Activity Intolerance is a decrease in physiological capacity to maintain activity to the level desired or required.
Defining Characteristics:
Major :
- Change the client's physiological response to the activity undertaken.
- Respiratory: dyspnea (breathing frequency increased exaggeration).
- Shortness of breath (decrease frequency).
- Pulse: weak, declining, excessive increase, the increase in the rhythm, failed to return to the level before the activity after 3 minutes.
- Blood pressure: failed to increase the activity, an increase in diastolic over 15 mmHg.
Minor:
Subjective Data:
- weakness
- fatigue
- dyspnea
- lack of sleep
Objective Data :
Assess the strength and balance, the evaluation of an individual's ability to:
- Changing positions himself on the bed.
- Ambulation.
- Doing ADL (activity daily living) or daily activities.
Assess for the presence of:
- pale
- cyanosis
- mental chaotic
- vertigo
Nursing Interventions:
Activity intolerance related to physical weakness
Goal: after the act of nursing for 5 x 24 hours the patient does not experience injury.
Expected outcomes:
- The patient is able to identify risk factors and individual strengths that affect tolerance to activity.
- Participate in rehabilitation programs to improve the ability to move.
- Being able to choose several alternatives to maintain the level of activity.
Intervention:
1. Assess the level of the client's ability to exercise.
R /: As a base to provide an alternative and appropriate motion exercises with ability.
2. Plan on giving training program according to the ability of the patient.
R /: Exercise may increase the movement of muscles and stimulate blood circulation.
3. Provide a diet high in calcium.
R /: Helps replace calcium lost.
4. Teach the client on how to perform daily activities.
R /: To improve the movement and perform safe movement.
5. Involve the family to train the patient's mobility.
R /: To support the patient.
6. Consult with a physical therapist.
R /: Helpful in developing individualized exercise program and identify the need for a tool to eliminate muscle spasm, improving motor function, prevent / decrease atrophy and contractures in the muscular system.
(doengoes, 2000)
Nursing Diagnosis for Activity Intolerance
