Activity-Exercise Pattern
Activity Intolerance* (Specify Level) (1982)
DEFINITION
Abnormal responses to energy-consuming body movements involved in required or desired daily activities
DEFINING CHARACTERISTICS
Diagnostic Cues*
Report of dyspnea or shortness of breath
Observation of difficulty breathing with activity
Report of fatigue (evaluate in context of other cues)
Heart rate changes (especially with cardiorespiratory problems)
Muscle weakness, discomfort, pain (especially with neuro-musculoskeletal problems) and/or following energy-consuming activity
Failure of heart rate to return to normal (baseline rate) within approximately 3 minutes
Requiring Immediate Attention and Evaluation
Reports discomfort or chest pain with activity (specify level of activity)
Arrhythmias with activity (specify level of activity)
Diastolic pressure increased by 15 mm Hg or more during activity
Ischemic changes on ECG with activity (specify level of activity)
Failure of blood pressure to increase with activity
Dyspnea at rest (unless this is a baseline)
Level I: Walk, regular pace, on level ground indefinitely; one flight or more but more short of breath than normally
Level II: Walk one city block 500 feet on level ground; climb one flight slowly without stopping
Level III: Walk no more than 50 feet on level ground without stopping; unable to climb one flight of stairs without stopping
Level IV: Dyspnea and fatigue at rest
OUTCOME
Activity Tolerance
Physiological response to energy-consuming movements with daily activities; specify level to be attained
ETIOLOGICAL OR RELATED FACTORS
Generalized weakness
Sedentary lifestyle
HIGH-RISK POPULATIONS
Imbalance between oxygen supply and demand (e.g., cardiovascular, pulmonary conditions, and changes with aging)
Activity progression (e.g., cardiac and other rehabilitation)
Long-term bed rest or immobility, deconditioned status
Risk for Activity Intolerance (1982)
DEFINITION
Presence of risk factors for abnormal response to energy-consuming body movements
RISK FACTORS
Deconditioned status (prolonged bed rest, inactivity)
Documented respiratory problems
Documented cardiac problems
History of previous intolerance to activity
Documented circulatory problems
Currently on an activity-progression program
Desire or need to engage in a higher level of activity
Inexperience with the activity
Generalized weakness (chronic disease)
OUTCOME
Activity Tolerance
Physiological response to energy-consuming movements with daily activities
Sedentary Lifestyle (2004)
DEFINITION
Reports a habit of life that is characterized by a low physical activity level
DEFINING CHARACTERISTICS
Chooses a daily routine lacking physical exercise
Demonstrates physical deconditioning
Verbalizes preference for activities low in physical activity
OUTCOME
Activity Lifestyle
Thirty minutes per day of physical activity/exercise
ETIOLOGICAL OR RELATED FACTORS
Knowledge deficit (health benefits of exercise)
Lack of training for accomplishment of physical exercise
Lack of resources (time, money, companionship, facilities)
Lack of motivation/interest
Fatigue (1988, 1998)
DEFINITION
Overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level
DEFINING CHARACTERISTICS
Diagnostic Cues
Reports unremitting and overwhelming lack of energy
Insufficient energy to maintain usual routine (physical activity, required tasks; decreased work performance)
Supporting Cues
Increase in rest requirements; inability to restore energy even after sleep
Drowsy, tired, listless
Irritable
Increase in physical complaints
Decreased concentration
Compromised libido
Disinterest in surroundings
Feelings of guilt for not keeping up with responsibilities
OUTCOME
Activity Tolerance
Absence of fatigue with energy-consuming daily activities
ETIOLOGICAL AND RELATED FACTORS
Physiological Factors
Situational Factors
Negative life events
Occupation
Environmental Factors
Lights, noise during sleep time
Humidity
Temperature
HIGH-RISK POPULATIONS
Anemia
Disease states
Pregnancy
Deficient Diversional Activity (1980)
DEFINITION
Decreased engagement in recreational or leisure activities
DEFINING CHARACTERISTICS
Diagnostic Cues
Expressed wish for something to do, such as read
Report of boredom or daytime napping
SUPPORTING CUES
States usual hobbies or activities cannot be undertaken (e.g., in hospital)
OUTCOME
Leisure Participation
Use of relaxing, interesting, and enjoyable activities to promote well-being
ETIOLOGICAL OR RELATED FACTORS
Long-term hospitalization apathy
Environmental lack of diversional activity
HIGH-RISK POPULATIONS
Frequent lengthy treatments
Long-term illness
High job and/or family demands
Impaired Physical Mobility (Specify Level) (1973, 1998)
DEFINITION
Limitation of independent, purposeful body movement in the environment
DEFINING CHARACTERISTICS
Diagnostic Cues
Inability to purposefully move within the physical environment
Postural instability during performance of routine activities
Decreased muscle control, strength, or mass
Supporting Cues
Gait changes, for example, decreased walk speed, difficulty initiating gait, small steps, shuffles feet, exaggerated lateral postural sway
Reluctance to initiate movement, for example, fear, insufficient self-efficacy
Engages in substitutions for movement, for example, fixation on activity, increased attention to other’s activity, controlling behavior, focus on pre-illness or predisability activity
Functional Level Classification
Level I: Requires use of equipment or device
Level II: Requires help from another person for assistance, supervision, or teaching
Level III: Requires help from another person and equipment or device
Level IV: Dependent; does not participate in activity
OUTCOME
Mobility
Ability to move purposefully in own environment independently with or without assistive device (specify level to be attained)
ETIOLOGICAL OR RELATED FACTORS
Activity intolerance (e.g., movement-induced shortness of breath; limited cardiovascular endurance)
Joint stiffness or contractures (limited range of motion)
Pain, discomfort
Musculoskeletal impairment (e.g., loss of integrity of bone structures)
Neuromuscular impairment (e.g., limited ability to perform fine/gross motor skills uncoordinated or jerky movements, movement-induced tremor)
Cognitive-sensory-perceptual impairment (e.g., decreased reaction time)
Depressive mood state or anxiety
Sedentary lifestyle, disuse, deconditioning
Body mass index above 75th age-appropriate percentile
Prescribed movement restriction (e.g., physical or chemical restraints, bed rest prescription, use of mechanical equipment that restricts movement, therapeutic immobilization)
Impaired Bed Mobility (Specify Level) (1998)
DEFINITION
Limitation of independent movement from one bed position to another
DEFINING CHARACTERISTICS
Diagnostic Cues
One or more of the following:
Impaired ability to turn side to side
Impaired ability to move from supine to sitting or sitting to supine
Impaired ability to “scoot” or reposition self in bed
Impaired ability to move from supine to prone or prone to supine
Impaired ability to move from supine to long sitting or long sitting to supine
Functional Level Classification
Level I: Requires use of equipment or device
Level II: Requires help from another person(s) for assistance, supervision, teaching
Level III: Requires help from another person(s) and equipment or device
Level IV: Dependent; does not participate in movement
OUTCOME
Body Positioning: Self-Initiated
Ability to change own body position independently with or without assistive device (specify level to be attained)
ETIOLOGICAL OR RELATED FACTORS
HIGH-RISK POPULATIONS
Paralysis
Musculoskeletal impairment
Neuromuscular impairment
Cognitive impairment
Impaired Transfer Ability (Specify Level) (1998)
DEFINITION
Limitation of independent body movement between two nearby surfaces
DEFINING CHARACTERISTICS
Diagnostic Cues
One or more of the following:
Impaired ability to transfer from bed to chair and chair to bed
Impaired ability to transfer on or off a toilet or commode
Impaired ability to transfer in and out of tub or shower
Impaired ability to transfer between uneven levels
Impaired ability to transfer from chair to car or car to chair
Impaired ability to transfer from chair to floor or floor to chair
Impaired ability to transfer from standing to floor or floor to standing
Functional Level Classification
Level I: Requires use of equipment or device
Level II: Requires help from another person(s) for assistance, supervision, teaching
Level III: Requires help from another person(s) and equipment or device
Level IV: Dependent; does not participate in movement
OUTCOME
Transfer Performance
Ability to change body location independently with or without assistive device (specify level to be attained)
ETIOLOGICAL OR RELATED FACTORS
Mild cognitive impairment
Deconditioning
Deficient knowledge
Environmental constraints (e.g., bed height, inadequate space, wheelchair type, treatment equipment, restraints)
Impaired vision
Insufficient muscle strength
Pain
HIGH-RISK POPULATIONS
Paralysis
Peripheral sensory loss
Marked weakness
Marked obesity
Impaired Wheelchair Mobility (1998)
DEFINITION
Limitation of independent operation of wheelchair within the environment
DEFINING CHARACTERISTICS
Diagnostic Cues
One or more of the following:
Impaired ability to operate manual wheelchair on even or uneven surface
Impaired ability to operate manual wheelchair on an incline or decline
Impaired ability to operate manual wheelchair on curbs
Impaired ability to operate power wheelchair on even or uneven surface
Impaired ability to operate power wheelchair on an incline or decline
Impaired ability to operate power wheelchair on curbs
OUTCOME
Ambulation: Wheelchair
Ability to move from place to place using a wheelchair (specify level to be attained)
ETIOLOGICAL OR RELATED FACTORS
HIGH-RISK POPULATIONS
Sensory or neuromuscular loss (e.g., spinal cord injury, muscular dystrophy, cerebral vascular accident)
Marked weakness
Severe arthritis
Impaired Walking (Specify Level) (1998)
DEFINITION
Limitation of independent movement within the environment on foot (or with a device, e.g., cane, crutches, walker)
DEFINING CHARACTERISTICS
Diagnostic Cues
One or more of the following:
Impaired ability to climb stairs
Impaired ability to walk required distances
Impaired ability to walk on an incline or decline
Impaired ability to walk on uneven surfaces
Impaired ability to navigate curbs
Functional Level Classification
Level I: Requires use of equipment or device (cane, crutches, walker)
Level II: Requires help from another person(s) for assistance, supervision, teaching
Level III: Requires help from another person(s) and equipment or device
Level IV: Dependent; does not participate in movement
OUTCOME
Mobility
Ability to move purposefully in own environment independently with or without assistive device (specify level to be attained)
ETIOLOGICAL OR RELATED FACTORS
Cognitive Impairment
Depressed mood
Impaired vision
Impaired balance
Deconditioning
Environmental constraints (e.g., stairs, inclines, uneven surfaces, unsafe obstacles, restraints, distances, lack of assistive devices or person)
Fear (falling)
Insufficient muscle strength
Limited endurance
Contractures
Muscular skeletal or neuromuscular impairment
Obesity
Pain
Deficient knowledge
HIGH-RISK POPULATIONS
Sensory-motor loss
Severe arthritis
Severe weakness
Limb amputation
Wandering (2000)
DEFINITION
Meandering, aimless, or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles; may be sporadic or continual
DEFINING CHARACTERISTICS
Diagnostic Cues
One or more of the following:
Frequent or continuous movement from place to place, often revisiting the same destinations
Persistent locomotion in search of “missing” or unattainable people
Haphazard locomotion
Locomotion into unauthorized or private spaces
Locomotion resulting in unintended leaving of premises
Long periods of locomotion without an apparent destination
Locomotion that cannot be easily dissuaded or redirected
Following behind or shadowing a caregiver’s locomotion
Hyperactivity
Scanning, seeking, or searching behaviors
Periods of locomotion interspersed with periods of nonlocomotion (e.g., sitting, standing, sleeping)
Multiple episodes of getting lost
Supporting Cues
Trespassing
Fretful locomotion or pacing
Inability to locate significant landmarks in a familiar setting
OUTCOME
Safe Home Environment
Physical arrangements minimize environmental factors that might cause physical harm or injury in the house/community
ETIOLOGICAL OR RELATED FACTORS
Cognitive impairment, specifically memory and recall deficits, disorientation, poor visuoconstructive or visuospatial ability, language defects (primarily expressive)
Cortical atrophy
Premorbid behavior (e.g., outgoing, sociable personality; premorbid dementia)
Separation from familiar people and places
Sedation
Frustration, anxiety, boredom, depression (agitation)
Overstimulating/understimulating social or physical environment
Physiological state or need (e.g., hunger/thirst, pain, urination, constipation)
Time of day
Risk for Disuse Syndrome* (1988)
DEFINITION
Presence of risk factors for deterioration of body systems as the result of prescribed or unavoidable musculoskeletal inactivity
RISK FACTORS
Paralysis
Mechanical immobilization (e.g., lower-body cast, leg traction, vascular lines)
Prescribed immobilization
Severe pain
Altered level of consciousness
Severe depression
OUTCOME
Immobility Consequences: Physiological/Psychocognitive
Normal physiological/psychocognitive functioning
Risk for Joint Contractures
DEFINITION
Presence of risk factors for shortening of tendons at movable joints (back, head, upper and lower extremities)
RISK FACTORS
Loss of voluntary postural muscle control
Prolonged joint flexion in sitting or recumbent position
Spasticity
Report of pain or discomfort on movement
Imposed restrictions of joint movement (e.g., casts, traction)
Assumption of abnormal posture resulting from psychosocial factors or cognitive deficit
OUTCOME
Joint Motion
Functional range of joint motion
Self-Neglect (2008)
DEFINITION
A constellation of culturally framed behaviors involving one or more self-care activities in which there is a failure to maintain a socially accepted standard of health and well-being (Gibbons, Lauder, & Ludwick, 2006)
DEFINING CHARACTERISTICS
Inadequate personal hygiene
Inadequate environmental hygiene
Nonadherence to health activities
OUTCOME
Self-Care: Hygiene
Maintains own personal cleanliness and appearance with or without assistive device(s)
ETIOLOGICAL OR RELATED FACTORS
Functional impairment
Lifestyle/choice
Capgras syndrome
Cognitive impairment (e.g., dementia)
Depression
Learning disability
Fear (institutionalization)
Maintaining control
Malingering
Substance abuse
Major life stressor
Reference: Gibbons, S., Lauder, W., & Ludwick, R. (2006, Jan-March). Self-neglect: A proposed new NANDA diagnosis. International Journal of Nursing Terminologies and Classifications, 17(10), 10-18.
HIGH-RISK POPULATIONS
Frontal lobe dysfunction and executive processing ability
Schizotypal personality disorders
Paranoid personality disorders
Obsessive-compulsive disorder
Depression
Total Self-Care Deficit (Specify Level)
DEFINITION
Inability to complete feeding, bathing, toileting, dressing, and grooming of self
DEFINING CHARACTERISTICS
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