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6.1 Mobility and Hazards of Immobility

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

6.1 Mobility and Hazards of Immobility

Key Takeaways Explain This Topic AI

Immobility affects all body systems: respiratory (atelectasis, pneumonia), cardiovascular (DVT, PE), musculoskeletal (contractures, muscle atrophy), and integumentary (pressure injuries)

Turn immobile patients every 2 hours to prevent pressure injuries and promote circulation

Incentive spirometry and deep breathing exercises prevent atelectasis and hypostatic pneumonia in immobile patients

Sequential Compression Devices (SCDs) and antiembolism stockings help prevent venous stasis and DVT formation

  • Early ambulation is the single most effective intervention to prevent complications of immobility
  • Last updated: January 2026

The ability to move freely is fundamental to health. When patients become immobile—whether from illness, surgery, injury, or weakness—every body system suffers. Understanding these hazards allows nurses to implement preventive interventions before complications develop.

Why Immobility Matters

Immobility is never benign. Bed rest, once prescribed as treatment, is now recognized as a source of serious complications. Within 24-48 hours of immobilization, physiological changes begin that can lead to life-threatening conditions.

Key Principle: Prevention is always easier than treatment. The nurse's role is to recognize risk factors and implement interventions before complications occur.

Hazards of Immobility by Body System

Body System Complication Pathophysiology Prevention

Respiratory Atelectasis, Hypostatic pneumonia Secretion pooling, decreased lung expansion Turn q2h, incentive spirometry, deep breathing

Cardiovascular DVT, Pulmonary embolism Venous stasis, hypercoagulability SCDs, antiembolism stockings, early ambulation

Musculoskeletal Contractures, Muscle atrophy Decreased muscle use, joint immobility ROM exercises, proper positioning

Integumentary Pressure injuries (decubitus ulcers) Tissue ischemia from sustained pressure Reposition q2h, pressure-relieving surfaces

  • Urinary Stasis, UTI, Calculi Urine pooling, incomplete emptying Hydration, upright positioning if possible
  • Gastrointestinal Constipation Decreased peristalsis Fiber, fluids, activity
  • Metabolic Negative nitrogen balance Muscle catabolism Adequate protein intake, activity
  • Respiratory Complications
  • Atelectasis

Atelectasis is the collapse of alveoli due to inadequate expansion. In immobile patients, secretions accumulate in dependent lung regions, blocking airways and causing alveolar collapse.

Risk Factors:

  • Bed rest, especially supine positioning
  • Post-surgical patients (especially abdominal or thoracic surgery)
  • Decreased cough reflex
  • Pain limiting deep breathing

Nursing Interventions:

  • Encourage deep breathing exercises every hour while awake
  • Use incentive spirometry 10 times per hour
  • Reposition every 2 hours
  • Administer pain medication before breathing exercises
  • Hypostatic Pneumonia

When secretions pool in the lungs and aren't cleared, bacteria proliferate, causing pneumonia. This is called hypostatic pneumonia because it results from static (unmoving) fluid in the lungs.

The "Turn, Cough, Deep Breathe" Protocol:

  • Turn the patient to a new position
  • Encourage coughing to clear secretions
  • Instruct deep breathing to fully expand lungs
  • Repeat every 2 hours
  • Cardiovascular Complications
  • Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis occurs when blood clots form in the deep veins, typically in the legs. Immobility causes venous stasis—blood pools rather than flowing, allowing clots to form.

Virchow's Triad (three factors that promote clot formation):

  • Venous stasis — Blood not moving (immobility)
  • Hypercoagulability — Blood clotting too easily (surgery, cancer, pregnancy)
  • Endothelial injury — Damage to vessel walls (IV lines, trauma)

Signs of DVT:

  • Unilateral leg swelling
  • Warmth and redness over affected area

Positive Homans' sign (calf pain with dorsiflexion) — Note: This test has low sensitivity and is no longer routinely performed

Palpable cord in the calf

Prevention Strategies:

Intervention Mechanism Application

SCDs (Sequential Compression Devices) Mechanical compression promotes venous return Apply when patient is in bed

Antiembolism stockings (TEDs) Graduated compression prevents pooling Measure properly, remove q8h for skin assessment

  • Early ambulation Muscle contraction promotes blood flow Start as soon as medically appropriate
  • Anticoagulants Prevent clot formation Enoxaparin (Lovenox), Heparin
  • Hydration Prevents blood concentration Encourage oral fluids
  • Pulmonary Embolism (PE)

A Pulmonary Embolism occurs when a DVT dislodges and travels to the lungs. This is a life-threatening emergency.

Signs of PE:

  • Sudden dyspnea
  • Sharp chest pain (pleuritic)
  • Tachycardia, tachypnea
  • Anxiety, sense of impending doom
  • Hemoptysis (coughing blood)
  • Hypoxia

Nursing Action: This is an emergency. Administer oxygen, position the patient upright, notify the provider immediately, and prepare for anticoagulation therapy.

  • Musculoskeletal Complications
  • Muscle Atrophy and Weakness

Muscles lose mass and strength quickly during immobility—up to 1-1.5% per day in critically ill patients. This "use it or lose it" principle means even a few days of bed rest can significantly impair mobility.

Contractures

Contractures are permanent shortening of muscles and tendons, causing fixed joint deformity. They develop when joints remain in one position without movement.

High-Risk Joints:

  • Shoulders (frozen shoulder)
  • Hips (flexion contractures)
  • Knees (flexion contractures)
  • Ankles (footdrop)

Prevention:

  • Perform Range of Motion (ROM) exercises at least twice daily
  • Position joints in functional alignment
  • Use footboards or splints to prevent footdrop
  • Avoid prolonged positioning in one position
  • Range of Motion (ROM) Exercises
  • Type Description When to Use
  • Active ROM Patient moves joints independently Alert, able patients
  • Active-Assistive ROM Patient moves with nurse assistance Weak patients
  • Passive ROM Nurse moves joints for patient Unconscious, paralyzed, or very weak patients
  • Integumentary Complications: Pressure Injuries

Pressure injuries (formerly called pressure ulcers or decubitus ulcers) develop when sustained pressure on tissue causes ischemia and cell death.

Pressure Injury Stages

  • Stage Description Appearance
  • Stage 1 Non-blanchable erythema Intact skin, redness that doesn't blanch when pressed

Stage 2 Partial-thickness skin loss Shallow open ulcer with red-pink wound bed, may have intact or ruptured blister

  • Stage 3 Full-thickness skin loss Fat visible, may see slough, no bone/tendon exposure
  • Stage 4 Full-thickness tissue loss Bone, tendon, or muscle exposed
  • Unstageable Full-thickness, obscured Base covered by slough/eschar, true depth unknown
  • Deep Tissue Injury Intact skin with localized damage Purple or maroon discolored area, blood-filled blister
  • High-Risk Areas

Pressure injuries develop over bony prominences:

  • Supine: Occiput, scapulae, sacrum, heels
  • Lateral: Ears, shoulders, greater trochanter, knees, malleoli
  • Prone: Cheeks, shoulders, iliac crests, knees, toes
  • Sitting: Ischial tuberosities, sacrum
  • Prevention Strategies
  • Reposition every 2 hours — The cornerstone of prevention
  • Float heels off the bed — Use pillows under calves (not knees)
  • Use pressure-relieving surfaces — Foam mattresses, air mattresses
  • Keep skin clean and dry — Moisture increases friction
  • Maintain adequate nutrition — Protein is essential for skin integrity
  • Assess skin with every position change — Early detection is key
  • On the Exam

NCLEX questions about immobility often test prioritization and prevention:

  • Priority: Respiratory complications are often most immediately life-threatening
  • Prevention: Expect questions about turning schedules, incentive spirometry, and DVT prophylaxis
  • Assessment: Know the signs of DVT, PE, and pressure injuries
  • Delegation: UAP can assist with repositioning and ROM, but the RN must assess and plan
  • Key Takeaways
  • Turn immobile patients every 2 hours to prevent both pressure injuries and respiratory complications
  • Use incentive spirometry and deep breathing to prevent atelectasis
  • SCDs and early ambulation are key interventions for DVT prevention
  • ROM exercises prevent contractures and muscle atrophy
  • Pressure injuries are preventable —regular assessment and repositioning are essential