Nursing diagnosis: Fatigue related to decreased metabolic energy production, increased energy requirements— hypermetabolic state, effects of treatment; overwhelming psychological and emotional demands; altered body chemistry—side effects of pain and other medications, chemotherapy, radiation therapy, biotherapy
Possibly evidenced by
Unremitting, overwhelming lack of energy; inability to maintain usual routines, decreased performance, impaired ability to concentrate, lethargy, listlessness
Disinterest in surroundings
Desired Outcomes/Evaluation Criteria—Client Will
Report improved sense of energy.
Perform ADLs and participate in desired activities at level of ability.
Nursing intervention with rationale:
1. Have client rate fatigue, using a numeric scale, if possible, and the time of day when it is most severe.
Rationale: Helps in developing a plan for managing CRF to improve client’s quality of life (de Nijs et al, 2008).
2. Plan care to allow for rest and uninterupted sleep periods. Schedule activities for periods when client has most energy. Involve client and SO in schedule planning.
Rationale: Plan care to allow for rest and uninterupted sleep periods. Schedule activities for periods when client has most energy. Involve client and SO in schedule planning.
3. Establish realistic activity goals with client.
Rationale: Provides for a sense of control and feelings of accomplishment.
4. Assist with self-care needs when indicated; keep bed in low position and pathways clear of furniture; and assist with ambulation.
Rationale: Weakness may make ADLs difficult to complete or place the client at risk for injury during activities.
5. Encourage client to do whatever possible, such as selfbathing, sitting up in chair, and walking. Increase activity level as individual is able.
Rationale: Enhances strength and stamina and enables client to become more active without undue fatigue.
6. Encourage aerobic exercise, as client is able, with goal of 30 minutes per day.
Rationale: Aerobic exercise minimizes fatigue, increases strength and stamina, and stimulates release of natural endorphins, which promotes sense of well-being.
7. Monitor physiological response to activity, such as changes in BP or heart and respiratory rate.
Rationale: Tolerance varies greatly depending on the stage of the disease process, nutrition state, fluid balance, and reaction to therapeutic regimen.
8. Perform pain assessment and provide pain management.
Rationale: Poorly managed cancer pain can contribute to fatigue.
9. Encourage adequate fluid intake.
Rationale: Prevents dehydration, which increases fatigue.
10. Refer to physical and occupational therapy.
Rationale: Programmed daily exercises and activities help client maintain or increase strength and muscle tone and enhance sense of well-being. Use of adaptive devices may help conserve energy.