Assessment Nursing Planning Nursing Intervention Rationale Evaluation

Diagnosis
Objective Data Fatigue related Short term Independent Goal met as
Sleepy to Decreased Plan evidenced by:
 Looks tired hemoglobin and Assess the specific The specific cause of
 lack of diminished In 5-8 hours of cause of fatigue. fatigue is due to tissue Patient was
energy oxygen-carrying nursing hypoxia from normocytic able to show
 Inability to capacity of the intervention the anemia; Other related understanding
maintain blood. Client will medical problems can on how to
usual level verbalize use of also compromise activity conserve
of physical energy tolerance. energy.
activity. conservation
 T-36.5 0C principles. Client regain
 P-75bpm Client will Assess the client’s ability Fatigue can limit the strength.
 R-20cpm verbalize to perform activities of client’s ability to
reduction of daily living (ADLs), and participate in self-care
 BP-110/70
fatigue, as the demands of daily and perform his or her
mmHg
evidenced by living, role responsibilities in
reports of family and society, such
increased as working outside the
energy and home.
ability to
perform desired
activities. Assist the client in This will allow the client
planning and prioritizing to maximize his/her time
activities of daily living for accomplishing
(ADL). important activities. Not
all self-care and hygiene
activities need to be
completed i the morning.
Likewise, not all
housework needs to be
completed in one day.
Assist the client in
developing a schedule
for daily activity and rest.
Stress the importance of
frequent rest periods.
Energy reserves may be
depleted unless the
client respects the
body’s need for
increased rest. A plan
that balances periods of
activity with periods of
rest can help the client
complete desired
activities without adding
levels to fatigue.

Educate energy- Clients and caregivers

conservation techniques. may need to learn skills
for delegating task to
others, setting priorities,
and clustering care to
use available energy to
complete desired
activities. Organization
and time management
can help the client
conserve energy and
reduce fatigue.

Instruct the client about Recombinant human

medications that may erythropoietin, a
stimulate RBC hematological growth
production in the bone factor, increases
marrow. hemoglobin and
decreases the need for
RBC transfusions.

Collaborative
Oxygen saturation
should be kept at 90% or
greater.
Provide supplemental
oxygen therapy, as
needed. Packed RBCs increase
oxygen-carrying capacity
of the blood.
Anticipate the need for
the transfusion of The occupational
packed RBCs. therapist can teach the
client about using
assistive devices. The
Refer the client and therapist also can help
family to an occupational the client and family
therapist. evaluate the need for
additional energy-
conservation measures
in the home setting.