2 Respiratory Complications of Immobility

How immobility affects breathing

When a person remains in bed, breaths may become smaller, the lungs may expand less fully, and coughing may become less effective. Secretions can collect in the airways, increasing the risk of Atelectasis and Pneumonia. These are related complications, but they are not the same condition.

Atelectasis: causes and effects

Atelectasis is partial or complete collapse of alveoli. In an immobile patient, shallow breathing and prolonged recumbency reduce lung expansion, especially in dependent lung regions. Weakness, pain, sedation, or illness may also make deep breathing and coughing difficult.

When secretions obstruct a small airway, air beyond the obstruction may be absorbed, allowing that region to collapse. Reduced ventilation in the affected area can lower blood oxygen levels.

Recognizing and managing atelectasis

Limited atelectasis may cause no obvious symptoms. Possible findings include shortness of breath, faster or shallow breathing, cough, decreased oxygen saturation, and diminished breath sounds or crackles over the affected area. These findings alone cannot confirm atelectasis; the clinician considers them alongside the patient’s history and, when needed, imaging.

Prevention and care

• Change position regularly and help the patient sit upright when appropriate. Repositioning and mobility support lung expansion and secretion movement.

• Promote safe, early mobility, progressing from bed exercises and sitting at the bedside to standing or walking as the patient’s condition and mobility plan allow.

• Encourage slow, deep breaths and effective coughing. If needed, teach the patient to support a painful incision with a pillow. Manage pain as prescribed so it does not unnecessarily limit breathing or coughing.

• Use an Incentive spirometer if prescribed or included in the care plan. Demonstrate correct technique, encourage slow, sustained inhalation, and assess the patient’s ability to use it. The device supplements, but does not replace, mobility, positioning, and coughing.

• Support secretion clearance as appropriate. Respiratory therapy, assisted coughing, or suctioning may be needed when the patient cannot clear secretions independently.

• Monitor respiratory rate and effort, oxygen saturation, breath sounds, cough, and secretions. Promptly report new or worsening breathing difficulty or falling oxygen saturation. Oxygen, imaging, and other treatments should follow clinical assessment and orders.

Pneumonia: risk and signs

Pneumonia is an infection of the lungs caused by pathogens such as bacteria or viruses. Immobility may contribute to risk by reducing deep breathing and cough effectiveness, allowing secretions to pool. Organisms in the mouth can also enter the lungs through Aspiration, so oral hygiene and attention to swallowing and aspiration risk matter in care.

Common signs and symptoms include cough, shortness of breath, fever or chills, fatigue, and chest pain with breathing or coughing. Older adults may instead show new confusion or a change in usual function. Symptoms can vary, so a new decline in breathing or overall condition warrants assessment.

Preventing and responding to pneumonia

Maintain mobility and upright positioning as safely tolerated. When walking is not possible, follow the care plan for position changes and appropriate bed or chair activity. Provide regular oral care.

Follow Aspiration precautions and swallowing instructions. If swallowing difficulty is suspected, report it and follow instructions for assessment, food, fluids, and medications. For a patient who needs assistance or has difficulty swallowing, an aspiration-aware approach may include upright or side-lying positioning and suction equipment when indicated by the care plan.

Encourage breathing exercises and effective coughing when appropriate, and support prescribed measures to clear secretions. Assess and report possible infection by monitoring temperature, respiratory effort, oxygen saturation, cough and sputum, lung sounds, and mental status. The clinician determines whether further evaluation, such as imaging or other tests, is needed.

If pneumonia is diagnosed, follow the treatment plan. Care may include oxygen or other respiratory support and prescribed medicines. Antibiotics are used when indicated for bacterial infection; they do not treat viral pneumonia and should not be started solely because atelectasis is suspected.

Putting assessment into practice

A patient who has been mostly in bed after surgery begins breathing shallowly because of pain and has a weaker cough. The care team supports pain management, helps the patient sit upright and mobilize as permitted, and encourages prescribed breathing exercises and coughing.

If the patient develops worsening shortness of breath, lower oxygen saturation, fever, or new confusion, staff promptly report the change for clinical evaluation rather than assuming it is only atelectasis.