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NCLEX & CGFNS Practice Questions
Activity Intolerance
  • Actual
  • Risk for (Potential)

Related To: [Check those that apply]

  • Generalized weakness
  • Sedentary lifestyle
  • Insufficient sleep or rest periods
  • Lack of motivation or depression
  • Prolonged bedrest
  • Imposed activity restriction
  • Imbalance between O2 supply and demand
  • Pain
  • Side effects of medications

As evidenced by: [Check those that apply]

  • Verbal report of fatigue or weakness
  • Inability to begin or perform activity
  • Abnormal heart rate or blood pressure (BP) response to activity
  • Exertional discomfort or dyspnoea

Patient’s Diagnosis: –
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Objective/Expected Outcome;The patient will:

  • Identify factors that reduce activity tolerance.
  • Maintains activity level within capabilities
  • Verbalizes and uses energy-conservation techniques.
  • Exhibit a decrease in anoxic signs of increased activity. (eg: BP, pulse, resp.)

Note: you need to indicate time frame/target as objective must be measurable.

Nursing Interventions Scientific Rationale
Determine patient's perception of causes of fatigue or activity intolerance. Assessment guides treatment.
Assess patient's level of mobility. Aids in defining what patient is capable of, which is necessary before setting realistic goals.
Assess nutritional status. Adequate energy reserves are required for activity
Assess patient's cardiopulmonary status before activity To serve as baseline data
Provide bedside commode as indicated. To reduce energy expenditure.
Encourage adequate rest periods, especially before activities of daily living, exercise sessions, and ambulation. To reduce cardiac workload.
Progress activity gradually. To prevent overexerting the heart and promote attainment of short-range goals, as with the following
Teach patient/caregivers to recognize signs of physical overactivity. Promotes awareness of when to reduce activity.
Involve patient and caregivers in goal setting and care planning. Setting small attainable goals can increase self-confidence and self-esteem.
Teach appropriate use of environmental aids (e.g., bed rails). To conserve energy and prevent injury from fall.

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