- Assess for cause of activity intolerance. Cause of the intolerance will guide interventions.
Discuss with patient the need for activity. Lack of activity causes physical deconditioning and may also have a negative impact on psychological well-being.- Involve patient in planning and decision-making to encourage greater compliance with activity plan.
- Identify activities the patient considers desirable and meaningful. Engaging patient in activities that have personal meaning gives the patient a greater sense of independence and may motivate patient to continue developing tolerance.
Teach patient exercises for increasing strength and endurance to improve breathing and promote general physical reconditioning.- Encourage patient to help plan activity progression, being sure to include activities the patient considers essential. Participation in planning may encourage patient compliance with the plan.
- Encourage active exercise:
- Provide a trapeze or other assistive device whenever possible. Such devices simplify moving and turning for many patients and help them to strengthen upper-body muscles.
- Teach isometric exercises to help patient maintain or increase muscle tone and joint mobility.
- Have patient perform self-care activities and assist with turning and transfer. Begin slowly and increase daily as tolerated. Performing self-care activities helps patient regain independence and enhances self-esteem.
- Monitor physiologic responses to increased activity level, including respirations, heart rate and rhythm, and blood pressure to ensure they return to normal within 2 to 5 minutes after stopping exercise.
- Support and encourage activity to patient's level of tolerance to help foster patient's independence.
- Gradually increase activity to meet patient's abilities. Activity progression builds strength and endurance.
- Instruct and help patient alternate periods of rest and activity. Providing rest periods prevents fatigue and encourages patient to continue improving activity tolerance.
- Teach patient how to conserve energy while performing ADLs—for example, sitting in a chair while dressing, wearing lightweight clothing that fastens with Velcro or a few large buttons, and wearing slip-on shoes. These measures reduce cellular metabolism and oxygen demand.
- Remove barriers that prevent patient from achieving goals that have been established to minimize factors that may decrease patient's exercise tolerance.
Refer patient to physical therapist. Physical therapist can develop plan to increase activity level and build strength.- Turn and reposition patient at least every 2 hours. Establish a turning schedule for the dependent patient. Post schedule at bedside and monitor frequency. Turning and repositioning prevent skin breakdown, atelectasis, and improve lung expansion.
Maintain proper body alignment to avoid contractures and to maintain optimal musculoskeletal balance and physiologic function.- Perform active or passive ROM exercises to all extremities every 2 to 4 hours. These exercises foster muscle strength and tone, maintain joint mobility, and prevent contractures.
- Provide emotional support and encouragement to improve patient's self-concept and motivate patient to perform ADLs.
- Before discharge, formulate a plan with patient and caregivers that will enable the patient either to continue functioning at maximum activity tolerance or to gradually increase tolerance. For example, teach patient and caregivers to monitor patient's pulse during activities, to recognize the need for oxygen (if prescribed), and to use oxygen equipment properly. Participation in discharge planning encourages patient satisfaction and compliance.
- Make sure that a case manager or social worker has assessed patient's home and made the appropriate modifications to accommodate patient's level of mobility. Making adjustments in the home allows patient a greater degree of independence in performing ADLs, thus better conserving energy.
Suggested NIC Interventions