Nursing diagnosis – deficient diversional activity

Deficient Diversional Activity
Decreased stimulation from (or interest or engagement in)
recreational or leisure activities
• Usual hobbies are not performed in hospital setting.
• Patient states feelings of boredom or wishing for something to do.
• Environmental lack of diversional activity
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Cardiac function
• Emotional status
• Neurocognition
The patient will
• Express interest in using leisure time meaningfully.
• Express interest and participate in activities that can be provided
(e.g., watch selected television program, listen to radio or music
• Report satisfaction with use of leisure time.
• Modify environment to provide maximum stimulation (e.g.,
hanging posters or cards and moving bed next to a window).
Leisure Participation; Motivation; Social Involvement
Determine: Assess leisure activity preferences. Identify the type of music
patient prefers; seek help from family and hospital resources to provide
selected music daily that relieves boredom and stimulates interest.
Perform: Provide supplies and set time to indulge in hobby. Obtain
radio, television, or crochet hook and yarn (if desired). Allow
patient to (if TV or radio) select programs. Communicate patient’s
desires to coworkers (e.g., Turn on television set at _____ [time]
to _____ [channel]. Give crochet hook and yarn to patient daily
at _____ [time]). Specifying time for activity indicates its value.
Avoid scheduling activities during leisure time, which is integral
to quality of life.
Ask volunteers (friends, family, or hospital volunteer) to read
newspapers, books, or magazines to patient at specific times.
Personal contact helps alleviate boredom.
Engage patient in conversation while carrying out routine care.
Discuss patient’s favorite topics as much as possible. Conversation
conveys caring and recognition of patient’s worth.
• Physical status
• Respiratory function
Provide talking books or I-Pod if available. These provide loweffort
sources of enjoyment for bedridden patient.
Obtain an adapter for television to provide captions for hearingimpaired
Provide plants for the patient to tend to. Caring for live plants
may stimulate interest.
Change scenery when possible; for example, take the patient outside
in a wheelchair to help reduce boredom.
Attend: Encourage discussion of previously enjoyed hobbies,
interests, or skills to direct planning of new activities. Suggest performing
an activity helpful to others or otherwise productive to promote
Encourage patient’s family or caregiver to bring personal articles
(posters, cards, and pictures) to help make environment more stimulating
(the patient may respond better to objects with personal
Manage: Make referral to recreational, occupational, or physical
therapist for consultation on adaptive equipment to carry out
desired activity; arrange for therapy sessions. Adaptive equipment
allows patient to continue enjoying activities or may stimulate interest
in new activities.
Activity Therapy; Animal-Assisted Therapy; Art Therapy; Recreation
Wheeler, S. L., & Houston, K. (2005, March–April). The role of diversional
activities in the general medical hospital setting. Holistic Nursing Practice,
19(2), 87–89.

Nursing diagnosis – risk for activity intolerance

Risk for Activity Intolerance
At risk for experiencing insufficient physiological or psychological
energy to endure or complete required or desired activity
• Circulatory or respiratory
• History of previous intolerance
• Inexperience with a particular
• Deconditioned status
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Activity/exercise
• Cardiac function
• Respiratory function
The patient will
• Maintain muscle strength and joint ROM.
• Carry out isometric exercise regimen.
• Communicate understanding of rationale for maintaining activity
• Avoid risk factors that may lead to activity intolerance.
• Perform self-care activities to tolerance level.
• Maintain blood pressure, pulse, and respiratory rate within
prescribed range during periods of activity (specify).
Activity Tolerance; Endurance; Energy Conservation; Self-Care:
ADLs; Self-Care: IADLs
Determine: Assess patient’s level of functioning using the functional
mobility scale to determine patient’s capabilities.
Assess patient’s physiologic response to increased activity (blood
pressure, respirations, heart rate, and rhythm). Monitoring vital
signs helps assess tolerance for increased exertion and activity.
Perform: Position patient to maintain proper body alignment. Use
assistive devices as needed to maintain joint function and prevent
musculoskeletal deformities.
Turn and position patient at least every 2 hr. Establish turning
schedule for the dependent patient. Post at bedside and monitor frequency.
Turning helps prevent skin breakdown by relieving pressure.
Unless contraindicated, perform ROM exercises every 2–4 hr.
Progress from passive to active, according to patient tolerance.
ROM exercises prevent joint contractures and muscular atrophy.
Encourage active movement by helping patient use trapeze or
other assistive devices to improve muscle tone and enhance selfesteem.
Inform: Teach patient how to perform isometric exercises to
maintain and improve muscle tone and joint mobility.
Teach patient, family member, or other caregiver skills such as
placing joints in proper body alignment or correct positioning to
maximize patient’s participation in self-care. Informed caregivers can
encourage patient to become more independent.
Teach patient symptoms of overexertion, such as dizziness, chest
pain, and dyspnea, to help him or her take responsibility for monitoring
his or her own activity level.
Assist patient in carrying out self-care activities. Increase patient’s
participation in self-care, as tolerated, to foster independence and
improve mobility.
Attend: Encourage patient to become involved in planning care and
making decisions related to treatment. Participation in planning
enhances patient compliance.
Explain rationale for maintaining or improving activity level. Discuss
factors that increase the risk of activity intolerance. Education
helps patient avoid activity intolerance.
Encourage patient to carry out ADLs. Provide emotional support,
and offer positive feedback when the patient displays initiative.
Offering emotional support enhances patient’s self-esteem and motivation.
Manage: Communicate patient’s level of functioning to all staff.
Communication among staff members ensures continuity of care and
enables patient to preserve the identified level of independence.
Activity Therapy; Ambulation; Body Mechanics Promotion; Energy
Management; Exercise Promotion: Strength Training; Exercise
Therapy: Balance, Joint Mobility, Muscle Control
Killey, B., & Watt, E. (2006, July). The effect of extra walking on the mobility,
independence, and exercise self-efficacy of elderly patients: A pilot study.
Contemporary Nurse, 22(1), 120–133.

Nursing diagnosis – activity intolerance

Activity Intolerance
Insufficient physiological or psychological energy to endure or complete
required or desired daily activities
• Abnormal blood pressure and heart rate response to activity
• Electrocardiographic changes reflecting arrhythmias and/or ischemia
• Exertional discomfort and/or dyspnea
• Verbal report of fatigue and/or weakness
• Bed rest • Immobility
• Generalized weakness • Sedentary lifestyle
• Imbalance between oxygen
supply and demand
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Activity/exercise
• Cardiac function
• Respiratory function
The patient will
• Regain and maintain muscle mass and strength.
• Maintain maximum joint range of motion (ROM).
• Perform isometric exercises.
• Help perform self-care activities.
• Maintain heart rate, rhythm, and blood pressure within expected
range during periods of activity.
• State understanding of and willingness to cooperate in maximizing
the activity level.
• Perform self-care activities to tolerance level.
Activity Tolerance; Endurance; Energy Conservation; Self-Care:
Activities of Daily Living (ADLs); Self-Care: Instrumental Activities
of Daily Living (IADLs)
Determine: Monitor physiologic responses to increased activity level,
including respirations, heart rate and rhythm, and blood pressure, to
ensure that these return to normal within 2–5 min after stopping
Perform: Perform active or passive ROM exercises to all extremities
every 2–4 hr. These exercises foster muscle strength and tone, maintain
joint mobility, and prevent contractures.
Turn and reposition patient at least every 2 hr. Establish a turning
schedule for the dependent patient. Post schedule at bedside and
monitor frequency. Turning and repositioning prevent skin
breakdown and improve lung expansion and prevent atelectasis.
Maintain proper body alignment at all times to avoid
contractures and maintain optimal musculoskeletal balance and
physiologic function.
Encourage active exercise: Provide a trapeze or other assistive
device whenever possible. Such devices simplify moving and turning
for many patients and allow them to strengthen some upper-body
Inform: Teach about isometric exercises to allow patients to maintain
or increase muscle tone and joint mobility.
Teach caregivers to assist patients with ADLs in a way that maximizes
patients’ potential. This enables caregivers to participate in
patients’ care and encourages them to support patients’
Attend: Provide emotional support and encouragement to help
improve patient’s self-concept and motivate patient to perform
Involve patient in planning and decision making. Having the ability
to participate will encourage greater compliance with the plan
for activity.
Have patient perform ADLs. Begin slowly and increase daily, as
tolerated. Performing ADLs will assist patient to regain independence
and enhance self-esteem.
Manage: Refer to case manager/social worker to ensure that a home
assessment has been done and that whatever modifications were
needed to accommodate the patient’s level of mobility have been
made. Making adjustments in the home will allow the patient a
greater degree of independence in performing ADLs, allowing better
conservation of energy.
Activity Therapy; Ambulation; Body Mechanics Promotion; Energy
Management; Exercise Promotion: Strength Training; Exercise
Therapy: Balance, Joint Mobility, Muscle Control
Shin, Y., Yun, S., Jang, H., & Lim, J. (2006). A tailored program for the promotion
of physical exercise among Korean adults. Applied Nursing
Research, 19(2), 88–94.

Nursing diagnosis – ineffective activity planning

Ineffective Activity Planning
Inability to prepare for a set of actions fixed in time and under
certain conditions
• Verbalization of fear toward a task to be undertaken
• Verbalization of worries toward a task to be undertaken
• Excessive anxieties toward a task to be undertaken
• Failure pattern of behavior
• Procrastination
• Unmet goals for chosen activity
• Lack of sequential organization
• Lack of plan
• Lack of family support
• Lack of friend support
• Unrealistic perception of events
• Defensive flight behavior when
faced with proposed solution
• Hedonism
• Compromised ability to
process information
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Behavior
• Communication
The patient will
• Demonstrate improved self-confidence to accomplish tasks.
• Demonstrate improved concentration in task planning and execution.
• Minimize procrastination.
• Articulate personal goals for activity planning and completion.
• Verbalize diminished fear and anxiety concerning task planning
and execution.
Cognition; Cognition Orientation; Concentration; Decision-Making;
Information Processing; Memory
Determine: Assess patient’s concerns related to activity planning and
execution to be able to suggest strategies to overcome challenges.
Perform: Model effective techniques for planning and executing
activities. Patients who are challenged by planning and executing
activities often find it helpful to observe practical approaches instead
of solely hearing theoretical information.
Inform: Teach behavior management strategies to help the person
minimize fears of failure.
• Roles/relationships
• Self-perception
Attend: Praise successes in any steps of planning or executing activities;
positive reinforcement enhances self-confidence.
Manage: Refer or comanage with behavioral specialists. Colleagues
in related disciplines bring valuable additional perspectives to these
complex clinical situations.
Anxiety Reduction; Behavior Management; Behavior Modification;
Calming Technique; Memory Training; Planning Assistance;
Sequence Guidance
Adler, D. A., McLaughlin, T. J., Rogers, W. H., Chang, H., Lapitsky, L., &
Lerner, D. (2006). Job performance deficits due to depression. American
Journal of Psychiatry, 163, 1569–1576.