Activity Intolerance and Generalized Weakness Nursing Care Plan

Nurses play a vital role in recognizing and caring for patients with general weakness or intolerance to activity. Whether it’s due to a patient’s recent surgery or chronic condition, decreased tolerance to activity can greatly impact a their ability to perform daily tasks and their overall well-being. You can use this nursing care plan guide for generalized weakness to help you create nursing interventions and nursing diagnosis for this condition.

What is activity intolerance?

Activity intolerance is a condition in which an individual lacks the physical or mental energy to perform or complete necessary activities. It is different from fatigue, which is a subjective and persistent feeling of exhaustion that can be relieved by rest. The goal of treatment for fatigue is to help the client adapt to the fatigue, while the goal of treatment for activity intolerance is to increase the client’s tolerance to activity.

Causes of intolerance to activity

Intolerance to activity is caused by a variety of factors but most especially due to generalized weakness caused by chronic conditions or diseases. Identifying the underlying cause is crucial for developing an appropriate care plan and implementing targeted interventions to improve activity tolerance. Specifically, decreased tolerance to activities can be caused by:

• Cardiovascular conditions. Heart failure, angina, or arrhythmias can lead to reduced cardiac output, impaired blood flow, and compromise in oxygen transport, resulting in activity intolerance.
• Respiratory diseases. Chronic obstructive pulmonary disease (COPD), asthma, or pneumonia can restrict airflow and decrease oxygenation, and can cause imbalances between oxygen supply and demand leading to difficulty in performing activities.
• Circulatory diseases such as anemia, hypovolemia, peripheral arterial diseases that can cause imbalance between oxygen supply and demand.
• Increased metabolic demands such as in infection, metabolic disorders, renal diseases, inflammatory diseases, and etc.
• Inadequate energy sources due to obesity, malnutrition, or inadequate diet.
• Sedentary lifestyle and physical deconditioning or due to lack of sleep or rest periods.
• Psychological problems such as depression that can cause inactivity.
• Surgery or injury due to imposed activity restriction or prolonged bed rest.
• Side effects of medications such as use of beta-blockers, antihistamines, relaxants, alcohol, sedatives.

Signs and symptoms

Identifying and addressing these symptoms is crucial for managing decrease in tolerance to activity and develop appropriate nursing interventions to improve functional abilities and quality of life. Symptoms of may include the following:

• Generalized weakness. A feeling of overall reduced strength or lack of energy, making it difficult to perform activities.
• Shortness of breath. Breathlessness or difficulty breathing during physical exertion or even mild activities.
• Rapid heart rate. An abnormally fast heartbeat or palpitations that occur with minimal activity or exertion.
• Excessive fatigue. A persistent feeling of tiredness, exhaustion, or lack of energy that hinders the ability to engage in activities.
• Muscle pain or discomfort. Unexplained muscle aches, soreness, or discomfort during or after activities.
• Dizziness or lightheadedness. Feeling unsteady, dizzy, or faint during or after physical exertion.
• Verbal reports of weakness. Inability to perform or endure desired activities.

Goals and outcomes

The following are the common nursing care planning goals and expected outcomes for patients with decreased tolerance to activity.

• Patient will identify the factors that aggravate decreased tolerance to activity.
• Patient will identify methods and techniques to reduce activity intolerance.
• Patient will demonstrate methods of controlled breathing technique to conserve energy.
• Patient will describe adaptive techniques to perform activities of daily living.

Nursing assessment

Ongoing assessment is essential in order to identify potential problems that may have lead to decreased tolerance to physical activity and generalized weakness as well as identify any issues that may arise during nursing care. Monitoring the individual’s responses to activity are cue points in performing an assessment related to activity intolerance:

1. Assess the physical activity level and mobility of the patient.
To provide baseline information for formulating nursing goals and to help guide nursing interventions. Assessment to monitor patient’s response to activity should include the following steps:

• Take the resting pulse, blood pressure, and respirations.
• Consider the rate, rhythm, and quality of the pulse.
• If the signs are normal, have the patient perform the activity.
• Obtain the vital signs immediately after activity
• Have the patient rest for 3 minutes and then take the vital signs again.

Discontinue the activity if the patient responds with:

• chest pain, vertigo, and/or dizziness
• decreased pulse rate, systemic blood pressure, respiratory response

Reduce the duration and intensity of the activity if:

• Pulse takes longer than 3 minutes to return to within 6-7 beats of the resting pulse.
• RR increase is excessive after the activity.

2. Investigate the patient’s perception of causes of activity intolerance.
Causative factors may be temporary or permanent as well as physical or psychological. Determining the cause can help guide the nurse during the nursing intervention.

3. Determine the patient’s level of activity intolerance.
To provide a baseline for comparison and track patient’s progress.

• Level I: Walk, regular pace, on level indefinitely; climb one flight or more but more short of breath than normal.
• Level II: Walk one city block or 500 ft on level; climb one flight of stairs slowly without stopping.
• Level III: Walk no more than 50 ft on level without stopping; unable to climb one flight of stairs without stopping.
• Level IV: Dyspnea and fatigue at rest.

4. Assess the patient’s nutritional status.
Adequate energy reserves are needed during activity. Nutritional deficiencies can lead to weakness, fatigue, and decreased endurance, making it more difficult for a person to tolerate activity. Assessment of a patient’s nutritional status can help identify deficiencies that may be affecting their decreased activity tolerance.

5. Observe and monitor the patient’s sleep pattern and the amount of sleep achieved over the past few days.
Sleep deprivation and difficulties during sleep can affect the activity level of the patient – these needs to be addressed before successful activity progression can be achieved.

6. Determine the patient’s daily routine and over-the-counter medication.
Fatigue can limit the patient’s ability to perform needed activity. It can also be a medication side effect. Pay attention to the patient’s use of beta-blockers, calcium channel blockers, tranquilizers, antihistamines, relaxants, alcohol, and sedatives.

7. Assess the need for ambulation aids (e.g., cane, walker) for ADLs.
Assistive devices enhance the mobility of the patient by helping him overcome limitations.

8. Assess the patient’s baseline cardiopulmonary status (e.g., heart rate, orthostatic BP) before initiating activity.
In normal adults, HR should not increase more than 20 to 30 beats/min above resting with routine activities. Older patients are more susceptible to orthostatic drops in BP with position changes. Dramatic changes in the patient’s cardiopulmonary status results from imbalance of oxygen supply and demand.

9. Assess emotional response to limitations in physical activity.
Depression over the inability to perform activities can be a source of stress and frustration.

Nursing interventions and rationales

These nursing interventions aim to improve the patient’s activity tolerance, enhance their functional abilities, and support their overall physical and emotional well-being. It is important to individualize the interventions based on the patient’s specific needs and goals, while closely monitoring their response to the interventions and adjusting the care plan as necessary. The following are the therapeutic nursing interventions for patients with intolerance to activity:

Improving tolerance to activity

1. Establish guidelines and goals of activity with both patient and SO.
Motivation and cooperation are enhanced if the patient participates in goal setting.

2. Provide emotional support and positive attitude regarding abilities.
Patient may be fearful of overexertion and potential damage to the heart. Appropriate supervision during early efforts can enhance confidence.

3. Have the patient perform the activity more slowly, in a longer time with more rest or pauses, or with assistance if necessary.
Helps in increasing the tolerance for the activity.

4. Gradually increase activity with active range-of-motion exercises in bed, increasing to sitting and then standing.
Gradual progression of the activity prevents overexertion.

5. Dangle the legs from the bedside for 10 to 15 minutes.
Prevents orthostatic hypotension.

6. Refrain from performing nonessential activities or procedures.
Patient with limited activity tolerance need to prioritize important tasks first.

7. Assist with ADLs while avoiding patient dependency.
Assisting the patient with ADLs allows conservation of energy. Carefully balance provision of assistance; facilitating progressive endurance will ultimately enhance the patient’s activity tolerance and self-esteem.

8. Use portable pulse oximetry to assess for oxygen desaturation during activity.
May determine the use of supplemental oxygen to help compensate for the increased oxygen demands during physical activity.

9. Provide bedside commode as indicated.
Use of commode requires less energy expenditure than using a bedpan or ambulating to the bathroom.

10. Encourage physical activity consistent with the patient’s energy levels.
Helps promote a sense of autonomy while being realistic about capabilities.

11. Instruct patient to plan activities for times when they have the most energy.
Activities should be planned ahead to coincide with the patient’s peak energy level. If the goal is too low, negotiate.

12. Encourage verbalization of feelings regarding limitations. Provide a positive atmosphere.
Verbalization of feelings can help the patient to cope and minimizes frustration. Acknowledge the patient’s feelings about activity intolerance as this can be both physically and emotionally difficult. This can foster a more empathetic and compassionate relationship between the nurse and patient.

13. Gradually progress patient activity with the following.
Duration and frequency should be increased first before intensity. These activities can include:

• Range-of-motion (ROM) exercises in bed, gradually increasing duration and frequency (then intensity) to sitting and then standing.
• Deep-breathing exercises three or more times daily.
• Sitting up in a chair 30 minutes three times daily.
• Walking in room 1 to 2 minutes TID.
• Walking down the hall 20 feet or walking through the house, then slowly progressing walking outside the house, saving energy for the return trip.

14. Encourage active ROM exercises. Encourage the patient to participate in planning activities that gradually build endurance.
Exercise maintains muscle strength, joint ROM, and exercise tolerance. Physical inactive patients need to improve functional capacity through repetitive exercises over a long period of time. Strength training is valuable in enhancing endurance of many ADLs.

15. Provide the patient with the adaptive equipment needed for completing ADLs.
Appropriate aids will enable the patient to achieve optimal independence for self-care and reduce energy consumption during activity.

16. Teach the patient and/or SO to recognize signs of physical overactivity or overexertion.
Knowledge promotes awareness to prevent the complication of overexertion.

17. Evaluate the need for additional help at home.
Coordinated efforts are more meaningful and effective in assisting the patient in conserving energy.

18. Teach energy conservation techniques.
These techniques can help reduce oxygen consumption, allowing a more prolonged activity. These may include:

• Sitting to do tasks
• Frequent position changes
• Pushing rather than pulling
• Sliding rather than lifting
• Working at an even pace
• Placing frequently used items within easy reach
• Resting for at least 1 hour after meals before starting a new activity
• Using wheeled carts for laundry, shopping, and cleaning needs
• Organizing a work-rest-work schedule

For patients with pulmonary insufficiency

19. Encourage conscious-controlled breathing techniques (e.g., pursed-lip breathing and diaphragmatic breathing) during increased activity and times of emotional or physical stress.
Helps in performing efficient breathing by maximizing the expansion of the lungs. Techniques can include the following:

Pursed-lip breathing

• Have the client breathe in through the nose, then breathe slowly out through partially closed lips while counting to seven and making a “puuu” sound.

Diaphragmatic-breathing or abdominal breathing: 

1. Have the patient sit comfortably with knees bent and shoulders, head, neck relaxed.
2. Breath in slowly through the nose so that the stomach moves out against your hand.
3. The hand on the chest should remain as still as possible.
4. Place one hand in the upper chest and the other just below the rib cage to allow the palpation of the movement of the diaphragm during breathing.
5. Tighten the stomach muscles, letting them fall inward during exhalation through pursed-lip.
6. The hand on the upper chest must remain as still as possible

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

References and Sources

Recommended resources and to further your study for this acute pain nursing care plan.

1. de Souza, V., Salloum Zeitoun, S., Takao Lopes, C., Dias de Oliveira, A. P., de Lima Lopes, J., & Bottura Leite de Barros, A. L. (2015). Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study. Journal of Clinical Nursing, 24(17-18), 2478-2487.
2. Hur, H. K., Park, S. M., Kim, S. S., Storey, M. J., & Kim, G. Y. (2005). Activity intolerance and impaired physical mobility in elders. International Journal of Nursing Terminologies and Classifications, 16(3‐4), 47-53.
3. Rodrigues, C. G., Moraes, M. A., Sauer, J. M., Kalil, R. A. K., & de Souza, E. N. (2011). Nursing diagnosis of activity intolerance: clinical validation in patients with refractory angina. International Journal of Nursing Terminologies and Classifications, 22(3), 117-122.