Nursing Diagnosis: “Decreased activity intolerance related to imbalance between oxygen supply and demand as evidence by respiratory disease (Covid 19), and shortness of breath on excertion”
Priority (Top 3) Interventions, Rationales and Education to Perform for Nursing Diagnosis
Priority (Top 3) Information/Findings/Signs and Symptoms (Cues)
Priority (Top 3) Lab Values/Diagnostic Results Related to Nursing Diagnosis
Potential and Actual Complications (Include dietary risk factors)
Priority (Top 3) Contributing Social Determinants of Health (SDOH/Healthcare Disparities Factors)
Priority (Top 3) Patient Outcomes and Actions to evaluate the Outcomes
Priority (Top 3) Medication(s) and Patient Teaching r/t Diagnosis. (Include medication side effects and nursing interventions for each)
Priority (Top 3) Discharge Instructions and Evaluation of Effectiveness of Teaching
Identify how the Four Spheres of Care (AAC,2019) were addressed while caring for your patient.
1. Wellness, Disease Prevention
2. Chronic Disease Management
3. Regenerative/Restorative Care
4. Hospice/Palliative Care
Monitor Oxygen Saturation and Respiratory Rate: Regularly assess the patient’s oxygen saturation levels and respiratory rate before, during, and after activity. This helps determine the effectiveness of oxygenation and the patient’s tolerance to activity. Rationale: It provides objective data on the patient’s respiratory status and guides the need for supplemental oxygen or modifications in activity level. Educate the patient about the importance of monitoring these parameters to recognize signs of worsening respiratory distress.
Plan and Implement Gradual Activity Progression: Collaborate with the patient and interdisciplinary team to develop an individualized activity plan that gradually increases the intensity and duration of physical activity. Start with low-level activities and gradually progress based on the patient’s tolerance. Rationale: Gradual activity progression helps improve endurance, build strength, and increase functional capacity while minimizing the risk of fatigue and exacerbation of respiratory symptoms. Educate the patient about the rationale behind gradual activity progression and the importance of pacing themselves to avoid overexertion.
Provide Energy Conservation Techniques: Teach the patient energy conservation techniques to optimize activity tolerance. This includes techniques such as prioritizing activities, pacing activities with rest breaks, and using assistive devices as needed. Rationale: Energy conservation techniques help minimize the energy expenditure required for daily activities, reducing the demand on the respiratory system and promoting optimal activity tolerance. Educate the patient about these techniques and encourage their implementation in daily life.
Shortness of Breath on Exertion: The patient experiences difficulty breathing or breathlessness when engaging in physical activity or exertion.
Fatigue and Weakness: The patient may report feelings of tiredness, lack of energy, and overall weakness, limiting their ability to perform activities of daily living.
Increased Respiratory Rate: The patient may exhibit an elevated respiratory rate during and after physical activity, indicating increased work of breathing.
Oxygen Saturation (SpO2): Decreased oxygen saturation levels may indicate impaired oxygenation and the need for supplemental oxygen during activity.
Arterial Blood Gas (ABG) Analysis: ABG results can provide information about the patient’s acid-base balance, oxygenation, and carbon dioxide levels, which are essential in assessing the adequacy of oxygen supply and demand.
Pulmonary Function Tests (PFTs): PFTs help evaluate lung function and provide objective data on lung volumes, airflow, and gas exchange, aiding in the assessment of activity intolerance and respiratory impairment.
Acute Respiratory Distress: In severe cases, patients with decreased activity intolerance may develop acute respiratory distress, requiring immediate medical intervention.
Pulmonary Infections: Reduced mobility and compromised respiratory function increase the risk of respiratory tract infections, including pneumonia.
Malnutrition: Dietary risk factors such as poor appetite, altered taste sensation, and reduced energy expenditure may lead to inadequate nutrition, impacting the patient’s overall health and recovery.
Access to Healthcare: Limited access to healthcare services or disparities in healthcare resources may affect the patient’s ability to receive timely and appropriate management of their respiratory condition, impacting their activity tolerance.
Socioeconomic Factors: Socioeconomic factors, such as low income or lack of social support, may influence the patient’s access to nutritious food, housing conditions, and overall well-being, contributing to decreased activity tolerance.
Environmental Factors: Environmental factors, such as air pollution or exposure to allergens, can exacerbate respiratory symptoms, further limiting the patient’s activity tolerance.
Improved Activity Tolerance: Monitor the patient’s ability to engage in activities of daily living without experiencing significant shortness of breath or fatigue.
Maintained Oxygenation: Assess the patient’s oxygen saturation levels during activity to ensure adequate oxygenation and respiratory function.
Enhanced Quality of Life: Evaluate the patient’s perception of their overall well-being, ability to participate in meaningful activities, and satisfaction with their level of activity tolerance.
Bronchodilators: Medications such as short-acting bronchodilators (e.g., albuterol) or long-acting bronchodilators (e.g., salmeterol) may be prescribed to alleviate bronchospasm and improve airflow, enhancing activity tolerance. Educate the patient about the proper use of inhalers, including correct technique and adherence to the prescribed regimen.
Inhaled Corticosteroids: These medications (e.g., fluticasone) help reduce airway inflammation and prevent exacerbations. Teach the patient about the importance of regular use and potential side effects such as oral candidiasis, emphasizing the need for proper mouth care after inhaler use.
Oxygen Therapy: In some cases, supplemental oxygen therapy may be necessary to maintain adequate oxygenation during activity. Educate the patient about the proper use and maintenance of oxygen equipment, including safety precautions and signs of oxygen therapy-related complications.
Home Activity Plan: Provide the patient with a customized home activity plan that includes gradual activity progression, energy conservation techniques, and self-monitoring of symptoms. Reinforce the importance of following the plan and pacing activities.
Medication Management: Review the prescribed medications, their purpose, proper administration techniques, and potential side effects. Emphasize the importance of medication adherence and regular follow-up with healthcare providers.
Symptom Recognition and Action Plan: Educate the patient about the signs and symptoms that warrant immediate medical attention, such as increased shortness of breath, chest pain, or sudden worsening of symptoms. Provide them with clear instructions on when and how to seek emergency care.
Wellness, Disease Prevention: The nursing interventions aimed at improving activity tolerance and educating the patient about self-management strategies promote wellness and disease prevention by empowering the patient to actively engage in their care and maintain optimal health.
Chronic Disease Management: The focus on managing COPD, preventing exacerbations, and enhancing activity tolerance aligns with the principles of chronic disease management. The interventions aim to improve the patient’s quality of life and minimize the impact of the disease on their daily activities.
Regenerative/Restorative Care: The nursing interventions encompass strategies to optimize respiratory function, promote healing, and restore the patient’s functional capacity
through gradual activity progression and energy conservation techniques. These interventions aim to support the regenerative and restorative process in the patient’s respiratory system.
Hospice/Palliative Care: While the patient in this scenario is not specifically receiving hospice or palliative care, it is important to consider the patient’s comfort and quality of life. Palliative care principles may be incorporated into the overall care plan to address the patient’s symptom management and emotional well-being.
In conclusion, the nursing care for a patient with decreased activity intolerance due to COPD involves monitoring oxygen saturation and respiratory rate, implementing gradual activity progression and energy conservation techniques, and providing patient education on medication management and symptom recognition. By addressing the priority interventions, findings, lab values, complications, social determinants of health, patient outcomes, medication management, and discharge instructions, the nursing team can effectively support the patient in managing their respiratory condition and improving their activity tolerance. The care provided aligns with the four spheres of care, encompassing wellness, disease prevention, chronic disease management, regenerative/restorative care, and considering elements of hospice/palliative care where applicable.
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