Friday, June 18, 2010

Nursing Diagnosis Fatigue

Nursing Definition for Nursing Diagnosis Fatigue An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level

Characteristics: Inability to restore energy even after sleep; lack of energy or inability to maintain usual level of physical activity; increase in rest requirements; tired; inability to maintain usual routines; verbalization of an unremitting and overwhelming lack of energy; lethargic or listless; perceived need for additional energy to accomplish routine tasks; increase in physical complaints; compromised concentration; disinterest in surroundings, introspection; decreased performance; compromised libido; drowsy; feelings of guilt for not keeping up with responsibilities

Related Factors:
Boring lifestyle; stress; anxiety; depression
Humidity; lights; noise; temperature
Negative life events; occupation
Sleep deprivation; pregnancy; poor physical condition; disease states (cancer, HIV, multiple sclerosis); increased physical exertion; malnutrition; anemia

NOC Outcomes (Nursing Outcomes Classification)
• Endurance
• Concentration
• Energy Conservation
• Nutritional Status: Energy

Client Outcomes
  • Verbalizes increased energy and improved well-being
  • Explains energy conservation plan to offset fatigue 

NIC Interventions (Nursing Interventions Classification)
Energy Management

Nursing Interventions
  • Assess severity of fatigue on a scale of 0 to 10; assess frequency of fatigue, activities associated with increased fatigue, ability to perform activities of daily living (ADLs), times of increased energy, ability to concentrate, mood, and usual pattern of activity.
  • Evaluate adequacy of nutrition and sleep. Encourage the client to get adequate rest. Refer to Imbalanced Nutrition: less than body requirements or Disturbed Sleep pattern if appropriate.
  • Determine with help from the primary care practitioner whether there is a physiological or psychological cause of fatigue that could be treated, such as anemia, electrolyte imbalance, hypothyroidism, depression, or medication effect.
  • Work with the physician to determine if the client has chronic fatigue syndrome.
  • Encourage client to express feelings about fatigue; use active listening techniques and help identify sources of hope.
  • Encourage client to keep a journal of activities, symptoms of fatigue, and feelings.
  • Assist client with ADLs as necessary; encourage independence without causing exhaustion.
  • Help client set small, easily achieved short-term goals such as writing two sentences in a journal daily or walking to the end of the hallway twice daily.
  • With physician's approval, refer to physical therapy for carefully monitored aerobic exercise program.
  • Refer client to diagnosis-appropriate support groups such as National Chronic Fatigue Syndrome Association or Multiple Sclerosis Association.
  • Help client identify essential and nonessential tasks and determine what can be delegated.
  • Give client permission to limit social and role demands if needed (e.g., switch to part-time employment, hire cleaning service).
  • Refer client to occupational therapy to learn new energy-conserving ways to perform tasks.
  • If client is very weak, refer to physical therapy for prescription and use of a mobility aid such as a walker.
  • Identify recent losses; monitor for depression as a possible contributing factor to fatigue.
  • Review medications for side effects. Certain medications (e.g., beta-blockers, antihistamines, pain medications) may cause fatigue in the elderly. 

Home Care Interventions
  • Assess client's history and current patterns of fatigue as they relate to the home environment. Fatigue may be more pronounced in specific settings for physical or psychological reason.
  • Assess home for environmental and behavioral triggers of increased fatigue
  • When assisting client with adapting to home and daily patterns, avoid activities of high energy output. Refer to occupational therapy to accomplish this if necessary.
  • Assist client with identifying or creating a safe, restful place within the home that can be used routinely (e.g., a room with familiar, nonthreatening, or nonfrightening belongings).

Client/Family Teaching
  • Share information about fatigue and how to live with it, including need for positive self-talk.
  • Teach strategies for energy conservation
  • Teach client to carry a pocket calendar, make lists of required activities, and post reminders around the house.
  • Teach the importance of following a healthy lifestyle with adequate nutrition and rest, pain relief, and appropriate exercise to decrease fatigue.
  • Teach stress-reduction techniques such as controlled breathing, imagery, and use of music. See Anxiety care plan if appropriate; anxiety is correlated with increased fatigue.

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