Activity Intolerance



Activity Intolerance





Activity Intolerance

Related to Insufficient Knowledge of Adaptive Techniques Needed Secondary to COPD

Related to Insufficient Knowledge of Adaptive Techniques Needed Secondary to Impaired Cardiac Function




Defining Characteristics


Major (Must Be Present)

An altered physiologic response to activity


Respiratory














Exertional dyspnea*


Shortness of breath


Excessively increased rate


Decreased rate



Pulse

















Weak


Decreased


Excessively increased


Failure to return to preactivity level after 3 minutes


Rhythm change


EKG changes reflecting arrhythmias or ischemia*



Blood Pressure













Abnormal blood pressure response to activity


Increased diastolic pressure greater than 15 mm Hg


Failure to increase with activity



Minor (May Be Present)
















Verbal report of weakness*


Verbal report of fatigue*


Pallor or cyanosis


Confusion


Verbal reports of vertigo



Related Factors

Any factors that compromise oxygen transport, physical conditioning, or create excessive energy demands that outstrip the individual’s physical and psychological abilities can cause activity intolerance. Some common factors follow.


Pathophysiologic

Related to deconditioning secondary to prolonged immobilization and pain

Related to imbalance between oxygen supply/demand*


Related to compromised oxygen transport system secondary to:


Cardiac



















Cardiomyopathies


Congestive heart failure


Dysrhythmias


Angina


Myocardial infarction (MI)


Valvular disease


Congenital heart disease



Respiratory













Chronic obstructive pulmonary disease (COPD)


Atelectasis


Bronchopulmonary dysplasia



Circulatory













Anemia


Peripheral arterial disease


Hypovolemia


Related to increased metabolic demands secondary to:

















Acute or chronic infections


Pain


Viral infection


Mononucleosis


Endocrine or metabolic disorders


Hepatitis



Chronic Diseases
















Renal


Hepatic


Inflammatory


Musculoskeletal


Neurologic


Related to inadequate energy sources secondary to:













Obesity


Inadequate diet


Malnourishment



Treatment Related

Related to increased metabolic demands secondary to:














Malignancies


Surgery


Diagnostic studies


Treatment schedule/frequency


Related to compromised oxygen transport secondary to:













Hypovolemia


Immobility*


Bed rest* (related to inactivity secondary to assistive equipment [walkers, crutches, braces])



Situational (Personal, Environmental)

Related to inactivity secondary to:













Depression


Sedentary lifestyle*


Inadequate social support


Related to increased metabolic demands secondary to:














Climate extremes (especially hot, humid climates)


Atmospheric pressure (e.g., recent relocation to high-altitude living)


Air pollution (e.g., smog)


Environmental barriers (e.g., stairs)


Related to inadequate motivation secondary to:

















Fear of falling


Pain


Depression


Dyspnea


Obesity


Generalized weakness*



Maturational

Older adults may have decreased muscle strength and flexibility, as well as sensory deficits. These factors can undermine body confidence and may contribute directly or indirectly to activity intolerance.





Key Concepts


General Considerations



  • “Consensus Guidelines for Physical Activity and Public Health from the American Heart Association and American College of Sports Medicine call for at least 150 minutes per week of moderate ET or 75 minutes per week of vigorous ET in the general adult population. Those guidelines also suggest that larger doses of ET may be necessary in some groups, such as those with or at risk for CHD (30 to 60 minutes daily), adults trying to prevent the transition to overweight or obesity (45 to 60 minutes per day), and formerly obese individuals trying to prevent weight regain (60 to 90 minutes per day). These guidelines also caution that high-intensity ET increases risk of musculoskeletal injuries and adverse CV events” (*Haskell et al., 2007; La Gerche, Robberecht, & Kuiperi, 2010).


  • The effects of bed rest and the supine position are illustrated in Figure II.1.


  • The effects of bed rest deconditioning develop rapidly and may take weeks or months to reverse. All people confined to bed are at risk for activity intolerance as a result of bed rest-induced deconditioning.


  • Early mobility has been linked to decreased morbidity and mortality as inactivity has a profound adverse effect on the brain, skin, skeletal muscle, pulmonary, and cardiovascular systems (Zomorodi, Darla Topley, & McAnaw, 2012).


  • Delirium, decubitus ulcers, muscular atrophy, and deconditioning may occur in the immobile patient, as a result of atelectasis, pneumonia, orthostatic hypotension, and deep venous thrombosis (Zomorodi et al., 2012).


  • Endurance is the ability to continue a specified task; fatigue is the inability to continue a specified task. Conceptually, endurance and fatigue are opposites. Nursing interventions, such as work simplification, aim to delay task-related fatigue by maximizing efficient use of the muscles that control motion, movement, and locomotion.


  • The ability to maintain a given level of performance depends on personal factors, strength, coordination, reaction time, alertness, and motivation, and on activity-related factors, frequency, duration, and intensity.


  • “Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias” (O’Keefe et al., 2012, p. 588).







FIGURE II.I Effects of Bedrest on Body Systems




Focus Assessment Criteria


Subjective Data


Assess for Defining Characteristics













Weakness


Fatigue


Dyspnea



Assess for Related Factors














Lack of incentive


Pain that interferes with performance of activities


Lack of confidence in ability to perform activity


Fear of injury or aggravating disease as a result of partici pation in activity

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Dec 6, 2019 | Posted by in NURSING | Comments Off on Activity Intolerance
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