A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client’s activity intolerance?
A. “What activities were you able to do 6 months ago compared to the present?”
B. “How long have you had this problem?”
C. “Have you been able to keep up with all your usual activities?”
D. “Are you more tired now than you used to be?”
Correct Answer: A. “What activities were you able to do 6 months ago compared with the present?”
It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client’s activity tolerance by asking the client to compare activities 6 months ago and at the present. Assess manifestations of activity intolerance. Tell the patient to rate perceived exertion on a 0-10 scale.
Option B: Asking a client how long a problem has existed is a very open-ended question that allows for too much subjectivity for any definition of the client’s activity tolerance. Also, the client may not even identify that a “problem” exists. Signs of activity intolerance and decreased tissue oxygenation include dyspnea on exertion, headaches, dizziness, palpitations, and verbalization of increased exertion level (rated perceived exertion or RPE is more than 3).
Option C: Asking the client whether he is staying abreast of usual activities addresses whether the tasks were completed, not the tolerance of the client while the tasks were being completed or the resulting condition of the client after the tasks were completed. Asking the client if he is more tired now than usual does not address his activity tolerance.
Option D: Tiredness is a subjective evaluation and again can be distorted by factors such as the gradual onset of the anemia or the endurance of the individual. Aid in the gradual increase of activities to tolerance as the patient’s strength progresses. This develops endurance while preventing problems caused by prolonged bed rest.
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