Elsevier Logo

Careplan

Activity Intolerance, Pediatrics

Jul.09.2018

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 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, 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.