3 Circulatory, Musculoskeletal, and Gastrointestinal Complications

How immobility affects the body

Reduced mobility can slow venous blood flow, weaken muscles, and decrease bowel activity. Early recognition and safe, individualized care can help prevent or address these complications. Plans should take account of the person’s condition, restrictions, abilities, and clinician-directed care.

Venous thromboembolism and risk

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT), usually a clot in a deep vein of the leg, and pulmonary embolism (PE), which occurs when a clot travels to the lungs. A PE can be life-threatening.

Immobility and prolonged bed rest slow blood flow and increase VTE risk. Other risk factors include recent surgery or trauma, prior VTE, cancer, older age, obesity, pregnancy or the postpartum period, estrogen-containing medications, and inherited clotting disorders. Risks can combine, so consider the person’s overall situation rather than assessing one factor alone.

Preventing and responding to VTE

Promote safe, early mobility by assisting the person to get out of bed and walk as soon as the care plan allows. If walking is not possible, encourage appropriate leg and ankle movement.

A clinician assesses clotting risk and bleeding risk to determine whether medication, a mechanical device, or both are appropriate. Use prescribed prophylaxis. Apply and check compression devices according to the order and local procedure; these devices do not replace prescribed medication.

New one-sided leg swelling, pain, warmth, or redness may indicate DVT. Report these findings promptly for clinical assessment, and do not massage a leg when DVT is suspected. Sudden shortness of breath, chest pain, coughing blood, fainting, or a rapid heartbeat may indicate PE and requires emergency assessment.

VTE can occur after a hospital stay. Teach patients to recognize warning signs and follow discharge instructions.

Muscle loss from inactivity

When muscles are used less, they lose strength and may decrease in size; this process is called disuse atrophy. Bed rest can contribute to loss of muscle mass and function, and decline may begin early in a period of inactivity. Older adults and people who are already weak, ill, or poorly nourished may be especially vulnerable.

Encourage early, regular movement within the person’s abilities and care plan. Suitable activity may include walking, sitting out of bed, active range-of-motion exercises, or therapist-directed strengthening. When the person cannot move independently, assist with prescribed positioning and range-of-motion exercises. Passive movement supports joint mobility but does not provide the same muscle-strengthening benefit as active movement.

Support adequate food and protein intake. Protein needs are individual; involve a dietitian or clinician when poor intake, illness, or dietary restrictions complicate nutrition. Use physical or occupational therapy when weakness, balance problems, pain, or functional limits affect safe activity. Increase activity progressively and monitor tolerance.

Constipation and contributing factors

Constipation may involve fewer than three bowel movements a week, hard or dry stools, difficulty passing stool, or a feeling that the bowel movement is incomplete. A person’s usual pattern matters; frequency alone does not define a problem.

Immobility, low fiber intake, inadequate fluid intake, ignoring the urge to defecate, and some medicines or supplements can contribute. Opioids are one medication class commonly associated with constipation. Older age and certain health conditions can also increase risk.

Preventing and responding to constipation

Encourage activity as tolerated, fiber-containing foods, and adequate fluids when not medically restricted. Adults’ general fiber needs vary by age and sex; increase fiber gradually and pair it with suitable fluid intake.

Offer privacy, a safe and comfortable toileting position, and time to use the toilet, especially when the person feels the urge. A regular toileting routine may help. Track bowel patterns and review medicines with the care team if constipation develops. Do not stop or change prescribed medication without clinical guidance. A bowel regimen or laxative may be appropriate when recommended by a clinician.

Seek prompt clinical assessment for severe or persistent abdominal pain, vomiting, blood in the stool, or other concerning new symptoms. For a person with reduced mobility who reports hard stools, consider the person’s usual bowel pattern and contributing medicines, and provide suitable movement, fiber, fluids if allowed, and a regular toileting opportunity.

Applying care to common situations

For a person on bed rest who develops new swelling and warmth in one calf, report the finding promptly for clinical assessment; do not massage the calf. For a person who has been mostly in bed and is losing strength, promote safe, progressive activity or prescribed exercises and support adequate nutrition with individualized guidance.

Across these complications, prevention centers on safe movement, individualized prophylaxis and nutrition, attention to bowel habits, and prompt reporting of warning signs.