Patient’s Name: M.

Assessment/ Cues Nursing Diagnosis Inference Goals Intervention Rationale Evaluation/Outco

me
Subjective: Activity intolerance Hemoglobin is Short Term: Short Term: Independent Short Term:
Patient verbalized related to the iron-containing oxy After hoursof proper Independent After one day of
gen-transport in the
“Madali akong imbalance between red blood cells. nursing intervention, proper nursing
mapagod kahit oxygen supply and Hemoglobin in the client will • Encourage patient • Participation in intervention, client
konting galaw lang.” demand secondary the blood is what to help plan activity planning helps demonstrated
demonstrate an
to hepatocellular transports oxygen progression being ensure patient increase tolerance
carcinoma from the lungs to the increased tolerance sure to include compliance for activity as
rest of the body where for activity as
Patient’s wife it releases the oxygen activities he evidenced by:
verbalized “mula Level I- Walk, for cell use. evidenced by: considers essential
nung nagkasakit regular pace, on • Adjust activities.
siya, ganyan nay an, level indefinitely; 1. verbalization of Reduce intensity 1. Verbalized of
mabilis hingalin.” one flight or more feeling less level or discontinue • To prevent feeling less
but more short of fatigued and activities that cause overexertion fatigued and
breath than weak undesired weak
Objective: normally physiologic
changes. 2. Used identified
• Teach patient how techniques to
2. Use identified to conserve energy enhance
techniques to while performing activity
enhance activity ADL for example • This measures intolerance
sitting in chair while cellular metabolism
tolerance
dressing, wearing
clothing with few
buttons, wearing
slip on shoes.
• Instruct and help
3. Blood pressure, patient to alternate
REFERENCES: pulse and periods of rest and
respiratory rates activity.
-Brunner & will remain within • Plan care with rest • To reduce the body’s
Suddarth’s prescribed limits periods between oxygen demand and
textbook of during activities. activities. prevent fatigue
Medical & Surgical • Provide positive
Nursing, 11th atmosphere, while
edition acknowledging • To reduce fatigue
difficulty of the
situation for the
client.
• Encourage
adequate rest
periods, especially • Helps to minimize
before meals,
frustrations,
other ADLs,
exercise sessions,
rechannel energy.
and ambulation.
• Refrain from
performing
nonessential
procedures. • Rest between
activities provides
time for energy
conservation and
recovery.

• Patients with limited

activity tolerance
need to prioritize
tasks.

References:
-Manual of Nursing
practice,8th edition
-Nurse’s Pocket
Guie,10th editon