Fatigue

Fatigue Nursing Care Plans Diagnosis and Interventions

Fatigue NCLEX Review Care Plans

5 Nursing Care Plans for Fatigue

Fatigue is a medical term used to describe having low energy levels and a general feeling of tiredness.  It is more than a feeling of drowsiness or sleepiness. Fatigue can affect a person’s motivation to perform activities and makes him/her vulnerable to a sedentary lifestyle.

It may result from poor dietary choices, lack of exercise, overexertion, substance abuse, emotional stress, or medical conditions.

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Causes and Risk Factors for Fatigue

  1. Lifestyle Factors
  • Sedentary lifestyle or lack of physical activity
  • Overexertion or too much physical activity
  • Emotional stress, including grief, anxiety, depression, and other mental health concerns
  • Lack of sleep
  • Obesity or overweight
  • Poor diet
  • Substance abuse, such as cocaine, tobacco, alcohol, and even overdoses of regular medications
  • As a side effect of certain medications, such as sedatives or antidepressants
  • Consumption of too much caffeine

2. Physical Health Problems

  • Anemia
  • Arthritis
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Infections
  • Thyroid disorders
  • Sleep disorders
  • Autoimmune disorders
  • Eating disorders
  • Cardiac diseases
  • Respiratory illnesses such as COPD
  • Liver disease
  • Kidney disease
  • Mental Health Problems
  • Clinical depression
  • Anxiety disorders
  • Seasonal affective disorder

Fatigue Scale

Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, there are three subjective rating scales that are commonly utilized to assess fatigue:

  1. Fatigue Severity Scale (FSS) – a self-report scale used to measure a person’s fatigue in terms of its severity and impact on his/her functional ability
  2. Chalder Fatigue Scale (CFS) – used in patients suspected to have chronic fatigue syndrome; consists of 14 questions that ask about a person’s physical and mental fatigue
  3. Fatigue Impact Scale (FIS) – used to gauge the impact of fatigue on a person’s quality of life through 3 domains: cognitive, physical, and psychosocial functioning

Nursing Care Plans for Fatigue

Nursing Care Plan 1

Anemia

Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized body weakness, blood sugar level of 220 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will verbalize ease of fatigue and demonstrate active participation in necessary and desired activities.

InterventionRationale
Assess the patient’s fatigue using a fatigue scale. Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, the nurse can use a subjective rating scale recommended by the care facility to assess fatigue more accurately.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Provide supplemental oxygen therapy if needed.Patients with anemia may have low oxygen levels due to a low number of circulating red blood cells. The oxygenation level must be maintained within the target range set by the physician (usually above 94% for non-COPD patients).
Administer recombinant human erythropoietin as prescribed.Patients with chronic anemia may benefit from recombinant human erythropoietin, a hematological growth factor that improves hemoglobin levels, thus increasing oxygen levels in the blood and reducing the need for transfusion.
Collect Group and Save blood sample.To prepare for packed red blood cells (RBCs) transfusion for patients with severe and/or chronic/recurrent anemia.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 2

Diabetes

Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized body weakness, blood sugar level of 220 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will verbalize ease of fatigue and demonstrate active participation in necessary and desired activities.

InterventionRationale
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, the nurse can use a subjective rating scale recommended by the care facility to assess fatigue more accurately.  
Encourage the patient to adhere to his/her dietary plan.Low fat, low calories, and high fiber foods are ideal for diabetic patients. Proper nutrition through healthy dietary choices may reduce fatigue levels.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity. Exercise decreases the blood glucose level as the demand for glucose (energy) in the cells increases with physical activity.  
Teach deep breathing exercises and relaxation techniques.To allow the patient to relax while at rest.  
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 3

Cancer

Nursing Diagnosis: Fatigue related to consequence of chemotherapy for cancer (e.g., immunosuppression and malnutrition) and/or emotional distress due to the diagnosis, as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will establish adequate energy levels and will demonstrate active participation in necessary and desired activities.

InterventionsRationales
Assess the patient’s fatigue using a fatigue scale. Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.  To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, the nurse can use a subjective rating scale recommended by the care facility to assess fatigue more accurately.
For patients with severe fatigue, consider discussing having a treatment break with the oncology team.Anti-cancer therapies such as chemotherapy treatments may increase the fatigue levels in a cancer patient, disabling them to perform even the most basic daily activities such as eating and bathing. Having a treatment break may be needed to allow the patient to recuperate before receiving further doses.
Encourage the patient to talk about his/her concerns and worries about cancer, treatment, and even personal situations.Emotional stress can be a huge factor in increased fatigue levels. Allowing the patient time to talk about his/her concerns can help reduce fatigue.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 4

Depression (Major Depressive Disorder)

Nursing Diagnosis: Fatigue related to decreased metabolic energy production as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized body weakness, blood sugar level of 220 mg/dL, and shortness of breath upon exertion

Desired Outcome: The patient will verbalize ease of fatigue and demonstrate active participation in necessary and desired activities.

InterventionRationale
Assess the patient’s fatigue using a fatigue scale. Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.  To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, the nurse can use a subjective rating scale recommended by the care facility to assess fatigue more accurately.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Administer anti-depressants as prescribed.Improper doses of anti-depressants may worsen fatigue levels.
Encourage the patient to eat nutritious food and drinks.Proper nutrition through healthy dietary choices may reduce fatigue levels.
Create a sleep plan with the patient, which involves making a sleep schedule, as well as gradually changing poor sleep hygiene and improving his/her sleep environment. Encourage the patient to have an uninterrupted sleep for at least 6 hours during the night, and gradually reduce day sleeping or afternoon naps.Lack of sleep and proper rest may contribute to increased fatigue levels. A sleep plan is helpful in encouraging the patient to have an uninterrupted sleep for 6 to 8 during the night, and gradually reduce day sleeping or afternoon naps.  
Refer to a sleep specialist as required.Patients with major depression may find it difficult to improve sleep hygiene and may require professional help from a sleep therapist.
Encourage the patient to talk about his/her concerns.Emotional stress can be a huge factor in increased fatigue levels. Allowing the patient time to talk about his/her concerns can help reduce fatigue.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 5

Heart Failure

Nursing Diagnosis: Fatigue related to decreased cardiac output secondary to heart  as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized body weakness, irregular heartbeat, heart rate of 130, and dyspnea upon exertion.

Desired outcome: The patient will be able to maintain adequate cardiac output in order to reduce fatigue levels.

InterventionRationale
Assess the patient’s fatigue using a fatigue scale. Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.  To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. Fatigue is a highly subjective symptom and there is no gold standard tool in measuring a person’s fatigability. However, the nurse can use a subjective rating scale recommended by the care facility to assess fatigue more accurately.
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer the cardiac medications, and diuretics as prescribed.  To alleviate the symptoms of heart failure which affect fatigue levels.  
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Educate patient on stress management, deep breathing exercises, pacing activities, proper rest periods, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate and can also result to increased fatigue levels.

Fatigue is a common symptom of many illnesses both physically and mentally. If the person’s fatigue is not alleviated by healthy diet, proper exercise and rest, it may be caused by an underlying medical condition that needs to be assessed by a healthcare provider.

People who experience fatigue along with severe physical symptoms (e.g., chest pain, headache, bleeding, dysrhythmias), suicidal ideation, or thoughts of violence against self or others are strongly encouraged to seek help by making an appointment with their physician.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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