Careplan

    Activity Intolerance, Pediatrics

    May.10.2021

    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

    • (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]
    • Case-Smith, J.; O'Brien, J. C. (2015). Occupational therapy for children and adolescents. 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]
    • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). 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. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • Palisano, R. J.; Orlin, M. N.; Schreiber, J. (2017). Campbell's physical therapy for children. St. Louis: Elsevier. [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]

    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.

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