4 Practice Questions on Immobility Complications

How immobility affects health

Immobility can contribute to pressure injuries, atelectasis, pneumonia, venous thromboembolism (VTE), muscle loss and weakness, reduced function, and constipation. Reducing these risks involves several coordinated measures rather than relying on bed rest.

Protect skin and relieve pressure

Persistent redness over a pressure area may indicate pressure-related skin damage. Relieve pressure, inspect the skin, report the finding, and follow an individualized repositioning plan.

Avoid rubbing or massaging reddened skin. Reduce friction and shear during transfers, and do not use a doughnut-shaped cushion directly under the sacrum.

Support lung health

Movement and deep breathing help expand the lungs and are recommended to help prevent atelectasis in people confined to bed. Encourage them as tolerated, and use an incentive spirometer when it is included in the patient’s care plan. Do not restrict coughing and deep breaths or keep a patient flat throughout the day as a default approach.

For pneumonia prevention, provide oral care, follow swallowing and aspiration precautions, and promote safe mobility. Position the patient according to the care plan and swallowing guidance, and provide appropriate assistance if there is a risk of aspiration. Avoid offering food while the patient is drowsy, and do not avoid movement simply because it can make the patient cough.

Respond to clot concerns

Limited movement slows blood flow and increases VTE risk. New pain and swelling in one calf require prompt reporting and clinical assessment. Do not massage the leg, apply a heating pad and wait, or encourage vigorous leg exercise before reporting the symptoms.

Sudden shortness of breath or chest pain may indicate a pulmonary embolism and requires emergency response. Prevention may include early movement and prescribed compression or medication, depending on the patient’s risk and care plan.

Build activity safely

Disuse can lead to muscle loss, weakness, and reduced function. When a patient is medically able, begin activity at a level appropriate to their condition and progress according to clinical guidance. Activity may include assisted range of motion, sitting, transfers, or walking.

Before assisted ambulation, check the patient’s current status and mobility plan, prepare needed assistance, and stop if concerning symptoms occur. Mobility should be individualized, with appropriate assistance and safety checks. Adjust or pause activity if the patient’s condition makes it unsafe; weakness does not automatically mean that all activity must be cancelled. Do not default to bed rest when activity is safe and appropriate.

Reduce constipation risk

Low activity, inadequate fluids, and too little fiber can contribute to constipation. When not contraindicated, encourage activity, adequate fluids, and fiber, and support responding to the urge to have a bowel movement. Do not restrict fluids or discourage movement as a routine approach.

Increase fiber gradually and ensure sufficient fluids when adding fiber, if appropriate to the patient’s condition. Review medications and report persistent or concerning symptoms.

Coordinate individualized prevention

Prevention should follow the patient’s care plan and local protocols. Assess safety and contraindications before repositioning, exercise, or mobilization.

A coordinated approach may combine repositioning and skin checks, safe progressive mobility, movement and deep breathing, oral care and aspiration precautions, prescribed VTE prevention measures, and appropriate fluids and fiber. Individualize the measures to the patient’s condition, and do not assume that every intervention is appropriate for every patient.

• Pressure injury