deficits or changes in nutrient metabolism secondary to:
Nausea
Side effects of medications
Vomiting
Gastric surgery
Diarrhea
Diabetes mellitus
Related to chronic inflammatory process secondary to:
AIDS
Cirrhosis
Arthritis
Inflammatory bowel disease
Lupus erythematosus
Renal failure
Hepatitis
Lyme disease
Treatment Related
Related to biochemical changes secondary to:
Chemotherapy
Radiation therapy
Side effects of medication (specify)
Related to surgical damage to tissue and anesthesia
Related to increased energy expenditure secondary to:
Amputation
Gait disorder
Use of walker, crutches
Situational (Personal, Environmental)
Related to stressors*
Related to prolonged decreased activity and physical deconditioning* secondary to:
Environmental constraints*
Increased mental exertion*
Increased physical exertion*
Sedentary Lifestyle
Demanding occupation
Altered sleep-wake cycle*
Stressors*
Anxiety *
Depressive symptoms*
Social Isolation
Pain*
Obesity
Related to excessive role demands
Related to overwhelming emotional demands
Maturational
Child/Adolescent
Related to hypermetabolic state secondary to:
Mononucleosis
Fever
Related to chronic insufficient nutrients secondary to:
Obesity
Excessive dieting
Eating disorders
Related to effects of newborn care on sleep patterns and need for continuous attention
Related to hypermetabolic state during first trimester
Individuals exposed to negative life event
Individuals with demanding occupation
Pregnant women
Women experiencing labor
Anemia
Chemotherapy
Chronic disease
Chronic inflammation
Dementia
Fibromyalgia
Hypothalamus-pituitary-adrenal axis dysregulation
Myasthenia gravis
Neoplasms
Radiotherapy
Stroke
AUTHOR'S NOTEFatigue as a nursing diagnosis differs from acute tiredness. Tiredness is a transient, temporary state (*Rhoten, 1982) caused by lack of sleep, improper nutrition, increased stress, sedentary lifestyle, or temporarily increased work or social responsibilities. Fatigue is a pervasive, subjective, drained feeling that cannot be eliminated; however, the nurse can assist the person to adapt to it. Activity intolerance differs from fatigue in that the nurse will assist the person with activity intolerance to increase endurance and activity.
The focus for the person with fatigue is not on increasing endurance. If the cause resolves or abates (e.g., acute infection, chemotherapy, radiation), Fatigue as a diagnosis is discontinued and Decreased Activity Intolerance can be initiated to focus on improving the deconditioned state. Individuals with peripheral vascular disease can serve as an example of the difference between Fatigue and Decreased Activity Intolerance. Early in the disease process, the individual is taught to walk as exercise and to walk into the pain (intermittent claudication), rest, and to continue walking. This is Activity Intolerance. If the person decreases their walking, the condition will worsen and any walking will be difficult, causing deconditioning.
Level 2 Extended Focused Assessment (community, primary care)
Subjective Data
Description of Fatigue
Onset
Pattern: morning, evening, transient, unfading
Precipitated by what?
Relieved by rest?
Effects of Fatigue on:
Activities of daily living
Libido
Concentration
Mood
Leisure activities
Motivation
Assess for Related Factors
Medical condition (acute, chronic)
Nutritional imbalances
Treatments
Chemotherapy
Medication side effects
Radiation therapy
Excessive role demands
Financial problems
Depression
Career problems
Family conflicts
NOCFatigue Disruptive Effects, Fatigue Levels, Self-Management, Chronic Disease, Endurance, Energy Conservation
The person will participate in activities that stimulate and balance physical, cognitive, affective, and social domains as evidenced by the following indicators:
- Discusses the causes of fatigue.
- Shares feelings regarding the effects of fatigue on life.
- Establishes priorities for daily and weekly activities.
NICEnergy Management, Environmental Management, Mutual Goal Setting, Socialization Enhancement, Coping Enhancement, Exercise Therapy
Level 2 Extended Focused Interventions (community, primary care)
Nursing interventions for this diagnosis are for people with fatigue regardless of etiology that cannot be eliminated. The focus is to assist the individual and family to adapt to the fatigue state.
Assess Causative or Contributing Factors
If fatigue has related factors that can be treated, refer to the specific nursing diagnosis, such as:
- Lack of sleep; refer to Disturbed Sleep Pattern
- Poor nutrition; refer to Imbalanced Nutrition
- Sedentary lifestyle; refer to Sedentary Lifestyle
- Inadequate stress management; refer to Stress Overload
- Chronic excessive role or social demands; refer to Ineffective Coping
Explain the Causes of Fatigue if Known
R:In many chronic diseases, fatigue is the most common. The symptoms are disruptive and distressing because they interfere with all aspects of one's life, such as working, ADL, recreation, and housework (Gambert, 2013).
Allow Expression of Feelings Regarding the Effects of Fatigue on Life
- Help to verbalize how fatigue interferes with roles and responsibilities.
- Encourage to convey how fatigue causes frustration and interferes with doing some activities.
Assist the Individual to Identify Strengths, Abilities, and Interests
- Identify values and interests.
- Identify areas of success and usefulness; emphasize past accomplishments.
- Use information to develop goals with the individual.
- Assist in identifying sources of hope (e.g., relationships, faith, things to accomplish).
- Assist in developing realistic short- and long-term goals (progress from simple to more complex; use a "goals poster" to indicate type and time for achieving specific goals).
R:Focusing on strengths and abilities may provide insight into positive events and lessen the tendency to overemphasize the severity of the illness with resultant depression (Halter, 2018).
Assist to Identify Energy Patterns
R:Identifying peak periods of energy and exhaustion can aid in planning desirable activities and its rewards.
Instruct to Record Fatigue Levels Every Hour over 24 Hours; Select a Usual Day
- Ask to rate fatigue using the Rhoten fatigue scale (0 = not tired, peppy; 10 = total exhaustion).
- Record the activities during each rating.
Analyze Together the 24-Hour Fatigue Levels
- Times of peak energy
- Times of exhaustion
- Activities associated with increasing fatigue
Explain Benefits of Exercise, and Discuss What Is Realistic
Explain the Purpose of Pacing and Prioritization
- Explore what activities the individual views as important to maintain self-esteem.
- Attempt to divide vital activities or tasks into components (e.g., preparing menu, shopping, storing, cooking, serving, cleaning up); the individual can delegate some parts and retain others.
- Plan important tasks during periods of high energy (e.g., prepare all meals in the morning).
- Assist in identifying priorities and eliminating nonessential activities.
- Plan each day to avoid energy- and time-consuming, nonessential decision-making.
- Distribute difficult tasks throughout the week.
- Rest before difficult tasks, and stop before fatigue ensues.
R:The individual requires rest periods before and after some activities to maximize energy conservation and productivity.
Teach Energy Conservation Techniques
- Modify the environment.
- Replace steps with ramps.
- Install grab rails.
- Elevate chairs 3 to 4 inches.
- Organize kitchen or work areas.
- Reduce trips up and down stairs (e.g., if there is no toilet on first floor, put a portable toilet on the first floor).
- Use a driving service instead of driving self.
- Delegate housework (e.g., employ a high-school student for a few hours after school).
- Discuss with individual some type of appropriate exercise component that could be integrated into his or her life, e.g., stationary bicycle.
- Utilize a supermarket that will deliver groceries and pharmacy.
R:The activity theory proposes that individuals would remain psychologically healthier if they remain active and socially fit (Miller, 2019).
Promote Socialization with Family and Friends (Miller, 2019)
- Encourage to participate in one social activity weekly.
- Explain that feelings of connectedness decrease fatigue.
Provide Significant Others Opportunities to Discuss Feelings in Private Regarding:
- Changes in person with fatigue
- Caretaking responsibilities
- Financial issues
- Changes in lifestyle, role responsibilities, and relationships
- See Caregiver Role Strain for additional strategies for caregivers.
Initiate Health Teaching and Referrals, as Indicated
- Counseling
- Community activities (local, bus tours)
- Community services (Meals on Wheels, housekeeper)
- Financial assistance