Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue

Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue

This article is about Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue. It can be referred to when formulating educational nursing care plans for Fatigue.

Fatigue

Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue
Fatigue

What is Fatigue?

Almost everybody is overtired or overworked from time to time. Words like lethargic, exhausted, tired and even ‘fatigue’ are always used when a symptom is difficult for the patient to describe.

Fatigue is a subjective complaint with both acute and chronic conditions. It is the self-recognized state in which an individual experiences an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work that is not relieved by rest. 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. However, it is important to know that fatigue is not the same as tiredness. Tiredness is temporary. Fatigue is associated with a variety of physical and psychological conditions. Fatigue may result from poor dietary choices, lack of exercise, overexertion, substance abuse, emotional stress, or medical conditions.

What are the Causes and Risk Factors of 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

How do you measure fatigue on a 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 Assessment for Fatigue

How do you Assess Fatigue?

Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue
Nursing Assessment for Fatigue

Assessment is required in order to identify potential problems that may have lead to Fatigue as well as name any episode that may happen during nursing care.

Assessment Rationales
Evaluate the patient’s description of fatigue: severity, changes in severity over time, aggregating factors or alleviating factors. Using an appropriate quantitative scoring scale, 1 to 10 for example, can aid the patient to formulate the amount of fatigue experienced. Further scoring scales can be developed by using pictures or descriptive language. This system allows the nurse to weigh against changes in the patient’s fatigue level over time. It is important to conclude if the patient’s level of fatigue is constant or if it varies over time.
Determine possible causes of fatigue, such as: 

  • Last physical illness
  • Pain
  • Emotional stress
  • Depression
  • Side effects of medication
  • Anemia
  • Sleep disorders
  • Imbalanced nutritional intake
  • Extended responsibilities and demands at home or work
Identifying the related factors with fatigue can benefit in recognizing potential causes and building a collaborative plan of care.
Assess the patient’s ability to perform ADLs, instrumental activities of daily living (IADLs), and demands of daily living (DDLs). Fatigue can restrict the patient’s ability to participate in self-care and do his or her role responsibilities in the family and society, such as working outside the home.
Assess the patient’s nutritional ingestion for adequate energy sources and metabolic demands. Fatigue may be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies.
Evaluate the patient’s outlook for fatigue relief, eagerness to participate in strategies to reduce fatigue, and level of family and social support. These will promote active participation 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.
Review results of laboratory or diagnostic test: 

  • Blood glucose
  • Hemoglobin/hematocrit
  • BUN
  • Oxygen saturation, resting and with activity
Changes in these physiological measures may be associated with other measurement data to recognize possible sources of the patient’s fatigue.
Observe physiological reaction to activities such as any alterations 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 subjected to.
Assess the patient’s typical level of exercise and physical movement. Increased physical exertion and inadequate levels of exercise can add to fatigue.
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. Changes in the patient’s sleep pattern may be a contributing factor in the development of fatigue. Numerous factors can exacerbate fatigue, together with sleep deprivation, emotional distress, side effects of drugs, and progressing CNS disease.
Assess the patient’s routine recommendation and over-the-counter drugs. Fatigue may be a medication side effect or an indication od a drug interaction. The nurse must perform particular notice to the patient’s utilization of beta-blockers, calcium channel blockers, tranquilizers, alcohol, muscle relaxants, and sedatives.
Assess the patient’s emotional reaction to fatigue. The common emotional responses associated with fatigue are anxiety and depression. These emotional conditions can increase the person’s fatigue level and produces a vicious cycle.

Nursing Interventions for Fatigue

What are the Nursing Interventions for Fatigue?

Fatigue, Nursing Assessment for Fatigue, Nursing Interventions for Fatigue, and 5 Nursing Care Plan Examples for Fatigue
Nursing Interventions for Fatigue

The following are the therapeutic nursing interventions for Fatigue:

Interventions Rationales
Restrict environmental stimuli, especially during planned times for rest and sleep. Vivid lighting, noise, visitors, numerous distractions, and litter in the patient’s physical surroundings can limit relaxation, disturb rest or sleep, and contribute to fatigue.
Encourage the patient to maintain a 24-hour fatigue or activity log for at least 1 week. Recognizing relationships between specific activities and levels of fatigue can aid the patient recognize unnecessary energy outflow. The log may indicate times of day when the person feels the least fatigued. This information can help the patient make choices about setting his or her activities to take advantage of episodes of high energy levels.
Implement the use of assistive devices for ADLs and IADLs: 

  • Long-handled sponge for bathing
  • Long shoehorn
  • Sock-puller
  • Long-handled grabber
Utilization of such devices can lessen energy expenditure and prevent injury with activities.
Aid the patient with developing a schedule for daily activity and rest. Emphasize the importance of frequent rest periods. A plan that balances periods of activity with periods of rest can aid the patient complete preferred activities without contributing to levels of fatigue.
Teach energy conservation methods. Collaborate with occupational therapist as needed. Patients and caregivers may need to learn skills for delegating tasks to others, setting priorities, and clustering care to use available energy to complete desired activities. Organization and time management can help the patient conserve energy and reduce fatigue. The occupational therapist can offer the patient with assistive devices and educate the patient energy conservation methods.
Assist the patient with setting 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 important activities. Attaining desired goals can develop the patient’s mood and sense of emotional health.
Promote sufficient nutritional intake. The patient will need properly balanced intake of fats, carbohydrates, proteins, vitamins, and minerals to provide energy resources.
Encourage an exercise conditioning program as appropriate. Fatigue caused by deconditioning and prolonged bed rest can be reduced through improved functional capacity using aerobic and muscle-strengthening exercise.
Provide comfort such as judicious touch or massage, and cool showers. These may reduce nervous energy that lead to relaxation.
Encourage verbalization of feelings about the impact of fatigue. Acknowledgement that living with fatigue is both physically and emotionally challenging helps in coping.
Offer diversional activities that are soothing. This method allows the use of nervous energy in a positive manner and may lessen anxiety.
Identify energy conservation methods such as sitting and dividing ADLs into convenient segments. Assist with movement or self-care demands as appropriate. Weakness can make ADLs almost not possible for patient to finish. Being with the patient prevents the patient from getting harm during activities.
Set practical activity goals with patient. This offers a sense of control and feelings of achievement.
Stay away from topics that annoy or disturb patient. Converse ways to react to these feelings. Increased irritability of the CNS can make the patient become easily excited, agitated, and prone to emotional outburst.
Educate the patient and family about task organization methods and time organization methods. Organization and management of time can assist the patient save energy and avoid fatigue.
Support the patient in escalating levels of physical activity and exercise. Exercise can reduce fatigue and assist the patient build stamina for physical activity.
Make the patient aware about the signs and symptoms of overexertion with activity. Changes in heart rate, oxygen saturation, and respiratory rate will reflect the patient’s tolerance for activity.
Aid 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.

5 Nursing Care Plan Examples for Fatigue

What are the Available Care Plans for a Patient Suffering from 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.

Intervention Rationale
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.

Intervention Rationale
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.

Interventions Rationales
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.

Intervention Rationale
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.

Intervention Rationale
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.

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

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.

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

 

 

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