Activity Intolerance (Adult Inpatient)

Clinical Description

Care of the hospitalized patient experiencing, or at risk for, insufficient physical or mental energy to complete required or desired daily activities or to sustain activities over time.

Key Information

Clinical judgment must be used to determine if it is appropriate to increase activity or participate in exercise. Most patients can benefit from some level of activity or exercise.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Enhanced Capacity and Energy

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Overview
Education: Self Management
Education: When to Seek Medical Attention

Correlate Health Status

Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care

Activity Intolerance

Signs/Symptoms/Presentation

cyanosis
diaphoresis
dizziness
dysrhythmia
fatigue
generalized weakness
inability to perform BADLs (basic activities of daily living)
inability to perform IADLs (instrumental activities of daily living)
nausea
pain increased during or after activity
pallor
shortness of breath during or after activity
syncope
visual disturbance

Vital Signs

significant vital sign change with activity

Problem Intervention

Optimize Activity Tolerance

Assess patient’s current rating of perceived exertion; compare to previous level.
Cluster, coordinate and organize care schedule per patient preference, priorities and tolerance.
Preplan and pace activity; balance activity with periods of rest; allow for uninterrupted sleep.
Support coping and manage anxiety to minimize energy expenditure.
Encourage gradual increase of activity as condition improves.
Position for optimal comfort and activity tolerance (e.g., sitting for self-care).
Monitor physiologic response to activity; adjust accordingly.
Provide range of motion actions (active, passive or assistive) per prescribed limitations.
Promote nutrition intake to optimize energy.
Determine need for assistive and adaptive equipment to facilitate activity.

Associated Documentation

Activity Management
Self-Care Promotion
Environmental Support

Education

CPG-Specific Education Topics

Overview

risk factors
signs/symptoms

Self Management

activity
assistive/adaptive devices
energy conservation
fluid/food intake

When to Seek Medical Attention

unresolved/worsening symptoms

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

Population-Specific Considerations

Geriatric

Older adults are at higher risk of losing ability to function and tolerate activity when hospitalized, even those with a good baseline of activity and function on admission. A person 75 years of age has half the skeletal muscle of a healthy young adult.

References

(2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
(2020). Paz, J. C.; West, M. P.; Panasci, K.; Greenwood, K. C (Eds.), Acute care handbook for physical therapists. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Boltz, M.; Capezuti, E.; Fulmer, T.; Zwicker, D. (2016). Evidence-based geriatric nursing protocols for best practice. (pp.29, 197). New York: Springer Publishing Company. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Connolly, B.; Salisbury, L.; O'Neill, B.; Geneen, L.; Douiri, A.; Grocott, M. P. W.; Hart, N.; Walsh, T. S.; Blackwood, B. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database of Systematic Reviews. 2015;(6) doi:10.1002/14651858.CD008632.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
Gordon, S.; Grimmer, K. A.; Barras, S. Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review. Journal of Rehabilitation Medicine. 2019;51(6), 397-404. doi:10.2340/16501977-2546 [Systematic Review]
Gulanick, M.; Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Kou, K.; Momosaki, R.; Miyazaki, S.; Wakabayashi, H.; Shamoto, H. Impact of nutrition therapy and rehabilitation on acute and critical Illness: A systematic review. Journal of University of Occupational and Environmental Health. 2019;41(3), 303-315. doi:10.7888/juoeh.41.303 [Systematic Review]
Nettina, S. M. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Vatwani, A.; Margonis, R. Energy conservation techniques to decrease fatigue. Archives of Physical Medicine and Rehabilitation. 2019;100(6), 1193-1196. doi:10.1016/j.apmr.2019.01.005 [Expert/Committee Opinion]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.