If a patient is experiencing exhaustion - reported on OASIS M1033 Hospitalization Risk – 8 - Exhaustion, determining the reason as well as careplanning for exhaustion would be indicated for the home health clinician.
If your patient has exhaustion, the careplan (i.e. the CMS485) should include related goals and interventions.
Causes of Exhaustion
Many diagnoses can cause exhaustion & fatigue. However exhaustion is COMMONLY experienced by patients who are taking certain medications, such as antidepressants, antihistamines, and medicines for nausea and pain and those having medical treatments, like chemotherapy and radiation, or recovery from major surgery.
Patients also experience exhaustion with…
- chronic diseases like diabetes, heart disease, kidney disease, liver disease, thyroid disease, and chronic obstructive pulmonary disease (COPD)
- untreated pain and diseases like fibromyalgia
- sleep apnea and other sleep disorders
- thyroid disease
Home Health Responsibilities
1. Report patient's exhaustion to the physician.
- If it is not already diagnosed - i.e. not identified in the patient history & physical, report.
2. Encourage the patient to keep a 'fatigue' diary.
Keeping a fatigue diary will help in determining patterns of exacerbations & relief to determine the root cause.
3. If not contraindicated, encourage any type of physical exercise.
“Exercise has consistently been linked to improved vigor and overall quality of life,” says Kerry J. Stewart, professor of medicine and director of clinical and research exercise physiology at Johns Hopkins University School of Medicine. “People who become active have a greater sense of self-confidence. But exercise also improves the working efficiency of your heart, lungs, and muscles,” Stewart says. “That’s the equivalent of improving the fuel efficiency of a car. It gives you more energy for any kind of activity.”
Encourage your patient to exercise regularly. Almost anyone, at any age, can do some type of physical activity. If you have concerns about starting an exercise program, ask your doctor if there are any activities you should avoid. Moderate exercise may improve your appetite, energy, and outlook. Some people find that exercises combining balance and breathing (for example, tai chi or yoga) improve their energy.
4. If not contraindicated, encourage drinking more water.
Dehydration zaps energy and impairs physical performance. “Our research shows that dehydration makes it harder for athletes to complete a weight lifting workout,” says Dan Judelson, PhD, assistant professor of kinesiology at California State University at Fullerton. "It’s reasonable to think that dehydration causes fatigue even for people who are just doing chores."
Dehydration has also been shown to decrease alertness and concentration.
How should the patient know if s/he is drinking enough water? “Urine should be pale yellow or straw colored,” Judelson says. “If it’s darker than that, you need to drink water.”
5. Encourage early bedtime and avoid naps.
Lack of sleep increases the risk of accidents and is one of the leading causes of daytime fatigue. Encourage the patient to get to bed early enough for a full night’s sleep.
When people enrolled in a 2004 Stanford University study were allowed to sleep as long as they wanted, they reported more vigor and less fatigue. Good sleep habits may also have important health benefits. Centenarians report better than average sleep.
Explain to your patient to avoid long naps (over 30 minutes) late in the day. Long naps can leave one feeling groggy and may make it harder to fall asleep at night.
6. Eat more frequently.
Some people may benefit by eating smaller meals more frequently during the day. This may help to steady blood sugar level.
Encourage whole grains and other complex carbohydrates. These take longer than refined carbohydrates to digest, preventing fluctuations of blood sugar.
7. Stop smoking and control weight.
If the patient eats more often instruct them to watch portion sizes to avoid weight gain.
Stop smoking. Smoking is linked to many diseases and disorders, such as cancer, heart disease, and breathing problems, which can drain energy.