Nursing Care Plan Severe Hypertension | Activity Intolerance

Nursing Diagnosis: Activity intolerance may be related to generalized weakness and imbalance between oxygen supply and demand possibly evidenced by verbal report of fatigue or weakness; abnormal heart rate or BP response to activity; exertional discomfort or dyspnea; and electrocardiogram (ECG) changes reflecting ischemia; dysrhythmias.

Desired Outcomes:
Participate in necessary/desired activities.
Report a measurable increase in activity tolerance.
Demonstrate a decrease in physiologic signs of intolerance.

Nursing Intervention with Rationale:
1. Assess the client’s response to activity, noting pulse rate more than 20 beats/min faster than resting rate; marked increase in BP during/after activity (systolic pressure increase of 40 mm Hg or diastolic pressure increase of 20 mm Hg); dyspnea or chest pain; excessive fatigue and weakness; diaphoresis; dizziness or syncope.
Rationale: The stated parameters are helpful in assessing physiologic responses to the stress of activity and, if present, are indicators of overexertion.

2. Instruct client in energy-conserving techniques; e.g., using chair when showering, sitting to brush teeth or comb hair, carrying out activities at a slower pace.
Rationale: Energy-saving techniques reduce the energy expenditure, thereby assisting in equalization of oxygen supply and demand.

3. Encourage progressive activity/self-care when tolerated. Provide assistance as needed.
Rationale: Gradual activity progression prevents a sudden increase in cardiac workload. Providing assistance only as needed encourages independence in performing activities.