Activity Intolerance

Activity Intolerance

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Alterations in O2 transport
(_) Chronic disease:____________
____________________________
(_) Depression
(_) Diabetes Mellitus
(_) Fatigue
(_) Lack of motivation
(_) Malnourishment
(_) Pain
(_) Prolonged immobility
(_) Stressors
(_) Other:_____________________________
____________________________________
____________________________________

 

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) _____________________________________________________
________________________________________________________
________________________________________________________

 

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
  The patient will:

(_) Identify factors that reduce activity tolerance.

(_) Progress to highest level of mobility possible. Describe:

 

 

(_) Exhibit a decrease in anoxic signs of increased activity. (eg: BP, pulse, resp.)

(_) Other:

  (_) Reduce or eliminate contributing factors by:
  • Assess patient's schedule. Allow rest periods between all activities.
  • Encourage person to note daily progress.
  • Evaluate patient's pain and the present treatment regimen.
  • Check pulse rates resting and after activity to avoid danger of too great an increase.
  • Assess skin color (hands, nails, circumoral) before and after activity.
  • Relaxation training (work with pulmonary rehab.)
  • Cough/deep breathe.
  • Encourage fluid intake, roughage.
  • Teach inhaler use.
  • Sit when conversing with patient.
  • Progress the activity gradually.

(_) Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature