NURSING MANAGEMENT PLAN Activity Intolerance Definition: Insufficient physiologic or psychologic energy to endure or complete required or desired daily

activities. Activity Intolerance Related to Cardiopulmonary Dysfunction DEFINING CHARACTERISTICS

Chest pain with activity Electrocardiographic changes with activity Heart rate elevations 15 beats/min above baseline with activity for patients on blockers or calcium channel blockers Heart rate elevations above baseline 5 minutes after activity Breathlessness with activity Spo2 <92% with activity Postural hypotension when moving from supine to upright position Patient reports fatigue with activity

OUTCOME CRITERIA

Heart rate elevations are less than 20 beats/min above baseline with activity and are less than 10 beats/min above baseline with activity for patients on -blockers or calcium channel blockers. Heart rate returns to baseline 5 minutes after activity. Chest pain with activity is absent. Patient reports tolerance to activity.

NURSING INTERVENTIONS AND RATIONALE

1.Encourage active or passive range-of-motion exercises while the patient is in bed to keep joints flexible and muscles stretched. 2.Teach patient to refrain from holding breath while performing exercises and to avoid the Valsalva maneuver. 3.Encourage performance of muscle-toning exercises at least 3 times daily, because a toned muscle uses less oxygen when performing work than an untoned muscle. 4.Progress ambulation to increase tolerance to activity. 5.Teach patient to take pulse to determine activity tolerance: Take pulse for full minute before exercise and then for 10 seconds and multiply by 6 at exercise peak.

Activity Intolerance Related to Prolonged Immobility or Deconditioning DEFINING CHARACTERISTICS

Systolic blood pressure (SBP) drop >20 mm Hg; heart rate increase >20 beats/min with postural change Syncope with postural change Patient reports light-headedness with postural change

OUTCOME CRITERIA

SBP drop is less than 10 mm Hg; heart rate increase is less than 10 beats/min with postural change. Syncope or light-headedness is absent with postural change.

NURSING INTERVENTIONS AND RATIONALE

1.Instruct the patient in how to perform straight leg raises, dorsiflexion/plantar flexion, and quadriceps-setting and gluteal-setting exercises to increase muscular and vascular tone. 2.Consult with physician regarding the administration of fluids to ensure that the patient is hydrated to 24-hour fluid requirements per body surface area (BSA) to increase preload and thus stroke volume and cardiac output. 3.Reposition patient incrementally to avoid syncope: o Head of bed to 45 degrees, and hold until symptom-free. o Head of bed to 90 degrees, and hold until symptom-free. o Dangle until symptom-free. o Stand until symptom-free, and ambulate. 4.Collaborate with physician regarding patient's activity level to ensure patient's safety.