Immobility and complete bed rest can lead to life threatening physical and psychological

complications and consequences. Members of the nursing care team and other health care
professionals like physical therapists must, therefore, promote client mobility and prevent
immobility whenever possible. Immobility can adversely affect all physiological bodily systems.
The complications and hazards associated with immobility and according to bodily system are
described below:

Urinary System
As the result of immobility, the urinary system can be adversely affected with urinary retention,
urinary stasis, renal calculi, urinary incontinence and urinary tract infections.

Gastrointestinal System
Constipation, impaction and difficult to evacuate feces can occur as the result of immobility and
the lack of exercise that is needed to promote normal bowel functioning. These bowel alterations
are further confounded when the client is not getting adequate fluid intake.

Musculoskeletal System
The muscles, joints and bones are adversely affected by immobility.
The bones lose calcium as a result of the lack of weight bearing activity and this can lead to
disuse osteoporosis, hypercalcemia, and fractures. At times a tilt table can be used to prevent this
damage by placing the client in a position of weight bearing to avoid these complications.
The joints are affected with stiffness, pain, impaired range of motion and contractures including
foot drop which is a plantar flexion contracture. Some of these joint disorders can be prevented
with frequent and proper positioning of the client in correct bodily alignment, the provision of
range of motion exercises to all joints several times a day, and the use of devices like a hand roll
and a bed board to prevent contractures of the hands and feet, respectively.
Muscles are adversely affected with weakness and atrophy as the result of immobility. These
hazards of immobility can be prevented with range of motion exercises and in bed exercises such
as isotonic, isometric and isokinetic muscular exercises.

Respiratory System
Some adverse respiratory system effects relating to immobility include the thickening of
respiratory secretions, the pooling of respiratory secretions and an increased inability of the
client to mobilize and expectorate these secretions, all of which can lead to atelectasis, hypostatic
pneumonia, and respiratory tract infections. Immobility can also lead to shallow, ineffective
respirations, decreased respiratory movement, and a decrease in terms of the client's vital
capacity.
Some of these complications of immobility can be prevented with respiratory hygiene measures
such as deep breathing, coughing, postural drainage, percussion and vibration. These techniques
will be discussed below immediately after this section.
Circulatory System
The circulatory system is jeopardized by immobility; some of these respiratory complications
and risks include venous stasis, venous dilation, decreased blood pressure, edema, embolus
formation, thrombophlebitis and orthostatic hypotension which is a risk factor that is often
associated with client falls.
Some of these complications can be prevented with leg exercises, the use of sequential
compression devices or antiembolism stockings, and the initiation of falls risk prevention
measures when an immobilized client is adversely affected with orthostatic hypotension.

Metabolic System
The metabolic system alterations associated with immobility are a decreased rate of metabolism
which can lead to unintended weight gain, a negative calcium balance secondary to the loss of
calcium from the bones during immobilization, a negative nitrogen balance secondary to an
increase in terms of catabolic protein breakdown, and anorexia.

Integumentary System
Immobility places clients at risk for skin breakdown, pressure ulcers, and poor skin turgor.
Preventive measures and the treatments of these skin integrity disorders will be discussed below
in the section entitled "Performing a Skin Assessment and Implementing Measures to Maintain
Skin Integrity and Prevent Skin Breakdown".

Psychological Alterations
Some of the psychological hazards of immobility can include apathy, isolation, frustration, a
lowered mood, and depression.