Prolonged Bed Rest & Immobility Nursing Care Plan

1. Promoting mobility within restrictions

• Collaborate with the provider and physical therapy to identify the maximum mobility allowed and progress activity as soon as clinically appropriate.
• Perform active or passive range-of-motion exercises to all extremities at least every shift to preserve joint mobility and muscle tone.
• Use assistive devices, trapeze bars, or slide boards to encourage the patient's own participation in position changes when able.
• Dangle the patient at the bedside before attempting to stand, allowing time for orthostatic adjustment.
• Encourage isometric muscle exercises (quad sets, ankle pumps) even when full mobility is restricted.

2. Preventing venous thromboembolism

• Apply graduated compression stockings or sequential compression devices as ordered and verify correct fit and continuous use.
• Administer pharmacologic prophylaxis (low-molecular-weight heparin or unfractionated heparin) as ordered.
• Encourage ankle pumps and leg exercises every hour while awake.
• Assess extremities daily for unilateral swelling, warmth, redness, or calf tenderness.
• Avoid massaging calves or placing pillows directly behind the knees, which can impede venous return.

3. Protecting skin integrity

• Reposition the patient at least every 2 hours, using a written turning schedule, and more frequently for high-risk patients.
• Assess skin, particularly over bony prominences, at every repositioning for early signs of breakdown.
• Use pressure-redistributing mattresses/overlays and heel-protection devices for high-risk patients.
• Keep skin clean, dry, and moisturized, and manage incontinence promptly to prevent moisture-associated skin damage.
• Use a validated risk assessment tool (e.g., Braden Scale) on a scheduled basis to guide the intensity of prevention measures.

4. Maintaining pulmonary and gastrointestinal function

• Encourage deep breathing and incentive spirometry every 1-2 hours while awake to prevent atelectasis.
• Reposition frequently and elevate the head of bed to promote lung expansion and reduce aspiration risk.
• Auscultate lung sounds regularly and encourage effective coughing.
• Promote adequate fluid intake, dietary fiber, and a bowel regimen to prevent constipation and impaction.
• Monitor bowel patterns and administer stool softeners or laxatives as ordered.

5. Preventing urinary complications

• Encourage adequate hydration unless contraindicated to reduce urinary stasis and calculi risk.
• Assist with upright or as-normal-as-possible positioning for voiding when feasible to promote complete bladder emptying.
• Monitor for signs of urinary tract infection and avoid unnecessary indwelling catheter use.
• Implement a scheduled toileting program if the patient has difficulty sensing the urge to void.

6. Supporting psychosocial well-being

• Provide orientation cues (clock, calendar, window access) and maintain a normal day-night routine.
• Encourage visits from family/friends and provide diversional activities appropriate to the patient's interests and abilities.
• Assess for signs of depression or sensory deprivation and refer for counseling or psychiatric evaluation as indicated.
• Involve the patient in decision-making about care and mobility goals to preserve a sense of control.
• Explain the rationale for restrictions and the plan for progressing activity to reduce frustration and promote cooperation.

What are the nursing diagnoses for Prolonged Bed Rest & Immobility?

Priority nursing diagnoses for Prolonged Bed Rest & Immobility: Impaired physical mobility; Risk for impaired skin integrity; Constipation; Risk for disuse syndrome.

What are the nursing interventions for Prolonged Bed Rest & Immobility?

Collaborate with the provider and physical therapy to identify the maximum mobility allowed and progress activity as soon as clinically appropriate. Perform active or passive range-of-motion exercises to all extremities at least every shift to preserve joint mobility and muscle tone. Use assistive devices, trapeze bars, or slide boards to encourage the patient's own participation in position changes when able. Dangle the patient at the bedside before attempting to stand, allowing time for orthostatic adjustment. Encourage isometric muscle exercises (quad sets, ankle pumps) even when full mobility is restricted. Apply graduated compression stockings or sequential compression devices as ordered and verify correct fit and continuous use.

What are the nursing care goals for Prolonged Bed Rest & Immobility?

The client will maintain or improve muscle strength and joint range of motion throughout the period of immobility. The client will remain free of venous thromboembolism, pressure injury, and pneumonia. The client will maintain regular bowel and bladder elimination patterns. The client will tolerate position changes without significant orthostatic symptoms. The client will verbalize feelings of adequate psychosocial stimulation and coping. The client will participate in mobilization activities to the fullest extent allowed as soon as medically cleared.

What should you assess in a patient with Prolonged Bed Rest & Immobility?

Reports of weakness, fatigue, or decreased endurance; Complaints of joint stiffness or pain with movement; Reports of constipation, bloating, or decreased appetite; Feelings of boredom, loneliness, sadness, or irritability; Complaints of dizziness or lightheadedness when repositioned; Sleep disturbances or altered day-night orientation; Decreased muscle strength and range of motion on assessment; Orthostatic vital sign changes with position change; Diminished breath sounds or crackles in dependent lung fields; Redness or skin breakdown over bony prominences; Decreased bowel sounds, distention, or infrequent stool; Unilateral leg swelling, warmth, or tenderness suggesting DVT; Decreased urine output or cloudy, foul-smelling urine; Flat affect, withdrawal, or disorientation to time