How bed rest harms the body, and how turning and positioning prevent it
NCLEX-RN topic: Mobility / immobility
- Bed rest cuts muscle strength by an estimated 20% a week.
- Turn a bed-bound client at least every 2 hours.
- Start range of motion early; joints start to change after about three days.
- Dangle the client on the edge of the bed before standing.
- Red skin that does not blanch is already a Stage 1 pressure injury.
Key facts
- Muscle strength drops by an estimated 20% per week of immobility, and joint changes can begin after only three days, so range-of-motion exercises start as soon as possible.
- Reposition a client who cannot move independently at least every 2 hours, following a turning schedule.
- A Stage 1 pressure injury is unbroken skin with a localized red area that stays red (does not blanch) when pressed.
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- Keeping the head of the bed at 30 degrees or less, when appropriate, and moving the client with two people and a draw sheet reduce shear and friction.
- Orthostatic hypotension is a systolic drop of 20 mm Hg or more, or a diastolic drop of 10 mm Hg or more, within 3 minutes of sitting or standing.
- Foot drop is plantar flexion of the foot caused by immobility; pillows, foot boots or braces keep the foot in position.
- DVT usually affects one leg and causes redness, warmth, swelling and pain or tenderness.
Quick check1 question · 2 more at the end
A client has been on bed rest for 4 days after abdominal surgery. The provider now prescribes ambulation. Which action should the nurse take first?
Correct answer: B.
After days in bed, blood pools in the legs and the client is at risk for orthostatic hypotension: a systolic drop of 20 mm Hg or more, or a diastolic drop of 10 mm Hg or more, within 3 minutes of sitting or standing. Safety comes first, so every transfer or walk begins with dangling at the edge of the bed and checking for dizziness before standing.
A Standing before a sitting check skips the step that detects dizziness and orthostatic hypotension while the client is still safe on the bed.
B Correct: dangling for a few minutes lets the nurse check for dizziness or orthostatic hypotension before the client bears weight.
C Walking comes later; a gait belt does not replace checking how the client tolerates sitting up first.
D Walking alone after 4 days of bed rest is unsafe until the client's tolerance and need for help are assessed.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: Bed rest drains muscle strength by an estimated 20% a week and harms almost every body system. Watch for orthostatic hypotension, clots, atelectasis, pressure injuries, contractures, foot drop, constipation and urinary retention. Mobilize the client early, turn a bed-bound client at least every 2 hours, start range of motion early, and dangle before standing.
1 Why is bed rest so dangerous?Staying in bed weakens nearly every body system at once, not just the legs. 1 min
Staying in bed weakens nearly every body system at once, not just the legs. Muscle strength falls by an estimated 20% per week of immobility, and the stillness also slows blood flow, breathing, the gut and the bladder.
| Body system | What immobility does | Complication to watch for |
|---|---|---|
| Cardiovascular | Blood pools in the legs, cardiac output falls | Orthostatic hypotension, blood clots (DVT) |
| Respiratory | Shallow breaths, weak cough, pooled secretions | Atelectasis, pneumonia |
| Skin | Pressure cuts off oxygen to tissue over bone | Pressure injuries |
| Musculoskeletal | Muscle loss, shortened connective tissue | Contractures, foot drop, osteoporosis, falls |
| Gastrointestinal | Slower peristalsis, less fluid intake | Constipation, impaction |
| Urinary | Urine is not fully emptied | Urinary retention, urinary tract infection |
A DVT usually shows up in one leg as redness, warmth, swelling and pain or tenderness.
2 Which bed positions should you know?Each position has a specific job, so match it to the problem. 1 min
Each position has a specific job, so match it to the problem.
- Supine: flat on the back. Use pillows or devices to keep the feet from dropping.
- Prone: on the stomach, head turned to the side. It can improve oxygenation in some lung disorders.
- Lateral: on one side with the top leg bent forward. It relieves pressure on the coccyx.
- Sims': halfway between supine and prone, legs bent. It is used for procedures such as an enema.
- Fowler's (45 to 90 degrees; high Fowler's is 90): helps the lungs expand and prevents aspiration while eating or during tube feeding.
- Semi-Fowler's (30 to 45 degrees): same purposes as Fowler's, but easier to tolerate for long periods because it puts less pressure on the coccyx.
3 How do you protect the skin from pressure and shear?Pressure injuries form over bony areas when pressure combines with shear. 1 min
Pressure injuries form over bony areas when pressure combines with shear. Sliding down in bed causes shear, because the skin stays stuck to the sheet while deeper tissue moves, so small vessels stretch and tear. Friction is skin rubbing against a surface.
- Turn the immobilized client at least every 2 hours on a schedule.
- Keep the head of the bed at 30 degrees or less when appropriate, to limit sliding.
- Move the client up in bed with at least two people and a draw sheet, never by dragging.
- Keep skin clean and dry, and use heel and elbow protectors and special mattresses for at-risk clients.
A Stage 1 pressure injury is intact skin with a localized red area that does not blanch when pressed. A Braden Scale total of 12 or less means high risk.
4 How do you prevent contractures and foot drop?Joints start to change after about three days without movement, so range-of-motion (ROM) exercise starts as early as possible. 1 min
Joints start to change after about three days without movement, so range-of-motion (ROM) exercise starts as early as possible. Passive ROM is done entirely by someone else, active ROM by the client alone, and active assist ROM with partial help.
A contracture is the loss of full passive joint motion from joint, muscle or soft-tissue limits. Foot drop is a plantar-flexed foot that interferes with standing and walking. Pillows, foot boots, hand rolls and splints hold limbs in a resting position that opposes flexion.
5 What the nurse doesThe nurse checks every system, mobilizes early and protects the client during position changes. 1 min
The nurse checks every system, mobilizes early and protects the client during position changes.
- Assess head to toe: blood pressure, pulses, edema, signs of DVT, lung sounds and oxygen saturation, skin over bony areas, last bowel movement, and the bladder for distention.
- Mobilize early and as fully as the condition allows (dangle, chair, walk).
- Before standing, have the client dangle on the edge of the bed for a few minutes and check for dizziness or orthostatic hypotension.
- For bed-bound clients, turn at least every 2 hours. Raise the head of the bed 30 to 45 degrees for lung expansion unless contraindicated. Teach deep breathing and coughing.
- Teach safe use of assistive devices and fall precautions, and give anticipated pain medicine before therapy.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: Dangle the client on the edge of the bed for a few minutes first, not stand them straight up after days in bed.
Watch out: Start range of motion as early as possible, not after the client has been in bed for a week; joint changes begin within days.
Watch out: Nonblanchable redness over intact skin is already a Stage 1 pressure injury, not a normal pressure mark that can be ignored.
Watch out: Semi-Fowler's (30 to 45 degrees) puts less pressure on the coccyx over long periods than Fowler's or high Fowler's, not more.
Watch out: Good body mechanics alone do not prevent lifting injuries; use lifting devices and help per agency policy, not your back.
How to remember it
Remember that "bed rest steals from every system," then run the list head to toe (veins, lungs, skin, muscles, gut, bladder).
Self-check:
- Name one complication of immobility for each of the six body systems in the table.
- Explain why you dangle a client before standing and what blood pressure drop defines orthostatic hypotension.
- Describe how shear damages tissue and two actions that reduce it.