Friday, November 26, 2010



NANDA Definition
Fatigue is an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.

Discussion of the Problem
Fatigue is a covert complaint. It can be present in both acute and chronic illnesses. In an acute illness, it serves as a defensive function that keeps the person from sustaining injury resulting from too hard work in a destabilized condition. Fatigue is associated with a variety of physical and psychological conditions. Patient who have the following medical conditions could experience fatigue: hepatitis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, myasthenia gravis, depression, AIDS, diabetes mellitus, diabetic ketoacidosis, thyrotoxicosis, and multiple sclerosis. The patient may be unable to work full-time and maintain acceptable performance on the job, when experiencing fatigue due to a chronic illness. Chronic fatigue syndrome, a condition characterized by prolonged, debilitating fatigue, neurological problems, general pain, gastrointestinal problems, and flu-like symptoms is not yet fully  understood, but is believed to be an abnormal response of the immune system to highly stressful physiological or psychological events. The goals of management focuses on the following:  conservation of energy, promotion of exercise, providing adequate nutrition, and enhancement of sleep.

Nursing Interventions Classification (NIC)
  • Energy Management
  • Exercise Promotion
  • Nutrition Management
  • Sleep Enhancement

Nursing Outcomes Classification (NOC)
  • Activity Tolerance
  • Endurance
  • Energy Conservation

Goal and Objectives
  • Patient will verbalize having plenty energy to complete preferred activities.

Subjective and Objective Data
·         Accident-prone
  • Compromised concentration
·         Disinterest in surroundings/introspection
  • Feelings of guilt for not keeping up with responsibilities
  • Inability to maintain usual routines
  • Inability to restore energy, even after sleep
  • Increased physical complaints
  • Increased rest requirements
  • Lethargic or listless
·         Drowsy; decreased performance
  • Perceived need for additional energy to accomplish routine tasks
·         Report of lack of energy, inability to maintain usual routines
  • Tired
·         Unremitting/overwhelming lack of energy; decreased performance, impaired ability to concentrate
·         Verbalizes no desire and/or lack of interest in activity

Related Factors
  • Environmental:
Ø  Humidity
Ø  Light
Ø  Noise
Ø  Temperature
  • Physiological:
Ø  Altered body chemistry: side effects of medication, chemotherapy, insufficient insulin, irritability of central nervous system (CNS);
Ø  Anemia
Ø  Bedrest or immobility; progressive disease state/debilitating condition
Ø  Decreased energy production, increased energy requirements to perform activities
Ø  Disease states
Ø  Generalized weakness
Ø  Hypermetabolic state/infection (decreased metabolic energy production, increased energy requirements)
Ø  Imbalance between oxygen supply and demand
Ø  Increased physical exertion
Ø  Malnutrition
Ø  Pain/discomfort
Ø  Poor physical condition
Ø  Pregnancy
Ø  Sleep deprivation
  • Psychological:
Ø  Anxiety
Ø  Boring lifestyle
Ø  Cognitive deficits/emotional status, secondary to underlying disease process/depression
Ø  Depression
Ø  Emotional lability/irritability; nervousness, tension
Ø  Impaired ability to concentrate
Ø  Jittery behavior
Ø  Overwhelming psychological/emotional demands
Ø  Pain, extreme stress
  • Situational:
Ø  Negative life event
Ø  Occupation

Assessment (Dx)
  • Review characteristics of fatigue:
Ø  Severity
Ø  Changes in severity over time
Ø  Aggregating factors
Ø  Alleviating factors
Utilizing a quantitative scoring scale, 1 to 10 for example, can assist the patient express the amount of fatigue experienced. Further scoring scales can be developed by utilizing pictures or descriptive language. This technique allows the nurse to weigh against changes in the patient’s fatigue level over time. It is significant to conclude if the patient’s level of fatigue is unvarying or if it varies over time.

  • Check for possible origins of fatigue:
1)     Latest physical illness
2)     Emotional stress
3)     Depression
4)     Side effects of medication
5)     Anemia
6)     Sleep disorders
7)     Imbalanced nutritional intake
8)     Greater than before responsibilities and demands at home or work
Determining the related factors with fatigue can help in identifying possible causes and creating a collaborative plan of care.

  • Assess the patient’s emotional reaction to fatigue. The more common emotional responses associated with fatigue are anxiety and depression. These emotional conditions can increases the person’s fatigue level and produces a vicious cycle.

  • Assess the patient’s routine recommendation and over-the-counter drugs. Medication side effect can cause fatigue. Drug interaction can signal fatigue. The nurse must perform particular notice to the patient’s utilization of the following drugs: -blockers, calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.

  • Assess the patient’s sleep patterns for quality, quantity, time taken to fall asleep and feeling upon awakening and observe alteration in thought processes or behaviors. Alteration in the person’s sleep pattern may be an aggravating factor in the development of fatigue. numerous factors can intensify fatigue, together with sleep deprivation, emotional distress, side effects of drugs, and progressing CNS disease

·         Check breath sounds. Observe feelings of panic or air hunger. Hypoxemia augments sense of fatigue, ttaht weakens capability to function.

  • Evaluate the patient’s nutritional ingestion of the following: calories, protein, minerals, and vitamins. Protein-calorie malnutrition, vitamin deficit, or iron deficit may cause fatigue.

  • Evaluate the patient’s typical level of exercise and physical movement. Both augmented physical exertion and inadequate levels of exercise can add to fatigue.

  • Review the patient’s capability to perform the following: activities of daily living, instrumental activities of daily living, and demands of daily living. Fatigue can bound the person’s capability to partake in self-care and carry out his or her role responsibilities in the family and society.

·         Watch physiological reaction to activity such as the follwing: changes in BP, respiratory rate, or heart rate. Tolerance varies significantly, depending on the phase of the disease progression, nutrition condition, fluid balance, and quantity or sort of opportunistic diseases that patient has been subject to.

  • Assess results of laboratory or diagnostic test:
1)     Blood glucose
2)     Hemoglobin/hematocrit
3)     BUN
4)     Oxygen saturation, resting and with activity
Alterations in these physiological measures can be contrasted with other measurement data to recognize possible sources of the patient’s fatigue.

  • Evaluate the patient’s outlook for fatigue relief, eagerness to partake in strategies to reduce fatigue, and level of family and social support. The patient will necessitate being an active participant in planning, implementing, and evaluating therapeutic management to alleviate fatigue. Social support will be essential to assist the patient put into practice changes to decrease fatigue.

  • Watch the patient’s nutritional ingestion for adequate energy sources and metabolic demands. The patient will necessitate sufficient ingestion of carbohydrates, protein, vitamins, and minerals to supply energy resources.

Therapeutic Interventions (Tx)
  • Give comfort measures such as the following:  judicious touch or massage, and cool showers. May reduce nervous energy that lead to  relaxation

  • Help out the patient to make a schedule for daily activity and rest. A plan that equates periods of activity with periods of rest can assist the patient finish preferred activities without contributing to levels of fatigue.

·         Identify energy conservation methods. For example, sitting, dividing ADLs into convenient segments. Maintain travelways clear of furniture. Assist with movement or self-care demands as appropriate. Weakness may make activities of daily living almost not possible for patient to finigh. Keeps the  patient from harm during activities.

·         Institute practical activity goals with patient. Offers a sense of control and feelings of achievement. Avoid discouragement from fatigue of overactivity.

·         Keep away from topics that annoy or disturb patient. Converse ways to react to these feelings. Heightened irritability of the CNS may make the  patient to become easily excited, agitated, and prone to emotional outburst

·         Offer calm milieu; cool room, lessened sensory stimuli, calming colors, calm music. Decreases stimuli that may intensify disturbance, hyperactivity, and insomnia.

·         Offer diversional activities that are soothing. Permits for utilization of nervous energy in a positive manner and may lessen anxiety.

  • Persuade the patient to utilize assistive devices for ADLs and IADLs:
1)     Long-handled sponge for bathing
2)     Long shoehorn
3)     Sock-puller
4)     Long-handled grabber
Utilization of assistive devices can diminish energy outflow and avoid harm with activities.

  • Assist the patient classify tasks that can be assigned to others. Assigning tasks and responsibilities to others can help the patient to save energy.

  • Assist the patient put priorities for preferred activities and role responsibilities. Setting priorities is one sort of an energy conservation method that permits the patient to utilize available energy to complete significant activities. Attaining desired goals can develop the patient’s mood and sense of emotional health.

·         Give supplemental O2 as specified. Incidence of anemia or hypoxemia decreases oxygen available for cellular uptake and adds to fatigue.

  • Lessen environmental stimuli, in particular during scheduled times for rest and sleep. Vivid lighting, noise, visitors, numerous distractions, and litter in the patient’s physical surroundings can restrain relaxation, disrupt rest or sleep, and adds to fatigue.

·         Maintain bed in low position, pathways clear of furniture; support with ambulation. Keeps patient from harm during activities.

  • Refer the patient to an occupational therapist. The occupational therapist can offer the patient with assistive devices and educate the patient energy conservation methods.

Educative (Edx)
  • Assist the patient build up habits to encourage effective rest or sleep patterns. Encouraging relaxation before sleep and providing for some hours of continuous sleep can add to energy refurbishment.

·         Counsel scheduling activities for episodes when patient has the majority energy. Plan care to permits for rest periods. Engage patient or significant other in schedule planning. Planning permits patient to be active during episoses when energy level is higher, which may refurbish a feeling of well-being and a sense of control. Numerous rest episodes are required to refurbish or save energy.

  • Educate the patient and family task organization methods and time organization methods. Organization and management of time can assist the patient save energy and avoid fatigue.

  • Help out the patient partake in escalating levels of physical activity and exercise. Exercise can lessen fatigue and assist the patient build stamina for physical activity.

  • Persuade the patient and family to express feelings about the impact of fatigue. Fatigue can have an intense unconstructive effect on family processes and social interaction.

  • Persuade the patient to maintain a 24-hour fatigue or activity log for at least 1 week. Being familiar with relationships between definite activities and levels of fatigue can assist the patient recognize unnecessary energy outflow. The log may signify times of day when the person feels the least fatigued. This information can assist the patient make choices about setting his or her activities to take advantage of episodes of high energy levels.

Show correct performance of activities of daily living, ambulation or position changes. Recognize safety issues, such as the following: utilization of assistive devices, temperature of bath water, keeping travel-ways clear of furniture. Keeps patient from harm during activities.

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