Fatigue – Nursing Diagnosis & Care Plan - Nurseslabs

Fatigue: An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.

Almost everybody is overtired or overworked from time to time. Words like lethargic, exhausted, tired and even ‘fatigue’ are always used when a symptom is difficult for the patient to describe.

Fatigue is a subjective complaint with both acute and chronic illness. It is the self-recognized state in which an individual experiences an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work that is not relieved by rest. However, it is important to know that fatigue is not the same as tiredness. Tiredness is temporary. Fatigue is associated with a variety of physical and psychological conditions.

In an acute illness, fatigue serves as a defensive function that keeps the person from sustaining injury resulting from too hard work in a destabilized condition. Patients who have hepatitis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, myasthenia gravis, depression, AIDS, diabetes mellitus, diabetic ketoacidosis, thyrotoxicosis, and multiple sclerosis may experience fatigue. A person may be unable to work full-time and maintain acceptable performance on the job when experiencing fatigue due to a chronic illness. Chronic fatigue syndrome is a condition characterized by prolonged, debilitating fatigue, neurological problems, general pain, gastrointestinal problems, and flu-like symptoms. The condition is not yet fully understood but is believed to be an abnormal response of the immune system to highly stressful physiological or psychological events.

The social effects of fatigue happen when a person decreases his or her participation in social liveliness and movement. Recently, attention has focused on sleep-disordered breathing as a cause for daytime somnolence, fatigue, and decreased alertness. Taking a careful and complete history is the key to help make the underlying diagnosis of the cause for the symptom of fatigue. The goals of management focus on the conservation of energy, promotion of exercise, providing adequate nutrition, and enhancement of sleep.

Related Factors


Here are some factors that may be related to Fatigue:

Physiological:

  • Anemia
  • Chemotherapy or radiation therapy
  • Disease states
  • Expanded physical exertion
  • Malnutrition
  • Poor physical state
  • Pregnancy
  • Sleep deprivation

Psychological:

Environmental:

  • Humidity
  • Lights
  • Noise
  • Temperature

Situational:

  • Occupation
  • Untoward life event

Defining Characteristics


Fatigue is characterized by the following signs and symptoms:

  • Accident-prone
  • Anticipated need for additional energy to accomplish routine tasks
  • Compromised concentration
  • Decreased performance
  • Failure to maintain usual routines
  • Feelings of guilt for not keeping up with responsibilities
  • Inability to recover and restore energy, even after sleep
  • Increased physical complaints
  • Increased rest requirements
  • Lethargic or sluggish
  • Reports of lack of energy, inability to maintain usual routines
  • Tired

Goals and Outcomes


The following are the common goals and expected outcomes for Fatigue:

  • Patient shares his or her feelings regarding the effects of fatigue in life.
  • Patient discusses what he or she thinks makes fatigue worse.
  • Patient demonstrates four energy saving techniques to help decrease fatigue.
  • Patient explains energy conservation plan to offset fatigue.
  • Patient verbalizes what important tasks during periods of fatigue have a higher priority than nonessential activities.

Nursing Assessment


Assessment is required in order to identify potential problems that may have lead to Fatigue as well as name any episode that may happen during nursing care.

Assessment Rationales
Evaluate the patient’s description of fatigue: severity, changes in severity over time, aggregating factors or alleviating factors. Using an appropriate quantitative scoring scale, 1 to 10 for example, can aid the patient formulate the amount of fatigue experienced. Further scoring scales can be developed by using pictures or descriptive language. This system allows the nurse to weigh against changes in the patient’s fatigue level over time. It is important to conclude if the patient’s level of fatigue is constant or if it varies over time.
Determine possible causes of fatigue, such as:

  • Last physical illness
  • Pain
  • Emotional stress
  • Depression
  • Side effects of medication
  • Anemia
  • Sleep disorders
  • Imbalanced nutritional intake
  • Extended responsibilities and demands at home or work
Identifying the related factors with fatigue can benefit in recognizing potential causes and building a collaborative plan of care.
Assess the patient’s ability to perform ADLs, instrumental activities of daily living (IADLs), and demands of daily living (DDLs). Fatigue can restrict the patient’s ability to participate in self-care and do his or her role responsibilities in the family and society, such as working outside the home.
Assess the patient’s nutritional ingestion for adequate energy sources and metabolic demands. Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies.
Evaluate the patient’s outlook for fatigue relief, eagerness to participate in strategies to reduce fatigue, and level of family and social support. These will promote active participation in planning, implementing, and evaluating therapeutic management to alleviate fatigue. Social support will be essential to assist the patient put into practice changes to decrease fatigue.
Review results of laboratory or diagnostic test:

Changes in these physiological measures may be associated with other measurement data to recognize possible sources of the patient’s fatigue.
Observe physiological reaction to activities such as any alterations in BP, respiratory rate, or heart rate. Tolerance varies significantly, depending on the phase of the disease progression, nutrition condition, fluid balance, and quantity or sort of opportunistic diseases that patient has been subjected to.
Assess the patient’s typical level of exercise and physical movement. Increased physical exertion and inadequate levels of exercise can add to fatigue.
Assess the patient’s sleep patterns for quality, quantity, time taken to fall asleep and feeling upon awakening and observe alteration in thought processes or behaviors. Changes in the patient’s sleep pattern may be a contributing factor in the development of fatigue. Numerous factors can exacerbate fatigue, together with sleep deprivation, emotional distress, side effects of drugs, and progressing CNS disease.
Assess the patient’s routine recommendation and over-the-counter drugs. Fatigue may be a medication side effect or an indication od a drug interaction. The nurse must perform particular notice to the patient’s utilization of beta-blockers, calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.
Assess the patient’s emotional reaction to fatigue. The common emotional responses associated with fatigue are anxiety and depression. These emotional conditions can increase the person’s fatigue level and produces a vicious cycle.

Nursing Interventions


The following are the therapeutic nursing interventions for Fatigue:

Interventions Rationales
Restrict environmental stimuli, especially during planned times for rest and sleep. Vivid lighting, noise, visitors, numerous distractions, and litter in the patient’s physical surroundings can limit relaxation, disturb rest or sleep, and contribute to fatigue.
Encourage the patient to maintain a 24-hour fatigue or activity log for at least 1 week. Recognizing relationships between specific activities and levels of fatigue can aid the patient recognize unnecessary energy outflow. The log may indicate times of day when the person feels the least fatigued. This information can help the patient make choices about setting his or her activities to take advantage of episodes of high energy levels.
Implement the use of assistive devices for ADLs and IADLs:

  • Long-handled sponge for bathing
  • Long shoehorn
  • Sock-puller
  • Long-handled grabber
Utilization of such devices can lessen energy expenditure and prevent injury with activities.
Aid the patient with developing a schedule for daily activity and rest. Emphasize the importance of frequent rest periods. A plan that balances periods of activity with periods of rest can aid the patient complete preferred activities without contributing to levels of fatigue.
Teach energy conservation methods. Collaborate with occupational therapist as needed. Patients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use available energy to complete desired activities. Organization and time management can help the patient conserve energy and reduce fatigue. The occupational therapist can offer the patient with assistive devices and educate the patient energy conservation methods.
Assist the patient with setting priorities for preferred activities and role responsibilities. Setting priorities is one sort of an energy conservation method that permits the patient to utilize available energy to complete important activities. Attaining desired goals can develop the patient’s mood and sense of emotional health.
Promote sufficient nutritional intake. The patient will need properly balanced intake of fats, carbohydrates, proteins, vitamins, and minerals to provide energy resources.
Encourage an exercise conditioning program as appropriate. Fatigue caused by deconditioning and prolonged bed rest can be reduced through improved functional capacity using aerobic and muscle-strengthening exercise.
Provide comfort such as judicious touch or massage, and cool showers. These may reduce nervous energy that lead to relaxation.
Encourage verbalization of feelings about the impact of fatigue. Acknowledgement that living with fatigue is both physically and emotionally challenging helps in coping.
Offer diversional activities that are soothing. This method allows the use of nervous energy in a positive manner and may lessen anxiety.
Identify energy conservation methods such as sitting and dividing ADLs into convenient segments. Assist with movement or self-care demands as appropriate. Weakness can make ADLs almost not possible for patient to finish. Being with the patient prevents the patient from getting harm during activities.
Set practical activity goals with patient. This offers a sense of control and feelings of achievement.
Stay away from topics that annoy or disturb patient. Converse ways to react to these feelings. Increased irritability of the CNS can make the patient become easily excited, agitated, and prone to emotional outburst.
Educate the patient and family about task organization methods and time organization methods. Organization and management of time can assist the patient save energy and avoid fatigue.
Support the patient in escalating levels of physical activity and exercise. Exercise can reduce fatigue and assist the patient build stamina for physical activity.
Make the patient aware about the signs and symptoms of overexertion with activity. Changes in heart rate, oxygen saturation, and respiratory rate will reflect the patient’s tolerance for activity.
Aid the patient develop habits to promote effective rest/sleep patterns. Promoting relaxation before sleep and providing for several hours of uninterrupted sleep can contribute to energy restoration.

See Also


Other nursing diagnoses available:

Further Reading


Recommended books and resources:

  1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes
  2. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
  3. Nursing Diagnoses 2015-17: Definitions and Classification
  4. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
  5. Manual of Psychiatric Nursing Care Planning
  6. Maternal Newborn Nursing Care Plans
  7. Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
  8. Maternal Newborn Nursing Care Plans

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Gil Wayne is a registered nurse and a contributor at Nurseslabs.com. Prefers writing, traveling and discovering stuffs. Not a fan of working in a hospital, but enjoys exploring nursing outside its walls! I like the color gray, but can’t imagine myself in gray scrubs... lol!