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