Fatigue & Lethargy Nursing Care Plans

Utilize this comprehensive guide to create a holistic nursing care plan and interventions specifically tailored for clients experiencing fatigue. This guide will equip nurses with a deep understanding of the nursing assessment, diagnosis, and interventions required to effectively manage fatigue and promote the overall well-being of clients. By addressing their individual needs, nurses can provide the necessary support for their recovery journey.

Table of Contents

• What is fatigue?
• Causes
• Nursing Care Plans and Management
• Nursing Problem Priorities
• Nursing Assessment
• Nursing Diagnosis
• Nursing Goals
• Nursing Interventions and Actions
  • 1. Assessing Risk Factors of Fatigue and Activity Tolerance Levels
  • 2. Decreasing Fatigue and Improving Sleep Patterns
    • Clients with mental health disorders
    • Clients with COPD
    • Clients with cardiovascular disorders
    • Clients with cancer or undergoing chemotherapy
  • 3. Restoring Activity Tolerance Levels
• Recommended Resources
• References and Sources

What is fatigue?

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 conditions. 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.

Trait fatigue describes the fatigue experienced by an individual over a longer period (weeks and months), which is relatively stable. Trait fatigue is a symptom associated with many diseases, such as multiple sclerosis, chronic obstructive pulmonary disease (COPD), and rheumatoid arthritis, and is a result of primary disease-related mechanisms as well as secondary mechanisms not directly caused by the disease but associated with it (Behrens et al., 2023).

Activity-induced state fatigue is characterized by an acute and temporary change in motor or cognitive performance as well as the subjective experience of weariness or exhaustion that occurs in the context of a specific motor or cognitive task. Thus, motor performance fatigue can be described as a decrease in the maximal voluntary force production capacity of the neuromuscular system, which is determined by neural and muscular factors. Cognitive performance fatigue, on the other hand, induced by sustained and/or intense cognitive tasks can be quantified as a decline in an objective cognitive performance measure during as well as after a cognitive task.

Chronic fatigue syndrome (CFS) is a disorder characterized by unexplained profound fatigue that is worsened by exertion. The fatigue is accompanied by cognitive dysfunction and impairment of daily functioning that persists for more than six months. CFS is a biological illness, not a psychological disorder. The cause of CFS is unknown, and there are no direct tests to diagnose CFS (Roberts & Stuart, 2020).

Fatigue can significantly impact a client’s ability to perform daily activities, affecting their quality of life and overall well-being. It can also lead to decreased motivation, social isolation, and other adverse effects.

Causes

Here are the common factors that can cause fatigue and lethargy:

1. Physical exertion. Prolonged or excessive physical activity can lead to fatigue as the body’s energy reserves become depleted and muscles become fatigued.
2. Sleep deprivation. Lack of sufficient sleep or poor sleep quality can result in fatigue, as the body and brain do not have adequate time to rest and rejuvenate.
3. Medical conditions. Various medical conditions such as anemia, thyroid disorders, chronic pain, and infections can contribute to fatigue by affecting the body’s physiological processes and energy production.
4. Medications. Certain medications, such as those used for pain management, sedatives, and some antidepressants, may have fatigue as a side effect.
5. Psychological factors. Mental health conditions like depression, anxiety, and chronic stress can cause or exacerbate fatigue by affecting sleep patterns, energy levels, and overall well-being.
6. Poor nutrition. Inadequate intake of essential nutrients, dehydration, and imbalances in blood sugar levels can lead to fatigue as the body lacks the necessary fuel for energy production.
7. Lifestyle factors. Unhealthy lifestyle habits, such as excessive alcohol consumption, smoking, lack of physical activity, and poor stress management, can contribute to fatigue by negatively impacting overall health and well-being.
8. Environmental factors. Exposure to extreme temperatures, noise, or prolonged exposure to stressful or demanding environments can result in fatigue due to the strain placed on the body and mind.

Nursing Care Plans and Management

Fatigue and lethargy are common reports that clients may experience due to a multitude of factors, ranging from underlying medical conditions to lifestyle choices. Nursing care plans are essential components in addressing the challenges posed by fatigue and lethargy, as they provide a structured approach to assessing, managing, and promoting the well-being of clients exhibiting these symptoms. Nursing care plans involve a series of systematic steps, including thorough history-taking and assessment, accurate diagnosis, goal setting, intervention implementation, and ongoing evaluation.

Nursing Problem Priorities

The following are the nursing priorities for clients with fatigue and lethargy:

1. Activity intolerance. Fatigue and lethargy often lead to a decreased ability to perform physical activities without experiencing extreme exhaustion.
2. Disturbed sleep pattern. Poor sleep patterns can contribute to fatigue and lethargy. Addressing sleep disturbances may restore the client’s energy levels.
3. Physical deconditioning. Prolonged periods of inactivity due to fatigue can lead to muscle weakness and physical deconditioning. Gradual exercise programs tailored to the client’s abilities can help improve strength and endurance.

Nursing Assessment

Priority nursing assessments for fatigue and lethargy involve evaluating its severity and duration, identifying potential causes, assessing sleep patterns and mental health, and evaluating the impact on daily activities.

• Persistent tiredness. The client experiences a constant feeling of exhaustion and lack of energy, often unrelated to physical activity or sleep.
• Difficulty concentrating. The client’s cognitive impairment, characterized by difficulty focusing, maintaining attention, and processing information, can significantly impact their task performance and decision-making abilities.
• Decreased motivation. The client may lack the drive or enthusiasm to engage in activities they previously enjoyed.
• Physical weakness. The client may experience a sense of weakness, heaviness, or lack of strength in their muscles. This can lead to difficulties with mobility and performing physical tasks.
• Sleep disturbances. Fatigue can be accompanied by disruptions in sleep patterns, such as insomnia, frequent awakenings, or unrefreshing sleep. These sleep disturbances can further contribute to feelings of tiredness and fatigue.
• Irritability and mood changes. The client may display increased irritability, mood swings, or emotional instability. These emotional changes can be a result of the physical and mental strain associated with fatigue.
• Reduced tolerance to stress. Fatigue can lower the client’s ability to cope with and manage stressors, making them more susceptible to feeling overwhelmed or emotionally drained.
• Physical symptoms. Fatigue can manifest in various physical symptoms, including headaches, muscle aches, dizziness, and general malaise. These symptoms may contribute to the overall feeling of being unwell.

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with fatigue and lethargy based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities. However, if you still find value in utilizing nursing diagnosis labels, here are some examples to consider:

• Fatigue related to inadequate sleep hygiene AEB patient reporting difficulty falling asleep, frequent nighttime awakenings, and feeling unrefreshed in the morning.
• Fatigue related to excessive physical exertion AEB patient stating, “I feel completely drained,” after minimal activity and decreased performance in physical tasks.
• Fatigue related to side effects of medication AEB patient reporting increased drowsiness and lack of energy since starting new medication regimen.
• Fatigue related to metabolic imbalance (e.g., hypothyroidism) AEB patient describing weight gain, cold intolerance, and sluggishness, despite adequate rest.
• Fatigue related to nutritional deficiencies (e.g., vitamin D, iron) AEB patient reporting cravings for non-nutritive substances, hair loss, and brittle nails.
• Fatigue related to respiratory compromise (e.g., chronic obstructive pulmonary disease) AEB patient reporting shortness of breath with exertion and needing frequent rests when walking.

Nursing Goals

The following are the common goals and expected outcomes for fatigue and lethargy.

• The client will identify risk factors and individual actions affecting fatigue.
• The client will identify alternatives to help maintain desired activity level.
• The client will demonstrate improved energy levels and reduced fatigue, as evidenced by reporting an increased ability to engage in daily activities without excessive tiredness.
• The client will adopt healthy lifestyle behaviors and self-care strategies to manage fatigue, as evidenced by practicing adequate sleep hygiene, engaging in regular physical activity, and implementing stress reduction techniques.
• The client will participate in necessary and desired activities.

Nursing Interventions and Actions

Therapeutic interventions and nursing action for clients with fatigue and lethargy may include:

1. Assessing Risk Factors of Fatigue and Activity Tolerance Levels

Nursing assessment is crucial for evaluating the underlying causes and contributing factors of fatigue and lethargy in clients, as it helps identify physical, psychological, and environmental factors that may be exacerbating fatigue and guides the development of individualized nursing interventions for managing and alleviating fatigue and lethargy.

Evaluate the client’s description of fatigue: severity, changes in severity over time, aggravating factors, or alleviating factors.
Using an appropriate quantitative scoring scale, 1 to 10 for example, can aid the client to 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 client’s fatigue level over time. It is essential to conclude if the client’s level of fatigue is constant or if it varies over time.

Assess the client’s ability to perform ADLs, instrumental activities of daily living (IADLs), and demands of daily living (DDLs).
Fatigue can restrict the client’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. One of the most frequently used tools to assess the client’s level of independence is the Functional Independence Measure (FIM). The FIM is a minimum data set, measuring 18 self-care items including eating, bathing, grooming, dressing the upper body, dressing lower body, toileting, bladder management, and bowel management.

Evaluate the client’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 client put into practice changes to decrease fatigue. The nurse should be aware of the client’s medical conditions or other health problems, the effect that they have on the ability to perform ADLs, and the family’s involvement in the client’s ADLs. this information is valuable in setting goals and developing a plan of care.

Observe physiological reactions 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 the client has been subjected to. In CFS, orthostatic intolerance or worsening of symptoms upon assuming and maintaining an upright posture may occur.

Assess for symptoms of chronic fatigue syndrome (CFS).
CFS involves fatigue for at least six months and at least four to six accompanying symptoms, such as increased tiredness after exertion, sleep disturbance, muscle and joint pain, head and neck pain, cognitive impairment, orthostatic disturbances, and marked restriction of everyday activities not attributable to any other specific disease. Symptoms tend to worsen with stress.

Assess the client’s typical level of exercise and physical movement.
Increased physical exertion and inadequate levels of exercise can add to fatigue. The nurse must observe and assess the client’s ability to perform ADLs to determine the level of independence in activities and the need for nursing intervention. The nurse may observe the client performing specific activities and note the degree of independence; the time taken; the client’s mobility, coordination, and endurance; and the amount of assistance required.

Assess the client’s sleep patterns for quality, quantity, time taken to fall asleep, and feeling upon awakening and observe an alteration in thought processes or behaviors.
Changes in the client’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. In clients with acute disease, sleep time is frequently reduced and fragmented by prolonged awakenings. Stiffness, depression, and medications may also compromise the quality of sleep and increase daytime fatigue.

Assess the client’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 produce a vicious cycle. Rather than obvious sadness, the client may exhibit more subtle signs of depression such as fatigue, diminished memory and concentration, feelings of worthlessness, sleep disturbances, restlessness, impaired attention span, and suicidal ideation.

Determine possible causes of fatigue, such as last physical illness, pain, emotional stress, depression, side effects of medication, anemia, sleep disorders, imbalanced nutritional intake, and extended responsibilities and demands at home or work.
Identifying the related factors to fatigue can benefit in recognizing potential causes and building a collaborative plan of care. Cancer-related and chemotherapy-related fatigue can greatly affect the client’s quality of life, during treatment, and for months after treatment. Fatigue is also a common and oppressive symptom of leukemia.

Assess the client’s nutritional ingestion for adequate energy sources and metabolic demands.
Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies. Numerous reviews reported that some nutritional deficiencies could be involved as etiologic agents for CFS. these include deficiencies of vitamin C, vitamin B complex, sodium, magnesium, zinc, folic acid, L-carnitine, L-tryptophan, essential fatty acids, and coenzyme Q10 (Bjørklund et al., 2019).

Assess the client’s routine recommendations and over-the-counter drugs.
Fatigue may be a medication side effect or an indication of a drug interaction. The nurse must take particular notice of the client’s utilization of beta-blockers, calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.  All medications can cause side effects, which may lead to new symptoms or worsen existing symptoms, so it is important to monitor routinely all prescription drugs, over-the-counter medicines, and supplements (Centers for Disease Control and Prevention, 2018).

Review results of laboratory or diagnostic tests such as blood glucose, hemoglobin/hematocrit, BUN, and oxygen saturation (resting and with activity).
Changes in these physiological measures may be associated with other measurement data to recognize possible sources of the client’s fatigue. Targeted laboratory testing should include blood sugar, complete blood count, erythrocyte sedimentation rate (ESR CRP), transaminases or y-GT, and TSH (Maisel et al., 2021).

Assess for a history of infectious diseases.
Viral respiratory infections, mononucleosis, Giardia infections, and other infections are important causes of fatigue. In clients with these conditions, further causative factors are usually present, including treatment side effects, sleep disturbances, anxiety, and depression, if the symptoms persist for many weeks.

Obtain laboratory tests for premenopausal clients.
In premenopausal women whose basic evaluation (normal history, physical examination, and basic laboratory tests) is negative, ferritin concentration should be measured.

2. Decreasing Fatigue and Improving Sleep Patterns

Decreasing fatigue and improving sleep patterns involve a combination of lifestyle changes, behavioral adjustments, and potentially medical interventions.

Restrict environmental stimuli, especially during planned times for rest and sleep.
Vivid lighting, noise, visitors, numerous distractions, and litter in the client’s physical surroundings can limit relaxation, disturb rest or sleep, and contribute to fatigue. The nurse needs to implement creative strategies that permit uninterrupted sleep for at least a few hours while still administering necessary medications on schedule.

Aid the client to develop habits to promote effective rest/sleep patterns.
Promoting relaxation before sleep and providing several hours of uninterrupted sleep can contribute to energy restoration. Strategies may also include establishing a set time to sleep and a regular wake-up time, creating a quiet sleep environment with a comfortable room temperature, avoiding factors that interfere with sleep, using relaxation exercises, getting out of bed and engaging in another activity, such as reading, if unable to sleep.

Encourage the client to maintain a 24-hour fatigue or activity log for at least one week.
Recognizing relationships between specific activities and levels of fatigue can aid the client in recognizing unnecessary energy outflow. The log may indicate times of day when the person feels the least fatigued. This information can help the client make choices about setting his or her activities to take advantage of episodes of high energy levels.

Implement assistive devices for ADLs and IADLs such as a long-handled sponge for bathing, a long shoehorn, a sock-puller, and a long-handled grabber.
Utilization of such devices can lessen energy expenditure and prevent injury with activities. If the client has difficulty performing an ADL, an adaptive or assistive device may be useful. Such devices may be obtained commercially or can be constructed by the nurse, occupational therapist, client, or family.

Aid the client 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 client in completing preferred activities without contributing to levels of fatigue. The nurse can help the client reduce limitations in activity by planning self-care activities and determining the best times for bathing, dressing, and other daily activities.

Teach energy conservation methods. Collaborate with an occupational therapist as needed.
Clients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use the available energy to complete desired activities. Organization and time management can help the client conserve energy and reduce fatigue. The occupational therapist can offer the client assistive devices and educate the client on energy conservation methods.

Assist the client with setting priorities for preferred activities and role responsibilities.
Setting priorities is one sort of energy conservation method that permits the client to utilize available energy to complete important activities. Attaining desired goals can develop the client’s mood and sense of emotional health. If the client has a severe disability, independent self-care may be an unrealistic goal. The nurse may educate the client on how to take charge by directing their care, or the client may require a personal attendant to perform ADLs.

Educate the client and family about task organization methods and time organization methods.
Organization and management of time can assist the client to save energy and avoid fatigue. A client’s approach may be affected by impaired mobility and influenced by family or cultural expectations. The nurse must help the client identify safe limits of independent activity; knowing when to ask for assistance is particularly important.

Clients with mental health disorders

Communicate openly with the client.
The nurse should advise the client empathetically and communicate openly so that the client can be motivated to change their behavior to modify unmanageable or insufficient physical and psychosocial challenges.

Encourage the client to keep a symptom diary.
Keeping a symptom diary can be useful as a basis for discussions about symptoms, impairments, and the associated feelings and conceptions. This therapeutic approach accords with the recommendations of the DEGAM guideline on fatigue.

Provide psychoeducative measures.
Psychoeducative measures to inform the client about the disease process and the appropriate way of dealing with it by assuming personal responsibility, thus strengthening client resources, with the aid of accompanying materials, are useful for dealing with excessive challenges in everyday life.

Administer the appropriate medications as prescribed.
Occasionally, pharmacologic measures are utilized, including antidepressants for clients with depression, anxiolytics for those with anxiety, hypnotics for clients with sleep disturbances, and psychostimulants for clients with fatigue that do not respond to other interventions.

Refer the client to behavior therapy.
Cognitive behavioral therapy (CBT) is recommended as the first-line treatment for adults of any age. Problem-oriented cognitive behavior therapy is useful in some cases as well. Behavior therapy has similar efficacy to other forms of therapy.

Clients with COPD

Pace the client’s activities throughout the day.
People with COPD have decreased exercise tolerance during specific periods of the day, especially in the morning on arising, because bronchial secretions have collected in the lungs during the night while the client is lying down. The client may have difficulty bathing or dressing and may become fatigued. Activities that require the arms to be supported above the level of the thorax may produce fatigue or respiratory distress but may be tolerated better after the client has been up and moving around for an hour or so.

Encourage the client to participate in self-care activities.
The client is encouraged to assume increasing participation in self-care activities. The client is taught to coordinate diaphragmatic breathing with activities such as walking, bathing, bending, or climbing stairs. The client should bathe, dress, and take short walks, resting as needed to avoid fatigue and excessive dyspnea.

Instruct the client on physical conditioning exercises.
People with COPD may benefit from exercise training, as it can increase tolerance and decrease dyspnea and fatigue. Physical conditioning techniques include breathing exercises and general exercises intended to observe energy and increase pulmonary ventilation.

Promote the use of breathing exercises.
Inspiratory muscle training and breathing retraining may help improve breathing patterns. Training in diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Pursed-lip breathing helps slow respiration, prevent the collapse of small airways, and control the rate and depth of respiration. It also promotes relaxation.

Encourage the client to engage in a new, healthy lifestyle.
A client with COPD should adopt a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity. As much as possible, the client should avoid emotional disturbances and stressful situations that might trigger a coughing episode. Self-management also includes getting sufficient rest and sleep.

Promote smoking cessation.
Smoking cessation goes hand in hand with lifestyle changes, and reinforcing the client’s efforts is a key nursing activity. Smoking cessation is the single most important therapeutic intervention for clients with COPD. There are many strategies, including prevention, cessation with or without oral or topical patch medications, and behavior modification techniques.

Administer oxygen as indicated.
Oxygen supplied to the homes comes in compressed gas, liquid, or concentrator systems. Portable oxygen systems allow the client to exercise, work, and travel. Explain the proper flow rate and required number of hours for oxygen use as well as the dangers of arbitrary changes in flow rate or duration of therapy.

Clients with cardiovascular disorders

Encourage the client to engage in regular physical activity.
The reduced physical activity caused by heart failure (HF) symptoms leads to physical deconditioning that worsens the client’s symptoms and exercise tolerance. An acute illness that exacerbates HF symptoms or requires hospitalization may be an indication for temporary bed rest. A typical program for a client with HF might include a daily walking regimen, with the duration increased over 6 weeks.

Alternate periods of activity and rest.
The primary provider, nurse, and client should collaborate to develop a schedule that promotes pacing and prioritization of activities. The schedule should alternate activities with periods of rest and avoid having two significant energy-consuming activities occur on the same day or in immediate succession.

Assist the client in gradually increasing activity, as tolerated.
The client should increase the duration of the activity, then frequency, before increasing the intensity of the activity. Before undertaking physical activity, the client should be given guidelines similar to walking with warm-up and cooldown activities.

Adjust ADLs to fit the client’s tolerance.
Methods of adjusting to an activity should be considered. For example, vegetables can be chopped or peeled while sitting at the kitchen table rather than standing at the kitchen counter. The nurse helps the client identify peak and low periods of energy, planning energy-consuming activities for peak periods. For example, the client may prepare meals for the entire day in the morning.

Monitor the client’s response to activities.
The client’s response to activities needs to be monitored. If the client is hospitalized, vital signs and oxygen saturation levels are monitored before, during, and after an activity to identify whether they are within the desired range. Heart rate should return to baseline within three minutes following activity. The degree of fatigue felt after activity can be used to assess the response.

Place the client in a position of comfort.
The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. The lower arms can be supported with pillows to eliminate fatigue caused by the pull of the client’s weight on the shoulder muscles.

Provide psychological support.
Clients with HF may exhibit signs and symptoms of anxiety due to concerns about their ability to carry out ADLs. The nurse should take steps to promote physical comfort and provide psychological support. In many cases, a family member’s presence provides reassurance, therefore, if needed, the nurse may contact them to visit the client.

Clients with cancer or undergoing chemotherapy

Provide educational interventions about cancer-related fatigue.
Educational interventions can reduce cancer-related fatigue and its interference with daily life. All clients should be educated on cancer-related fatigue, how it differs from normal fatigue, its contributing factors, self-monitoring, and management. Studies have shown that counseling can also be effectively delivered remotely via telehealth/internet to clients who are not in the active phase of treatment (Joly et al., 2019).

Encourage regular physical activity as tolerated.
Among non-pharmacologic interventions, the strongest and most consistent evidence supports the effectiveness and safety of physical activity interventions in reducing cancer-related fatigue. A meta-analysis of 27 exercise intervention trials showed that exercise training among clients with various types of cancer led to a significant reduction in fatigue. The client is encouraged to engage in at least moderate levels of physical activity after cancer treatment. A minimum of 150 minutes of moderate aerobic exercise per week is sufficient to meet the threshold of the recommended level, and this may include fast walking, cycling, or swimming.

Collaborate with the client in developing their exercise regimen.
Exercise interventions should be tailored to the individual client, based on factors including age, gender, and baseline level of physical fitness. Specifically, the choice of the most appropriate physical activity intervention to offer should account for the client’s medical history and comorbidities, as well as physical limitations, risk of injury, and other safety concerns.

Promote relaxation techniques, such as yoga.
Some evidence demonstrated yoga interventions can reduce fatigue during cancer treatment. A yoga program is associated with better sleep outcomes in exploratory analyses, and amelioration of such sleep parameters may, in turn, translate into improved cancer-related fatigue.

Recommend complementary and alternative therapies as appropriate.
There are varying degrees of evidence strength about the effectiveness of interventions such as massage therapy, acupuncture, music therapy, mindfulness meditation and relaxation, reiki, and qigong on reducing cancer-related fatigue. Regular massage therapy determined a greater reduction in fatigue. Acupuncture interventions also showed improvement in fatigue among the treatment group.

Refer the client to cognitive behavior therapy (CBT).
CBT and psychoeducational therapies can be beneficial in reducing cancer-related fatigue. The rationale that prompted the utilization of psychosocial interventions to reduce fatigue builds on the strong correlation that exists between emotional distress and fatigue.

Administer medications or supplements as indicated.
Psychostimulants, such as methylphenidate, and other wakefulness agents (modafinil) are effective in reducing cancer-related fatigue only among clients with advanced disease or those undergoing active cancer treatment. Additionally, the use of supplements has also been investigated, and the use of ginseng and vitamin D has been linked to some degree with improved cancer-related fatigue. 

3. Restoring Activity Tolerance Levels

Prolonged inactivity, which may be self-imposed, should be avoided because of its deconditioning effects and risks, such as pressure injuries and venous thromboembolism. Therefore, some type of physical activity every day should be encouraged.

Promote sufficient nutritional intake.
The client will need a properly balanced intake of fats, carbohydrates, proteins, vitamins, and minerals to provide energy resources. Multivitamin-mineral supplements could be a safe and easy approach to alleviate CFS symptoms and improve the client’s quality of life. According to analysis, vitamin A and vitamin E are promising vitamins that need further studies and examinations to help clients with fatigue.

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 exercises. When performed correctly, exercise assists in maintaining and building muscle strength, maintaining joint function, preventing deformity, stimulating circulation, developing endurance, and promoting relaxation.

Provide comforts such as judicious touch or massage, and cool showers.
These may reduce nervous energy which leads to relaxation. The Benson muscle relaxation technique is a concentration method, which can be easily learned and applied. This technique creates a quiet environment that results in the reduction of muscle tension and increases the client’s attention (Seifi et al., 2018).

Encourage verbalization of feelings about the impact of fatigue.
Acknowledgment that living with fatigue is both physically and emotionally challenging helps in coping.  Expressing concerns can lead to validation and reassurance from healthcare professionals, which contributes to a better understanding of the condition and potential solutions.

Offer diversional activities that are soothing.
This method allows the use of nervous energy in a positive manner and may lessen anxiety. Listening to nature sounds can be soothing and has a beneficial effect on people’s health. The indirect and direct effects of nature sound on the reduction of stress, and emotional, psychological, and cognitive processes have been described in many theories. Nature sounds have been found effective in the improvement of anxiety in clients undergoing surgery.

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 impossible for clients to finish. Being with the client prevents the client from getting harmed during activities. Often, performing a simple maneuver requires the client with a disability to concentrate intensely and exert considerable effort; therefore, self-care techniques need to be adapted to accommodate the individual client’s lifestyle.

Set practical activity goals with the client.
This offers a sense of control and feelings of achievement. The SMART (Specific, Measurable, Achievable, Relevant, Timely) acronym can be used to assist clients in developing their overarching goals regarding managing their fatigue. The strategies are intended to be short-term, explicit, attainable tasks that when achieved, would support the attainment of the goal (Hagan et al., 2017).

Support the client in escalating levels of physical activity and exercise.
Exercise can reduce fatigue and assist the client build stamina for physical activity. Therapeutic exercises are prescribed by the primary provider and performed with the assistance and guidance of the physical therapist or nurse. The client should have a clear understanding of the goal of the prescribed exercises.

Educate the client about the signs and symptoms of overexertion with activity.
Changes in heart rate, oxygen saturation, and respiratory rate will reflect the client’s tolerance for activity. Due to the decreased and inconsistent nature of the client’s energy levels, overexertion can occur from simply completing daily activities, such as grocery shopping or walking up a flight of stairs. Overexertion often leads clients with CFS to experience post-exertional malaise (PEM) and energy “crashes”. PEM is the worsening of fatigue and other symptoms after physical or mental exertion (O’Connor et al., 2017).

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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References and Sources

References and sources used for this nursing diagnosis guide for fatigue.

• Behrens, M., Gube, M., Chaabene, H., Prieske, O., Zenon, A., Broscheid, K.-C., Schega, L., Husmann, F., & Weippert, M. (2023). Fatigue and Human Performance: An Updated Framework. Sports Medicine, 53.
• Bjørklund, G., Dadar, M., Pen, J. J., Chirumbolo, S., & Aaseth, J. (2019). Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach. Biomedicine & Pharmacotherapy, 109.
• Centers for Disease Control and Prevention. (2018, July 12). Monitoring the Use of All Medicines and Supplements | Clinical Care of Patients | Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). CDC.
• Hagan, T. L., Arida, J. A., Hughes, S., & Donovan, H. S. (2017). Creating Individualized Symptom Management Goals and Strategies for Cancer-Related Fatigue for Patients with Recurrent Ovarian Cancer. NCBI.
• Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-surgical Nursing. Wolters Kluwer.
• Joly, F., Lange, M., Dos Santos, M., Vaz-Luis, I., & Di Meglio, A. (2019). Long-Term Fatigue and Cognitive Disorders in Breast Cancer Survivors. MDPI.
• Maisel, P., Baum, E., & Donner-Banzhoff, N. (2021). Fatigue as the Chief Complaint – PMC. NCBI.
• O’Connor, K., Sunnquist, M., Nicholson, L., Jason, L. A., Newton, J. L., & Strand, E. B. (2017). Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves. Sage Journals, 15(1).
• Roberts, J. R., & Stuart, M. (2020, September 6). Chronic Fatigue Syndrome (Myalgic Encephalomyelitis): Practice Essentials. Medscape Reference. Retrieved August 22, 2023, from
• Seifi, L., Ghezelijeh, T. N., & Haghani, H. (2018). Comparison of the Effects of Benson Muscle Relaxation and Nature Sounds on the Fatigue in Patients With Heart Failure. Holistic Nursing Practice, 32(1).