Prolonged Bed Rest Nursing Care Plan and Diagnosis
Nursing care plans and nursing diagnosis for prolonged bed rest

In this nursing care plan guide are 8 nursing diagnosis for patients on prolonged bed rest. Learn about the assessment, care plan goals, and nursing interventions in this post.

Bed rest is therapeutically used as a means to decrease the metabolic demand on the body and promote recovery during an illness. However, prolonged bed rest may have deleterious effects on the cardiovascular, respiratory, musculoskeletal, integumentary and cognitive system of the patient that may lead to the onset of diseases resulting in irreversible damage. With patients being released earlier from the hospital, most of the health care problems are being managed in assistive living facilities (nursing homes) or at home.

Nursing care plan goals for patients on prolonged bedrest includes maintaining peripheral and cerebral tissue perfusion, maximizing the patient’s functional ability, maintaining bowel function,  promoting sexual functioning, preventing disuse syndrome, achieving a maximum level of self-care, and managing potential health complications.

Here are eight (8) nursing diagnosis and nursing care plans for prolonged bed rest:

  1. Ineffective Peripheral Tissue Perfusion
  2. Ineffective Sexuality Patterns
  3. Constipation
  4. Ineffective Role Performance
  5. Deficient Diversional Activity
  6. Risk for Ineffective Cerebral Tissue Perfusion
  7. Risk for Disuse Syndrome
  8. Risk for Activity Intolerance

1. Ineffective Peripheral Tissue Perfusion

The immobility associated with prolonged bed rest has an impact on the normal peripheral blood flow causing complications. These complications may include venous stasis, venous dilation, edema, embolus formation, and thrombophlebitis.

Nursing Diagnosis

Related Factors

Here are the common related factors for ineffective peripheral tissue perfusion that can be as your “related to” in your nursing diagnosis statement for prolonged bed rest:

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  • Interrupted venous flow occurring with prolonged immobility

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

  • Discoloration of the skin; skin color pales upon elevation, normal color does not return upon lowering the limb
  • Calf pain at dorsiflexion of the foot (positive Homan’s sign)
  • Swelling and tenderness in one of the legs
  • Changes in skin temperature

Desired Outcomes

Expected outcomes or patient goals for ineffective peripheral tissue perfusion nursing diagnosis:

  • At least 24-hour prior to discharge, the patient will have adequate peripheral perfusion as evidenced by normal skin color and temperature and adequate distal pulses (greater than 2+ on a 0-4+ scale) in peripheral extremities.
  • The patient will perform exercises independently, comply to the prophylactic therapy, and maintain intake of 2-3 liter per day of fluid unless contraindicated.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the Ineffective Peripheral Tissue Perfusion for prolonged bed rest:

Nursing InterventionsRationale
Nursing Assessment
Assess calf or groin for any redness, pain, warmth in the affected area, unilateral swelling of a leg, and coolness, abnormal color, and external venous dilation distal to the affected area.Pain in the calf elicited upon dorsiflexion of the foot (positive Homan’s sign) along with these clinical signs may be indicative of deep vein thrombosis (DVT) or venous thromboembolism.
Monitor vital signs and review the erythrocyte sedimentation rate (ESR) results once available.Other signs of deep vein thrombosis may include tachycardia, fever, and increased ESR. The normal ESR range is 0-15 mm/hr for a male under 50 years old, 0-20 mm/hr for male older than 50 years old is; in females under 50 years old is 0-20 mm/hr, and older than 50 years is 30 ml/hr.
Measure and compare the circumference of the affected leg and non-affected leg.If the circumference of the affected leg is larger than the opposite leg, this is a sign of deep vein thrombosis (DVT) or venous thromboembolism.
Notify the physician for any significant findings of the patient.Once the patient showed signs of deep vein thrombosis (DVT), additional assessment and test will be needed to prevent the occurrence of a pulmonary embolus that could compromise the leg.
Review laboratory values such as prothrombin time (PT) international normalized ratio (INR), partial thromboplastin time (PTT).If the patient is on anticoagulant therapy, reference values for PTT are 60-70 sec or 1.5-2.5 x control value and INR value of 2.0-3.0. Values higher than these imply an increased risk for bleeding.
Therapeutic Interventions
Inform and educate the patient about the signs and symptoms of deep vein thrombosis (DVT).A patient who can recognize these symptoms is more likely to report to the health care provider immediately for timely intervention.
Instruct patient on ankle dorsiflexion-plantar flexion (calf-pumping) and ankle-circling exercises.Helps promote blood flow. Each movement of the patient should be repeated ten times, doing each exercise every hour during prolonged periods of immobility, as long as the patient does not have any symptoms of deep vein thrombosis (DVT) or venous thromboembolism.
Advice the patient to avoid crossing the feet at the ankles or knees while in bed.These actions may cause pooling of blood in the veins.
Advice deep breathing exercises.Diaphragmatic breathing increases negative pressure around the lungs and thorax to facilitate emptying of large veins and hence improve peripheral tissue perfusion.
Elevate foot part of the bed at 10 degrees if the patient is at risk for DVT.Elevating the foot of the bed promotes venous return.
Instruct the patient to wear anti-embolism hose, pneumatic sequential compression stockings, pneumatic foot pump devices, or thromboembolism-deterrent (TED) hose unless contraindicated by peripheral vascular disease (PVD).These devices reduce the risk of venous stasis. The pneumatic devices, which give increase compression than anti-embolism hose, are particularly useful in preventing deep vein thrombosis in patients who are immobile. Rest pain that is precipitated by the use of TED hose, foot pump devices, and pneumatic sequential compression stockings may be experienced by clients with peripheral vascular disease.
Remove pneumatic sequential compress stockings for 10-20 minutes every 8 hours. Reapply hose after elevating the patient’s legs at least 10 degrees for 10 minutes.Remove pneumatic sequential compress stockings enables inspection of underlying skin for evidence of irritation or breakdown. Elevating the legs before reapplying the pneumatic sequential compress stockings promotes venous return and decrease edema, which otherwise would remain and cause discomfort when the hose are reapplied.
In nonrestricted patients, increase fluid intake to at least 2-3 liters per day. Educate the patient about the need to drink large amounts of fluid (9-14 8-oz glasses) daily. Monitor intake and output to ensure compliance.Increased hydration reduces hemoconcentration, which can contribute to the development of DVT/VTE.
Administer anticlotting medication as prescribed.Patients at risk for DVT/VTE, including those with chronic infection and history of PVD and smoking, as well as patients who are older, obese, and anemic, may require anticoagulants to minimize the risk of clotting. Drugs such as aspirin, sodium warfarin, phenindione derivatives, heparin, or low-molecular-weight heparin may be given. Most patients are taught how to self-administer LMWH injections after hospital discharge.
Instruct the patient to self-monitor and observe any evidence of bleeding.Anticoagulant drugs increase the risk of bleeding. It is important for the patient to know signs of bleeding so that he or she can report them as soon as they are noted to ensure timely intervention. Possible types of bleeding include epistaxis, bleeding gums, hematuria, hematochezia, hematemesis, hemoptysis, ecchymoses, menometrorrhagia, and melena.
Educate patient about avoiding food, and herbal that can interact with anticoagulant therapy.Certain foods and over-the-counter herbals can increase bleeding such as Coenzyme Q-10, devil claw, echinacea, fenugreek, garlic, ginger, Ginko Biloba, goldenseal, green tea, passion flower, quinine, red clover, saw palmetto, St. John’s wort, and Valerian.
Educate patient on medications and foods that decrease the effect of anticoagulants.Examples of medications and foods are azathioprine, antithyroid medications, carbamazepine, dicloxacillin, glutethimide, griseofulvin, haloperidol, nafcillin, oral contraceptives, phenobarbital, rifampin, vitamin C, dark green leafy vegetables, spinach, kale, lettuce, broccoli, asparagus, cauliflower, and Brussels sprouts.

2. Ineffective Sexuality Patterns

This nursing diagnosis is chosen as the patient is experiencing sexual dysfunction due to perceived restrictions caused by the presence of an illness or prolonged hospitalization.

Nursing Diagnosis

  • Ineffective Sexuality Pattern: Expressions of concern regarding own sexuality.

Related Factors

Here are the common related factors for ineffective sexuality pattern that can be as your “related to” in your nursing diagnosis statement for prolonged bed rest:

  • Actual or perceived physiologic limitations on sexual performance occurring with a disease, therapy, or prolonged hospitalization
  • Lack of privacy

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

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  • Changes or limitations in sexual behaviors
  • Alterations in achieving perceived sex roles
  • Expressions of powerless

Desired Outcomes

Expected outcomes or patient goals for ineffective sexuality pattern nursing diagnosis:

  • Within 72 hours of this diagnosis, the patient will relate satisfaction with sexuality and understanding of the ability to resume sexual activity.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis ineffective sexuality pattern:

Nursing InterventionsRationale
Nursing Assessment
Determine the patient’s problem, and validate it with the patient.Identifies the cause of sexual dysfunction. These can be due to a present disease condition, lack of privacy, or perceived limitations. Signs of sexual dysfunction can include making inappropriate sexual gestures, inappropriate touching, regression, self-enforced isolation, and similar behaviors.
Assess the normal sexual function of the patient which includes weight of sex in the relationship, frequency of interaction, common positions used, and the couple’s ability to adjust to fulfill requirements of the patient’s limitation.Helps determine the patient’s normal sexual function and adjustments that will be needed under current circumstances.
Therapeutic Interventions
Allow the patient and significant others to express feelings and concerns regarding lack of sex, having sexual relationships in the health care setting, hurting the patient, or having to use new or alternative means for sexual satisfaction.Establishing open communication helps build a strong intimate relationship.
Allow acceptable expressions of sexuality by the patient.Examples of positive and acceptable behaviors may eliminate inappropriate behaviors. Examples for a woman could include wearing jewelry and makeup and for a man, shaving and wearing his own shirts and shorts.
Encourage collaboration with the patient and significant others developing strategies.This information will facilitate an understanding of methods to attain sexual satisfaction.
Encourage the patient and significant other to try alternative ways of sexual expression when necessary.Alternative ways of sexual expression may include mutual masturbation, changed positions, sex toys, and explore other sensual areas for each partner.
Tell the patient and significant other that it is possible to have private time for intimacy. Make sure to place a “Do not disturb” sign on the door to restrict staff and guests to the room, or arrange for temporary private quarters.These measures promote intimacy by ensuring private time between the patient and significant other.
Evaluate the need for professional sexual counseling when needed.Counseling may enhance communication and agreement of alternative means.

3. Constipation

Constipation is a common nursing diagnosis among patients on prolonged bed rest. Inadequate fluid intake and the lack of physical activity can affect normal bowel function of the body.

Nursing Diagnosis

  • Constipation:A decrease in a person’s normal frequency of defecation, accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool.

Related Factors

Here are the common related factors for Constipation that can be as your “related to” in your nursing diagnosis statement for prolonged bed rest:

  • Inadequate fluid or dietary intake and bulk
  • Lack of privacy
  • Positional restrictions
  • Immobility
  • Use of opioid analgesics

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

  • Changes in bowel pattern; difficulty in passing a stool
  • Abdominal tenderness; Pain upon defecation
  • Abdominal distention
  • Straining with defecation

Desired Outcomes

Expected outcomes or patient goals for Constipation nursing diagnosis:

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  • Within 24 hours of this diagnosis, the patient will verbalize knowledge of strategies that promote bowel elimination.
  • The patient will state the return of normal pattern and character of bowel elimination within 3-5 days of this diagnosis.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis constipation:

Nursing InterventionsRationale
Nursing Assessment
Assess the bowel history of the patient.Helps determine normal bowel habits and measures that are effectively used at home.
Monitor and record the patient’s bowel movements, current diet, and intake and output.This information tracks bowel movements and factors that promote or prevent constipation. Signs and symptoms of constipation include the following: passing fewer stools than the usual, abdominal pain or bloating, straining during the passage of stool, and complaints of rectal fullness. Fecal impaction may be described as continuous leaking of liquid stool upon digital rectal exam.
Therapeutic Interventions
Offer a bedpan; provide privacy; and time medications, enemas, or suppositories in a way that it will take effect at the time of day when the patient normally has a bowel movement.These actions maintain the patient’s normal bowel habits.
Use a gloved, lubricated finger to remove stool from the rectum if the patient is suspected to have a rectal impaction.Digital stimulation helps trigger bowel movement. Oil retention enema may be given to soften impacted stool
Offer warm fluids early in the morning and encourage toileting.These actions can trigger the gastrocolic and duodenocolic reflexes of the patient.
Instruct the patient to increase intake of fiber in the diet and fluid intake of at least 2-3 liters per day unless contraindicated.These interventions stimulate peristalsis. Examples of insoluble fiber foods include whole wheat or bran products, cereals, nuts, green beans, cauliflowers, and lentils.
Make use of the patient’s activity level within limitations of pain, endurance, and treatment.Physical activity stimulates peristalsis, which helps maintain normal bowel movement.
Educate nonpharmacologic means of pain management.Nonpharmacologic strategies that may reduce the need for opioid use include ice, massage therapy, guided imagery, music therapy, biofeedback, transcutaneous electrical nerve stimulation (TENS) and spinal cord stimulation (SCS).
Ask for pharmacologic therapy from the physician if needed.Beginning with the most gentle therapy helps relief from rebound constipation and ensures the least disruption of the patient’s normal bowel habits.The following is a recommended hierarchy of therapy:

  • Bulk-building additives (psyllium), bran
  • Mild laxatives (apple or prune juice, milk of magnesia)
  • Stool softeners (docusate sodium, docusate calcium)
  • Potent laxatives and cathartics (bisacodyl, cascara sagrada)
  • Medicated suppositories
  • Enemas
Explain the role that opioid agents and other medications play in causing constipation.Medications that are known to cause constipation includes opioids, antidepressants, anticonvulsants, iron supplements, diuretics, and calcium channel blockers. Methylnaltrexone, a μ-opioid receptor antagonist, is a drug that provides relief of opioid-induced constipation.

4. Ineffective Role Performance

In this case, this nursing diagnosis is related to the conflict between the dependence of the patient to others while on care and the desire of the patient to be independent when he or she is able to.

Nursing Diagnosis

  • Ineffective Role Performance: Patterns of behavior and self-expression that do not match the environmental contexts, norms, and expectations.

Related Factors

Here are the common related factors for ineffective role performance that can be as your “related to” in your nursing diagnosis statement for prolonged bed rest:

  • Necessity for dependence upon others during care vs. need for independence/self-care as condition improves.

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

  • Change in normal patterns of obligation/ability to resume a role
  • Altered role perception
  • Lack of opportunities to perform a role
  • Dissatisfied role

Desired Outcomes

Expected outcomes or patient goals for  ineffective role performance nursing diagnosis:

  • Within 48 hours of this diagnosis, the patient and caregivers will develop realistic goals for independence and participate in self-care.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis ineffective role performance:

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Nursing InterventionsRationale
Nursing Assessment
Assess the response of the patient to the care plan for recovery.It is necessary to have the patient gradually increasing activity and becoming more participative in self-care activities. Too much activity may result in burnout and delays in recovery.
Therapeutic Interventions
Refrain from minimizing the patient’s expressed feelings of depression. Allow expressions of emotions, but facilitate an environment full of understanding, support, and realistic hope for a positive role change.Minimizing a patient’s expressed feelings of depression can add to anger and depression. Giving realistic goals and encouragement can provide needed emotional support in the journey toward independence.
Provide consistency in conveying expectations of eventual independence.Consistency builds trusting relationships.
Encourage the patient to be as independent as possible within limitations of endurance, therapy, and pain.Encouragement will promote independence as much as feasible. Allow for temporary periods of dependence because they enable the individual to restore energy reserves needed for recovery.
Alert the patient to areas of excessive dependence, and involve him or her in collaborative goal setting.It is healthy to begin to foster a degree of independence as recovery progresses.
Provide assistive devices if indicated.These devices, such as long-handled reachers, canes, wheelchairs, and walkers can increase the patient’s independence with self-care routines.
Provide positive reinforcement when the patient meets or advances toward goals.Positive reinforcement builds on the patient’s strengths and facilitates self-efficacy.

5. Deficient Diversional Activity

This nursing diagnosis is chosen since the presence of an illness that requires long-term hospitalization and the lack of stimulation makes it difficult for the patient to have an interest in engaging in diversional activities.

Nursing Diagnosis

  • Deficient Diversional Activity: Decreased stimulation from (or interest or engagement in) recreational or leisure activities [Note: Internal/external factors may or may not be beyond the individual’s control].

Related Factors

Here are the common related factors for deficient diversional activity that can be as your “related to” in your nursing diagnosis statement for prolonged bed rest:

  • Prolonged illness and hospitalization

Defining Characteristics

The commonly used subjective and objective data or nursing assessment cues (signs and symptoms) that could serve as your “as evidenced by” for this care plan:

  • Physical limitations
  • Normal hobbies cannot be performed in the hospital, home, or other facilities
  • Lack of interest; inattentiveness

Desired Outcomes

Expected outcomes or patient goals for deficient diversional activity nursing diagnosis:

  • Within 24 hour of intervention, the patient will engage in diversional activities and relates the absence of boredom.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis Deficient Diversional Activity:

Nursing InterventionsRationale
Nursing Assessment
Assess the activity tolerance of the patient.Activity tolerance will determine the number of activity patients can participate in within limits of their illness.
Assess for evidence of the patient having an interest in something to read or do, daytime napping, and expressed inability to do leisure activities due to hospitalization.These are indicators of boredom.
Collect a database by evaluating the patient’s usual support systems and relationship patterns with significant others. Ask the patient and significant other about the patient’s interests.This allows the nurse to explore for diversional activities that may be appropriate for the health care setting and the patient’s level of activity tolerance.
Therapeutic Interventions
Allow discussion of previous activities or reminiscence.This could serve as an option for performing desired activities during recovery.
Encourage significant others to visit within limits of the patient’s endurance and to involve the patient in activities that are of interest to him or her.Visiting and partaking in activities with significant others likely decrease boredom.
Initiate activities that demand little concentration and progress to more complex tasks as the patient’s condition permits.Initially, the patient may find challenging tasks frustrating. Physiologic problems such as anemia and pain may make concentration difficult.
Provide low-level activities to the patient’s tolerance.These activities promote mental stimulation and reduce boredom. Examples include access to WiFi, iPods, iPads, iPhones, laptop computers, Kindles, and Get Well Network. Offering books or magazines related to the patient’s recreational or other interests, computer games, television, and providing writing implements for brief intervals of activity are other alternative actions.
Personalize the patient’s environment with favorite items and images of significant others.Promotes visual stimulation.
Increase the patient’s participation in self-care.Doing in-bed exercises, keeping track of intake and output, and related activities can and should be performed routinely by patients to provide a sense of control, purpose, and fulfillment, which likely will lessen boredom.
As the patient’s endurance improves, encourage the use of appropriate diversional activities such as puzzle, model kits, handicrafts, and computerized games and activities; Recommend that the patient’s significant other recreational devices, crafts, and personal grooming from home.Watching television, using the computer, listening to the radio or books on tape, and playing cards or board games usually are good diversions.
As the condition of the patient improves, Allow the patient to view outside activities by assisting him or her in a chair near a window, provide the patient an opportunity to sit in a solarium so that he or she can visit other patients, and if feasible, bring the patient outside for a short period.Being outdoors, speaking, and meeting with other people can reduce boredom.
Evaluate the need for occupational therapy, psychiatric nurse, social services, and spiritual services for consultation.Such referrals may cover other diversional activities.

6. Risk for Ineffective Cerebral Tissue Perfusion

One of the potential problems that a patient on prolonged bed rest faces is orthostatic hypotension. The neurologic symptoms of orthostatic hypotension such as lightheadedness and dizziness are produced because of decreased cerebral perfusion.

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Nursing Diagnosis

  • Risk for Ineffective Cerebral Tissue Perfusion (renal, cerebral, cardiopulmonary, gastrointestinal, peripheral): Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.

Risk Factors

Common risk factors for the nursing diagnosis risk for ineffective cerebral tissue perfusion for prolonged bed rest:

  • Interrupted arterial flow to the brain occurs with prolonged bed rest.

Defining Characteristics

  • Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Expected outcomes or patient goals for risk for ineffective cerebral tissue perfusion nursing diagnosis:

  • When getting out of bed, the patient will have adequate cerebral perfusion as evidenced by heart rate less than 120 beats per minute and blood pressure 90/60 mm Hg or greater (or within 20 mm Hg of the patient’s normal range) immediately after position change, normal skin color, dry skin, and absence of vertigo and syncope, with return of heart rate and blood pressure to resting levels within 3 minute of position change.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis risk for ineffective cerebral tissue perfusion:

Nursing InterventionsRationale
Nursing Assessment
Assess for recent diuresis, diaphoresis, or change in vasodilator therapy.These are factors that raise the risk of orthostatic hypotension due to changes in fluid volume.
Watch out for diabetic cardiac neuropathy, denervation following heart transplantation, advanced age, or severe left ventricular dysfunction.These are factors that increase the risk of orthostatic hypotension due to altered autonomic control.
Discuss the cause of orthostatic hypotension and interventions for preventing it.Patients who are knowledgeable of the cause and interventions of preventing orthostatic hypotension are more likely to avoid it.
Monitor blood pressure and advice the patient to immediately report symptoms of lightheadedness or dizziness.Hypotension, lightheadedness, and dizziness are signs of orthostatic hypotension and would require a return to the supine position.
Assess for a decline in systolic blood pressure of 20 mm Hg or higher and an increased pulse rate, together with symptoms of vertigo and impending syncope.These are signs of orthostatic hypotension that indicate the necessity for a return to the supine position.
Therapeutic Interventions
Instruct the patient to perform leg exercises shortly prior to mobilization.Leg exercises promote venous return, which helps avoid orthostatic hypotension.
Encourage position changes within the patient when the patient is preparing to move out of the bed.Changes in position help adjust patient to the upright position. These changes may be achieved with the use of assistive devices such as over-bed trapeze, hydraulic lift, and EZ Lift.
Apply anti-embolism hose once the patient is mobilized.The use of anti embolism hose and sequential compression hose prevents deep vein thrombosis and orthostatic hypotension.
Follow these guidelines for mobilization:
  • Instruct the patient to dangle legs and perform leg exercises at the bedside. Note for signs orthostatic hypotension, including lightheadedness or dizziness, diaphoresis, fatigue, tachycardia, hypotension, and syncope.
This intervention provides for a progressive adjustment to the possible effects of venous pooling and associated hypotension in individuals who have been lying down for a period of time.
  • If dangling of the leg is tolerated, allow the patient to stand at the bedside with two staff members in guidance, then if an adverse effect is not observed, gradually progress the patient to ambulation.
This action guarantees the safety of the patient in the case of a fall.

7. Risk for Disuse Syndrome

Risk for disuse syndrome may be related to the physiological changes brought about by physical inactivity. These changes may include a decrease in muscle strength, limited joint movement, and loss of bone density.

Nursing Diagnosis

  • Risk for Disuse Syndrome: At risk of deterioration of body systems as the result of prescribed or unavoidable musculoskeletal inactivity.

Risk Factors

Common risk factors for the nursing diagnosis risk for disuse syndrome for prolonged bed rest:

  • Paralysis
  • Mechanical immobilization
  • Prescribed immobilization
  • Severe pain
  • Altered level of consciousness

Defining Characteristics

  • Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Expected outcomes or patient goals for risk for disuse syndrome nursing diagnosis:

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  • When bed rest is no longer adviced, the patient will exhibit complete ROM of all joints with the absence of pain, and limb girth measurements are congruent with or increased over baseline measurements.

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis risk for disuse syndrome:

Nursing InterventionsRationale
Nursing Assessment
Assess the range of motion (ROM) of the joints especially to these areas:These areas are particularly prone to joint contracture.
  • Shoulders
Frozen shoulder prohibits extension and abduction.
  • Wrists
A wrist drop limits extension.
  • Fingers
Fingers can develop flexion contractures that prohibit extension.
  • Hips
Hips can develop flexion contractures that alter the gait by shortening the limb or develop external rotation or adduction malformations that affect the gait.
  • Knees
Knees may have flexion contractures that can develop to limit extension and affect the gait.
  • Feet
Feet can “drop” due to prolonged plantar flexion, which prohibits dorsiflexion and affects the gait.
Evaluate for footdrop by observing the feet for plantar flexion and assessing the patient’s ability to point the toes upward at the body. Record the assessment daily.Since feet lie normally in plantar flexion, foot drop may happen when plantar flexion is prolonged. Inability to dorsiflex is a manifestation of foot drop, and it needs immediate action to avoid irreversible damage. This may require the use of footboards or high-top tennis shoes to facilitate normal dorsal flexion position.
Therapeutic Interventions
Place the patient in a position that achieves proper standing. Maintain this position using assistive aids such as pillows, towels, foam heal positioners, footboards, PlexiPulse compression device, and high-top tennis shoes.A position in which the head is neutral or slightly flexed on the neck, hips are extended, knees are extended or minimally flexed, and feet are at right angles to the legs achieves proper standing alignment, which helps facilitate ambulation when the patient is able to do so.
When the head of bed (HOB) must be elevated 30 degrees, extend the patient’s shoulders and arms.This position keeps proper spinal posture.
Encourage position changes at least every 2 hours. Establish a turning schedule and post it at the bedside.Position changes maintain correct body alignment, limits contractures, decreases pressure on bony prominences, reduces venous stasis, and facilitates maximal chest expansions.
Make sure that the patient is prone or side-lying, with hips extended, for a similar amount of time spent in the supine position or, at a minimum, 3 times a day for 1 hour.These positions avoid hip flexion contractures.
Allow the fingertips of the patient to extend over the edge of the pillow.This position keeps the normal arching of the hands.
Put thin pads below the angles of the axillae and lateral areas of the clavicles.These pads help avoid shoulder internal rotation and keep the anatomic position of the shoulder girdle.
Allow the patient to extend his or her hips.This position helps avoids hip flexion contractures.
When the patient is allowed to be placed in a prone position, move him or her to the end of the bed and let the feet rest between the mattress and footboard.This avoids not only plantar flexion and hip rotation but also heel and toe injury.
When the patient is placed in a side-lying position, extend the lower leg from the hip.This position helps avoid hip flexion contractures.
Educate the patient and significant other the steps and purpose for range of motion exercises, and allow return demonstrations. Provide passive exercises for patients unable to perform active or active assisted exercises. Integrate movement patterns into care routines.These measures promote compliance with the exercise regimen and help avoid the formation of contractures.
Perform and record limb girth measurements, dynamography, and ROM, and develop exercise baseline restrictions.This evaluation of present muscle mass, strength, and joint motion allows succeeding assessment and encourages exercise and range of motion appropriate for the patient.
Provide the patient with a written copy of the exercise program. Advice the patient to follow the given exercises as required.These measures promote learning and compliance with the exercise program.
Discuss with the patient the reason why muscle atrophy happens. Stress the importance of exercise in maintaining periarticular tissue elasticity and muscle strength. If there is a presence of pathologic conditions, inquire with the physician on exercises appropriate for the patient.Muscle atrophy occurs because of unused or inability to use the joint, often caused by pain. This information encourages patients to perform exercises in as much as disuse eventually may result in decreased muscle mass and poor blood supply and a loss of periarticular tissue elasticity, which in turn can lead to increased muscle fatigue and joint pain with use.
Discuss the need to be involved in self-care as tolerated.Self-care helps maintain muscle strength and promote a sense of participation and control.
Determine the patient’s baseline level of performance on a given set of exercises, and then set realistic goals for repetitions.These goals help determine the effectiveness of the exercise plan and progress made.
Assist with resistive exercises for noncardiac patients requiring help with muscle strength; For patients in beds with Balkan frames or other types of over-bed frames to utilize weights, pulleys, and slings.Resistance builds the force required to do the exercise and facilitates the maintenance of muscle strength.
Provide a visual diagram of the progress of the patient the exercise therapy.Such progress and providing positive reinforcement encourages continued compliance with the regimen.
Instruct the use of isometric exercises to those patients needing some joint rest.In isometric exercises, the patient contracts a muscle and holds the position for a least 5 seconds. for a count of 5 or 10. The sequence is done again for increasing counts until enough level of endurance has been reached.
Post the exercise regimen at the bedside and allow the involvement of the patient’s significant others.These efforts ensure consistency by all health care personnel and participation and support of significant others.
Use positioning devices such as pillows, rolls, and blankets, knee abductors, drop seats, foot supports, back wedges, back support splints and wedges cushions.Enables the patient to remain functional as the activity increases.
When using adjunctive devices, regularly assess the skin for any alterations.Monitoring changes in skin integrity allow immediate measures that prevent skin breakdown.
Educate patient and significant others with transfer or crutch-walking techniques and use of a cane, walker, or wheelchair. Stress the value of proper body mechanics.These measures help ensure that patients can safely maintain the highest possible level of mobility while also improving circulation.
Encourage the use of assistive devices such as transfer boards, gait belts, and leg lifters.These aids facilitate movement and promote safety.
Provide a time of uninterrupted rest between exercises.Rest allows patients to refuel energy stores.
Evaluate the need for referral to physical therapy or occupational therapy as appropriate.Collaboration from other specialists will enable the patient to have the best ROM as possible.

8. Risk for Activity Intolerance

Bed rest if it is prolonged, it may lead to poor tolerance for activity related to deconditioning state.

Nursing Diagnosis

  • Activity Intolerance: At risk for insufficient physiologic or physiological energy to endure or complete required or desired activity.

Risk Factors

Common risk factors for the nursing diagnosis risk for activity intolerance for prolonged bed rest:

  • Deconditioned state

Defining Characteristics

  • Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Expected outcomes or patient goals for risk for activity intolerance nursing diagnosis:

  • Within 48 hours of discontinuing bedrest, the patient will exhibit cardiac tolerance to activity or exercise as evidenced by respiratory rate 20 breaths/min or less with normal depth and pattern; absence of rales, heart rate 20 bpm or less over resting heart rate; systolic blood pressure 20 mm Hg or less over or under resting systolic blood pressure; normal sinus rhythm; no evidence of new murmurs, new dysrhythmias, gallop, or chest pain; and warm and dry skin.
  • The patient will rate perceived exertion (RPE) at 3 or less on a scale of 0 (none) to 10 (maximum).
  • The patient will maintain muscle strength and joint range of motion (ROM).

Nursing Interventions and Rationale

In this section are the nursing actions or interventions and their rationale or scientific explanation for the nursing diagnosis risk for activity intolerance:

Nursing InterventionsRationale
Nursing Assessment
Assess patient’s tolerance to the exercise regimen and note for any physiologic changes.Transient pulmonary congestion secondary to ischemia, diminished lung volumes, decreased oxygen-carrying capacity of the blood, shunting of deoxygenated blood from the right to the left side of the heart all contributes to shortness of breath. If the cardiac output does not increase to meet the body’s needs during the low-level range of motion exercises, systolic blood pressure may fall; dysrhythmias and systolic murmur of mitral regurgitation may be noted; the skin may become cool, cyanotic, and diaphoretic; crackles (rales) may be auscultated.
Assess for orthostatic hypotension. Prepare the patient for this change by providing ample time in high Fowler’s position and moving the patient gradually.Orthostatic hypotension results from a decrease in blood volume and the inability of the body to adapt quickly to postural change.
Review complete blood count results and notify the physician for any abnormal value.The impact of conditions such as anemia can reduce the oxygen-carrying capacity of the blood making hard for the patient to tolerate any activity or exercise.
Therapeutic Interventions
Perform a range of motion exercises on each extremity.These type of exercises develop stamina by building muscle strength and endurance.
Avoid isometric exercises if the patient has a history of heart disease.Isometric exercise increases systolic, diastolic, and systemic arterial blood pressure.
Start with passive exercises, moving the joints through the motions of extension, flexion, abduction, and adduction. Progress to active-assisted exercises in which you support the joints while the patient contracts a certain muscle group, moves the extremity at a slow pace, and then relaxes the muscle group.Performing the least exerting to the most exerting exercises allows the patient to attain increase gradual tolerance.
Monitor heart rate and blood pressure at rest, peak exercise, and 5 minutes following an exercise.These assessments help evaluate patient’s tolerance with the exercises. If the heart rate or systolic blood pressure increases more than 20 bpm or more than 20 mm Hg over resting level, the number of repetitions should be minimized. If HR or SBP decreases more than 10 bpm or more than 10 mm Hg at peak exercise, this could be a sign of left ventricular failure, indicating that the heart is unable to meet workload.
Start exercise with 3-5 repetitions as tolerated by the patient.Starting with the least intensity and progressing step-by-step to higher intensity allows gradual tolerance.
Start exercise with 5 minutes or less of exercise. Gradually increase the exercise to 15 minutes as tolerated.Starting with the least time and progressing to higher time facilitates gradual tolerance.
Start with exercises 2 to 4 times a day.As duration increases, the frequency can be lessened.
Ask the patient to rate perceived exertion (RPE) during exercises using Borg’s scale:

  • 0 = Nothing at all
  • 1 = Very weak effort
  • 2 = Light effort
  • 3 = Moderate effort
  • 4 = Somewhat stronger effort
  • 5 = Strong effort
  • 7 =Very strong effort
  • 9 = Very, very strong effort
  • 10 = Maximum effort
Borg’s Scale is used to measure the patient’s level of intensity during exercise. Exercises that prevent deconditioning should be done at low levels of effort. RPE higher than 3 should not be felt by a patient performing ROM exercises.
Discontinue the exercise if the patient experiences shortness of breath, lightheadedness, dizziness, syncope, or severe pain. Notify physician accordingly.These exercises should be used with caution among patient with a recent illness, unexplained weight gain or joint swelling since these may indicate a severe health condition.
Discontinue any exercise once the patient complains of muscular or skeletal pain. Refer to a physical therapist about any modifications.This intervention avoids damage in an inflamed joint or diseased to tolerate this mode of exercise intensity.
Gradually increase activity in hospitalized patients as follows:A decrease in blood pressure more than 20 mm Hg, increase in HR to more than 120 bpm, and shortness of breath indicates activity intolerance.
Level I: Bedrest

  • Deep breathing 4 times a day, 15 breaths
  • Position change from side to side every 2 hours
  • Flexion and extension of extremities 4 times a day, 15 times each extremity
  • Using Vollman’s prone positioners and kinetic therapy beds
The use of Vollman’s prone positioner facilitates postural drainage thereby promoting lung expansion. Kinetic therapy beds provide a continual rotation of more than 200 times a day, which decreases the possibility of pneumonia and bed sores.
Level II: Out of bed to chair

  • As tolerated, 3 times a day for 20-30 minute
  • May perform ROM exercises 2 times a day while sitting in a chair

Level III: Ambulate in room

  • As tolerated, 3 times a day for 3 to 5 minutes in a room

Level IV: Ambulate in the hall

  • Initially, 50 to 200 feet 2 times a day, progressing to 600 feet 4 times a day
  • May incorporate slow stair climbing in preparation for hospital discharge
  • Monitor for signs of activity intolerance
Slowly increasing activities by working up to 20 to 30-minute sessions at least 3 to 4 times a week with the use of a walker or gait belt for assistance and providing nonskid footwear for ambulation improves conditioning and promotes safety.
Observe for nonverbal cues and provide emotional support to the patient and significant other as the patient’s activity level is increased.Emotional support helps alleviate fears of failure, pain, or medical setbacks.
Educate the patient’s significant other with measures in avoiding deconditioning and their rationale. Allow him or her to participate in the care plan.Knowledge and understanding of these measures will promote support and participation of the significant others in the patient’s activities.
Encourage the patient to perform self-care activities as tolerated.Self-care activities that may increase the activity level of the patient may include eating, personal care and hygiene, bathing, and dressing.

References and Sources

Here are the references and sources for this nursing care plan about Prolonged Bed Rest:

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  • Carpenito-Moyet, L. J. (2009). Nursing care plans & documentation: nursing diagnoses and collaborative problems. Lippincott Williams & Wilkins. [Link]
  • Donaldson, C. L., Hulley, S. B., Vogel, J. M., Hattner, R. S., Bayers, J. H., & McMillan, D. E. (1970). Effect of prolonged bed rest on bone mineral. Metabolism19(12), 1071-1084. [Link]
  • Knight, J., Nigam, Y., & Jones, A. (2019). effects of bedrest 2: respiratory and haematological systems. Nursing Times115(1), 44-47. [Link]
Prolonged Bed Rest Nursing Care Plan and Diagnosis
Prolonged Bed Rest Nursing Care Plan and Diagnosis
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