Careplan
Activity Intolerance, Pediatrics
Activity Intolerance (Pediatric Inpatient)
Clinical Description
- Care of the hospitalized child 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 children can benefit from some level of play, activity or exercise.
- Younger children’s natural enjoyment of play provides an opportunity to include tolerated activities into care.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Enhanced Capacity and Energy
- Education: Overview
- Education: Self Management
- Education: When to Seek Medical Attention
Correlate Health Status
Correlate health status to:
- history, comorbidity, congenital anomaly
- 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
- child and family/caregiver:
- 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
- Cluster, coordinate and organize care schedule honoring child’s home routine, preferences, priorities and tolerance.
- Pace and balance activity with periods of rest; allow for uninterrupted sleep.
- Support coping and manage anxiety to minimize energy expenditure (e.g., transitional objects from home, such as preferred toy or blanket; use of developmentally-appropriate activity and language).
- Encourage gradual increase of activity as patient condition improves.
- Monitor physiologic response to activity; adjust accordingly.
- Offer choices regarding activities and play.
- 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
- Environmental Support
- Self-Care Promotion
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
References
- Braam, K. I.; van der Torre, P.; Takken, T.; Veening, M. A.; van Dulmen-den Broeder, E.; Kaspers, G. J. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews. 2013;(4) doi:10.1002/14651858.CD008796.pub2. [Metasynthesis,Meta-analysis,Systematic Review]
- Bulechek, G. M.; Butcher, H. K.; McCloskey-Dochterman, J. M.; Wagner, C. (2013). Nursing Interventions Classification (NIC). St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Doenges, M. E.; Moorhouse, M. F.; Murr, A. C. (2016). Nurse's pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F. A. Davis. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- 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]
- Hockenberry, M. J.; Wilson, D. (2015). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Nettina, S. M. (2014). Lippincott Manual of Nursing Practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Radtke, T.; Nolan, S. J.; Hebestreit, H.; Kriemler, S. Physical exercise training for cystic fibrosis. Paediatric Respiratory Reviews. 2016;19, 42-45. doi:http://dx.doi.org/10.1016/j.prrv.2015.12.004 [Metasynthesis,Meta-analysis,Systematic Review]
- Swearingen, P. L. (2016). All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
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.
