Home Care Interventions
1. Begin discharge planning as soon as possible with case manager or social worker to assess need for home support systems and the need for community or home health services.
2. Assess the home environment for factors that precipitate decreased activity tolerance: presence of allergens such as dust, smoke, and those associated with pets; temperature; energy-intensive activity patterns; and furniture placement. Refer to occupational therapy if needed to assist the client in restructuring the home and activity of daily living patterns. R/ : Clients and families often estimate energy requirements inaccurately during hospitalization because of the availability of support.
3. Teach the client/family the importance of and methods for setting priorities for activities, especially those having a high energy demand (e.g., home/family events).
4. Provide client/family with resources such as senior centers, exercise classes, educational and recreational programs, and volunteer opportunities that can aid in promoting socialization and appropriate activity.
R/ : Social isolation can contribute to activity intolerance.
5. Discuss the importance of sexual activity as part of daily living. Instruct the client in adaptive techniques to conserve energy during sexual interactions.
R/ : Families may make unsafe choices for sexual activity or place added stress on themselves trying to cope with this issue without proper support or teaching.
6. Instruct the client and family in the importance of maintaining proper nutrition and rest for energy conservation and rehabilitation.
7. Refer to medical social services as necessary to assist the family in adjusting to major changes in patterns of living.
8. Assess the need for long-term supports for optimal activity tolerance of priority activities (e.g., assistive devices, oxygen, medication, catheters, massage), especially for hospice patients. Evaluate intermittently.
R/ : Assessments ensure the safety and appropriate use of these supports.
9. Refer to home health aide services to support the client and family through changing levels of activity tolerance. Introduce aide support early. Instruct the aide to promote independence in activity as tolerated. R/ : Providing unnecessary assistance with transfers and bathing activities may promote dependence and a loss of mobility (Mobily, Kelley, 1991).
10. Be aware of increased risk of bone fracture even after muscle strength is normalized, especially in osteopenic-prone individuals such as estrogen-deficient women and the elderly.
R/ : Reduction in weight bearing muscle activity during bed rest invariably produces significant changes in calcium balance and, in weeks, changes in bone mass (Bloomfield, 1997)
11. Allow terminally ill clients and their families to guide care.
R/ : Control by the client or family promotes effective coping.
12. Provide increased attention to comfort and dignity of the terminally ill client in care planning. For example, oxygen may be more valuable as a support to the client's psychological comfort than as a booster of oxygen saturation.
1. Instruct client on rationale and techniques for avoiding activity intolerance.
2. Teach client to use controlled breathing techniques with activity.
3. Teach client the importance and method of coughing, clearing secretions.
4. Instruct client in the use of relaxation techniques during activity.
5. Help client with energy conservation and work simplification techniques in ADLs.
6. Teach client the importance of proper nutrition.
7. Describe to client the symptoms of activity intolerance, including which symptoms to report to the physician.
8. Explain to client how to use assistive devices or medications before or during activity.
9. Help client set up an activity log to record exercise and exercise tolerance.
NANDA Activity Intolerance
Activity Intolerance - Home Care Interventions and Client / Family Teaching
Nursing Interventions and Rationales for Activity Intolerance