NCP Nursing Diagnosis: Fatigue

Nursing Diagnosis: Fatigue
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Activity Tolerance
* Endurance
* Energy Conservation

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Energy Management
* Exercise Promotion
* Nutrition Management
* Sleep Enhancement

NANDA Definition: An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level

Fatigue is a subjective complaint with both acute and chronic illnesses. In an acute illness fatigue may have a protective function that keeps the person from sustaining injury from overwork in a weakened condition. As a common symptom, fatigue is associated with a variety of physical and psychological conditions. Fatigue is a prominent finding in many viral infections such as hepatitis. Patients with rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, myasthenia gravis, and depression report fatigue as a profound symptom that reduces their ability to participate in their own care and fulfill role responsibilities. The patient with a chronic illness experiencing fatigue may be unable to work full-time and maintain acceptable performance on the job. The economic impact on the individual and the family can be significant. The social effects of fatigue occur as the person decreases his or her participation in social activities.

Chronic fatigue syndrome is a poorly understood condition that is characterized by prolonged, debilitating fatigue, neurological problems, general pain, gastrointestinal problems, and flu-like symptoms. While the exact cause of chronic fatigue syndrome is not known, one theory suggests that the disorder may represent an abnormal response of the immune system to highly stressful physiological or psychological events.

* Defining Characteristics: Inability to restore energy, even after sleep
* Lack of energy or inability to maintain usual level of physical activity
* Increased rest requirements
* Tired
* Verbalization of an unremitting and overwhelming lack of energy
* Inability to maintain usual routines
* Lethargic or listless
* Increased physical complaints
* Perceived need for additional energy to accomplish routine tasks
* Compromised concentration
* Feelings of guilt for not keeping up with responsibilities

* Related Factors: Psychological:
o Boring lifestyle
o Stress
o Anxiety
o Depression
* Environmental:
o Humidity
o Light
o Noise
o Temperature
* Situational:
o Negative life event
o Occupation
* Physiological:
o Sleep deprivation
o Pregnancy
o Poor physical condition
o Disease states
o Increased physical exertion
o Malnutrition
o Anemia

* Expected Outcomes Patient verbalizes having sufficient energy to complete desired activities.

Ongoing Assessment

* Assess characteristics of fatigue:
o Severity
o Changes in severity over time
o Aggregating factors
o Alleviating factors
Using a quantitative rating scale such as 1 to 10 can help the patient describe the amount of fatigue experienced. Other rating scales can be developed using pictures or descriptive words. This method allows the nurse to compare changes in the patient’s fatigue level over time. It is important to determine if the patient’s level of fatigue is constant or if it varies over time.
* Assess for possible causes of fatigue:
o Recent physical illness
o Emotional stress
o Depression
o Medication side effects
o Anemia
o Sleep disorders
o Imbalanced nutritional intake
o Increased responsibilities and demands at home or work
Identifying the related factors with fatigue can aid in determining possible causes and establishing a collaborative plan of care.
* Assess the patient’s ability to perform activities of daily living (ADLs), instrumental activities of daily living (IADLs), and demands of daily living (DDLs). Fatigue can limit the person’s ability to participate in self-care and perform his or her role responsibilities in the family and society.
* Assess the patient’s emotional response to fatigue. Anxiety and depression are the more common emotional responses associated with fatigue. These emotional states can add to the person’s fatigue level and create a vicious cycle.
* Evaluate the patient’s routine prescription and over-the-counter medications. Fatigue may be a medication side effect or an indication of a drug interaction. The nurse should give particular attention to the patient’s use of Beta-blockers, calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.
* Assess the patient’s nutritional intake of calories, protein, minerals, and vitamins. Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies.
* Evaluate the patient’s sleep patterns for quality, quantity, time taken to fall asleep, and feeling upon awakening. Changes in the person’s sleep pattern may be a contributing factor in the development of fatigue.
* Assess the patient’s usual level of exercise and physical activity. Both increased physical exertion and limited levels of exercise can contribute to fatigue.
* Evaluate laboratory/diagnostic test results:
o Blood glucose
o Hemoglobin/hematocrit
o Oxygen saturation, resting and with activity
Changes in these physiological measures can be compared with other assessment data to understand possible causes of the patient’s fatigue.
* Assess the patient’s expectations for fatigue relief, willingness to participate in strategies to reduce fatigue, and level of family and social support. The patient will need to be an active participant in planning, implementing, and evaluating therapeutic interventions to relieve fatigue. Social support will be necessary to help the patient implement changes to reduce fatigue.

Therapeutic Interventions

* Encourage the patient to keep a 24-hour fatigue/activity log for at least 1 week. Recognizing relationships between specific activities and levels of fatigue can help the patient identify excessive energy expenditure. The log may indicate times of day when the person feels the least fatigued. This information can help the patient make decisions about arranging his or her activities to take advantage of periods of high energy levels.
* Assist the patient to develop a schedule for daily activity and rest. A plan that balances periods of activity with periods of rest can help the patient complete desired activities without adding to levels of fatigue.
* Refer the patient to an occupational therapist. The occupational therapist can provide the patient with assistive devices and teach the patient energy conservation techniques.
* Encourage the patient to use assistive devices for ADLs and IADLs:
o Long-handled sponge for bathing
o Long shoehorn
o Sock-puller
o Long-handled grabber
The use of assistive devices can minimize energy expenditure and prevent injury with activities.
* Help the patient set priorities for desired activities and role responsibilities. Setting priorities is one example of an energy conservation technique that allows the patient to use available energy to accomplish important activities. Achieving desired goals can improve the patient’s mood and sense of emotional well-being.
* Monitor the patient’s nutritional intake for adequate energy sources and metabolic requirements. The patient will need adequate intake of carbohydrates, protein, vitamins, and minerals to provide energy resources.
* Encourage the patient to identify tasks that can be delegated to others. Delegating tasks and responsibilities to others can help the patient conserve energy.
* Minimize environmental stimuli, especially during planned times for rest and sleep. Bright lighting, noise, visitors, frequent distractions, and clutter in the patient’s physical environment can inhibit relaxation, interrupt rest/sleep, and contribute to fatigue.

Education/Continuity of Care

* Teach the patient and family task organization techniques and time management strategies. Organization and time management can help the patient conserve energy and prevent fatigue.
* Help the patient engage in increasing levels of physical activity and exercise. Exercise can reduce fatigue and help the patient build endurance for physical activity.
* inteMonitor the patient’s energy expenditure with activity. Changes in oxygen saturation, respiratory rate, and heart rate will reflect the patient’s tolerance for activity. Using MET (metabolic equivalent) activity levels can help evaluate energy expenditure with similar activities.
* Help the patient develop habits to promote effective rest/sleep patterns. Promoting relaxation before sleep and providing for several hours of uninterrupted sleep can contribute to energy restoration.
* Encourage the patient and family to verbalize feelings about the impact of fatigue. Fatigue can have a profound negative influence on family processes and social interaction.