NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00477 |
|---|---|
| Label | Excessive fatigue burden |
| Before (2021-2023) | Former code 00093 |
| Spanish label | Carga de fatiga excesiva |
| Domain | 4. Activity / rest |
| Class | 3. Energy balance |
| Type | Problem-focused |
| Status | Current |
What changed in 2024-2026
The label changed from "Fatigue" to "Excessive Fatigue Burden," and the code from 00093 to 00477. The qualifier makes it clear that normal tiredness after exertion or a bad night is not a diagnosis: it becomes one when it weighs more than expected and does not ease with rest. If your materials are from the previous edition, you will see 00093; for new assignments, use 00477.
What it means
It is lasting physical and mental exhaustion that does not improve with sleep or rest and is more intense than the person's activity would explain. It drains the energy they need to work, care for themselves or spend time with others.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Anemia, especially when hemoglobin is dropping progressively.
- Heart failure, COPD or chronic kidney disease.
- Cancer, chemotherapy or radiation therapy.
- Recovery from infections such as pneumonia, COVID-19 or hepatitis.
- Depression, ongoing stress or prolonged sleep deprivation.
- Pregnancy and the postpartum period, when exhaustion limits self-care or infant care.
What to assess
- Fatigue intensity on a 0-10 scale and how it changes throughout the day.
- How long it has been present, whether it improves with rest and what makes it worse.
- Activities the person has stopped doing: work, household chores, self-care, social life.
- Sleep: hours, awakenings and whether they wake up rested.
- Hemoglobin, glucose, thyroid function and electrolytes available in the chart.
- Food and fluid intake, and weight loss.
- Mood: sadness, loss of interest, anxiety.
- Medications that may cause drowsiness or tiredness.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Reports tiredness of 6 or higher on a 0-10 scale most of the day.
- States they wake up tired even after sleeping.
- Spends more time lying down or sitting than they used to.
- Leaves tasks unfinished or asks for help with activities they used to do alone.
- Has trouble concentrating or following a conversation or an explanation.
- Appears drowsy, with a flat expression or lack of initiative.
- Has stopped working, studying or socializing due to lack of energy.
- Takes naps that do not restore their energy.
- Reports heaviness in the arms and legs without having exerted themselves.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Insufficient or fragmented sleep due to noise, nighttime pain or medication schedules.
- Energy and protein intake below their needs.
- Sedentary lifestyle and physical deconditioning.
- Activities poorly spread out across the day.
- Ongoing stress, anxiety or worry.
- Uncontrolled pain.
- Not knowing energy conservation strategies.
At-risk populations
- People undergoing cancer treatment.
- Pregnant or postpartum women.
- Older adults with multiple chronic conditions.
- Primary caregivers of dependent family members.
- Workers on night or rotating shifts.
Associated conditions
- Anemia.
- Heart failure.
- Cancer, chemotherapy and radiation therapy.
- Chronic kidney disease.
- Hypothyroidism.
- Depression.
How to write it (PES)
Excessive Fatigue Burden related to fragmented sleep and insufficient protein and iron intake as evidenced by tiredness rated 8/10 that does not improve with sleep, 2-hour naps without regaining energy, and giving up household tasks for the past 3 weeks.
Excessive Fatigue Burden (00477).
What nursing can change: sleep, nutrition, how activities are spread out. Anemia or chemotherapy is written as an associated condition.
What the person reports and what you observe: intensity on a scale, how long it has lasted, whether it improves with rest and which activities they have stopped doing.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient reports fatigue ≤ 4/10 on a numeric scale within 2 weeks.
- Patient sleeps at least 6 hours a night with no more than 2 awakenings within 1 week.
- Patient resumes at least two daily activities they had stopped, with planned rest breaks, within 2 weeks.
- Patient keeps a daily energy and activity log for 7 days and uses it to plan their day.
- Patient eats three meals a day with a protein source at each one starting in the first week.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Rate fatigue every day on the same 0-10 scale and record how it varies. | Shows whether the measures are working and what time of day the patient has the most energy. |
| Ask the patient to keep an activity and energy diary. | Helps identify what wears them out and when they function best. |
| Plan important tasks with the patient for their peak energy hours, with breaks in between. | Pacing energy lets them do more with less exhaustion. |
| Improve sleep conditions: cluster nighttime care, reduce noise and light, avoid long afternoon naps. | Restorative nighttime sleep is the foundation for regaining energy. |
| Review intake and, if it does not meet the patient's needs, request a dietitian consult. | Without enough energy and protein, the body cannot recover. |
| Encourage light, gradual physical activity, such as short walks, if not contraindicated. | Complete bed rest worsens fatigue; paced movement reduces it. |
| Monitor hemoglobin and other available results, and report changes. | Treatable causes such as anemia need to be corrected alongside nursing measures. |
| Assess mood and refer if there are signs of depression. | Depression causes fatigue and needs its own treatment. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0008Fatigue: Disruptive Effects
- 0007Fatigue Level
- 0005Activity Tolerance
NIC interventions
- 0180Energy Management
- 0200Exercise Promotion
- 4310Activity Therapy
- 6040Relaxation Therapy
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Iron deficiency anemia in a young woman
Patient. 34-year-old woman with iron deficiency anemia due to heavy menstrual bleeding, on medical treatment for one week. She comes to the nursing clinic because she has stopped working due to exhaustion.
Assessment
- Hemoglobin 8.9 g/dL; resting HR 98 bpm.
- Tiredness rated 8/10 most of the day that does not improve with sleep.
- Sleeps 5 hours and wakes up 3 times to tend to her 2-year-old.
- Takes two naps of 1 to 2 hours without feeling rested.
- Eats twice a day; rarely eats meat, beans or leafy green vegetables.
- Stopped working 3 weeks ago and has trouble concentrating.
Nursing diagnosis
Excessive Fatigue Burden related to fragmented sleep and insufficient protein and iron intake as evidenced by tiredness rated 8/10 that does not improve with sleep, naps without regaining energy, and having stopped working for the past 3 weeks, in a patient with iron deficiency anemia (associated condition).
Goal
Within 4 weeks, patient reports fatigue ≤ 5/10 and returns to her part-time job.
Interventions
- Energy and activity diary for 7 days.
- Main tasks scheduled in the morning, when she reports more energy, with 15-minute breaks.
- Agreement with her partner to share nighttime awakenings.
- Teaching on iron-rich foods and how to take the prescribed treatment; dietitian referral.
- 10-minute daily walks, adding 5 minutes each week.
Evaluation
At 4 weeks she reports fatigue of 4/10, sleeps 6.5 hours and her hemoglobin has risen to 11.2 g/dL. She has returned to work part-time. The diagnosis remains active with monthly follow-up until fatigue stays at ≤ 3/10 consistently.
How it differs from similar diagnoses
- Decreased activity tolerance (00298): Exhaustion appears with activity and eases when the person stops. With excessive fatigue burden, the tiredness persists even at rest.
- Ineffective fatigue self-management (00397): The person has fatigue, but the focus is that they do not manage it well: they do not pace activities or use strategies. It sits in Domain 1, Health management class.
- Ineffective sleep pattern (00337): The main problem is sleep. If the fatigue is explained solely by poor sleep, start with the sleep pattern.
Common mistakes
- Still writing "Fatigue (00093)" in assignments based on the 2024-2026 edition.
- Using it for normal tiredness after exertion or a single bad night.
- Writing "related to anemia" or "related to chemotherapy" as the only factor: these are associated conditions.
- Ordering complete bed rest: inactivity increases fatigue.
Used in these conditions
Other diagnoses in the Energy balance class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for excessive fatigue burden?
00477. It belongs to Domain 4 (Activity/rest), Class 3 (Energy balance). It replaces Fatigue (00093) from the previous edition.
What happened to the Fatigue 00093 nursing diagnosis?
In NANDA-I 2024-2026 its name and code changed: it is now Excessive Fatigue Burden (00477). It is used for the same kinds of patients.
What is the difference between fatigue and decreased activity tolerance?
With decreased activity tolerance (00298), symptoms appear with movement and ease when the person stops. Fatigue persists at rest and does not improve with sleep.
What scale should I use to measure fatigue?
In practice, a 0-10 numeric scale is enough, as long as you always use the same one. In oncology patients, the tiredness item of the Edmonton Symptom Assessment System (ESAS) is also used.
Is anemia a related factor for fatigue?
No. It is an associated condition treated by the provider. The statement should include the factors nursing can change, such as sleep or intake.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Excessive fatigue burden (00477) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1. Reviewed November 2, 2026.