Complications of Immobility
Key Points
- Immobility causes preventable multisystem complications and functional decline.
- Major risks include pressure injuries, contractures, constipation, decreased lung function, fluid retention, and DVT.
- Prevention depends on early mobility, scheduled repositioning, skin care, bowel support, and respiratory exercises.
- Segmenting ADLs can preserve participation when endurance is limited.
Pathophysiology
Immobility reduces normal physiologic stimulation across multiple body systems, leading to progressive deconditioning. As activity falls, muscle strength and joint flexibility decline, skin pressure tolerance worsens, pulmonary expansion decreases, and venous return slows.
These changes increase the probability of secondary complications such as pressure-injuries, contractures, constipation, reduced lung function, and deep-vein-thrombosis. The source emphasizes that many of these outcomes are avoidable with proactive nursing care.
Classification
- Integumentary complications: Pressure injury risk from prolonged pressure and moisture exposure.
- Musculoskeletal complications: Muscle atrophy and contracture from limited joint movement.
- Gastrointestinal/urinary complications: Constipation and incontinence linked to inactivity and routine disruption.
- Respiratory/circulatory complications: Decreased lung function, DVT risk, fluid retention, and reduced cardiac performance.
- Psychological complications: Depression and social withdrawal when mobility and participation decline.
Nursing Assessment
NCLEX Focus
Questions commonly test which immobility complication has highest immediate risk and which preventive action is most time-sensitive.
- Assess tolerance for activity and identify when ADLs must be segmented to prevent overexertion.
- Observe skin condition and bony prominences for early breakdown indicators.
- Monitor bowel patterns, hydration status, and signs of constipation.
- Assess respiratory effort and need for coughing, deep breathing, or spirometry support.
- Report new edema, calf discomfort, or reduced mobility suggesting rising deep-vein-thrombosis risk.
Nursing Interventions
- Reposition at least every 1-2 hours and maintain consistent skin and incontinence care.
- Promote active or passive range-of-motion-exercises and use ordered splints or positioning devices.
- Encourage fluids, fiber intake, and scheduled toileting when not contraindicated.
- Support cough/deep breathing and activity as tolerated to maintain respiratory function.
- Promote ambulation, apply ordered compression devices, elevate extremities, and track daily weights.
Avoidable Harm Risk
Delayed repositioning and missed mobility interventions rapidly increase preventable complications, especially pressure injury and deconditioning.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| Not specified in source | None provided in this section | Prioritize nonpharmacologic prevention and early mobility interventions. |
Clinical Judgment Application
Clinical Scenario
A bedbound older adult with reduced endurance requires full morning care and has early sacral redness, reduced appetite, and shallow respirations.
Recognize Cues: Persistent immobility, skin risk, poor intake, and limited respiratory effort. Analyze Cues: Current status indicates high risk for pressure injury, pulmonary decline, and bowel complications. Prioritize Hypotheses: Immediate priority is preventable injury from prolonged pressure and inactivity. Generate Solutions: Reposition schedule, segmented ADL plan, skin/incontinence care, and respiratory exercises. Take Action: Reposition now, complete hygiene support, and implement activity-as-tolerated plan. Evaluate Outcomes: Skin remains intact, activity tolerance improves, and no new immobility complications emerge.
Related Concepts
- pressure-injuries - Prolonged pressure and moisture increase tissue damage risk.
- range-of-motion-exercises - Maintains joint mobility and reduces contracture progression.
- deep-vein-thrombosis - Immobility raises venous stasis and clot risk.
- fall-prevention - Progressive weakness from immobility increases fall risk during transfers.
- activities-of-daily-living - Segmenting care preserves participation despite limited endurance.
Self-Check
- Which immobility complication should be prioritized first when skin redness and poor endurance appear together?
- How does segmenting ADLs reduce physiologic stress while preserving functional participation?
- Which assessment findings indicate escalation for possible DVT in an immobile patient?