This guide to nursing care includes eight prolonged bed rest nursing care plans that patients on long-term rest can use. Find out more about assessment and care plan objectives and intervention strategies for nurses in this blog.
Bed rest is a therapeutic method to lower the demands on the metabolic body and aid in the recovery process during an illness.
However, prolonged rest can harm patients’ respiratory, cardiovascular muscles, and integumentary and mental systems.
This can lead to the onset of illness that can cause irreparable harm as patients are discharged earlier from hospitals. Most healthcare problems are treated by assisted living centers (nursing homes) or at home.
The goals of the nursing care plan for patients who are on bed rest are to maintain cerebral and peripheral blood flow and maximize the functional capacity of the patient to maintain bowel function as well as promote sexual health and prevent the disuse syndrome from reaching the maximum amount of self-care, and controlling the risk of health problems.
Bed Rest Nursing Care Plans
Below are the Eight (8) diagnostics for nursing as well as the nursing plans for long-term sleep:
- Ineffective Peripheral Tissue Perfusion
- Ineffective Sexuality Patterns
- Constipation
- Ineffective Role Performance
- Deficient Diversional Activity
- Risk for Ineffective Cerebral Tissue Perfusion
- Risk for Disuse Syndrome
- Risk for Activity Intolerance
Ineffective Peripheral Tissue Perfusion
The lack of mobility that comes with bed rest for a long time affects regular peripheral blood flow, which can cause complications.
These issues could include the affected venous system and edema, venous dilation, embolus formation, and thrombophlebitis.
Nursing Diagnosis
- Ineffective Peripheral Tissue Perfusion
Related Factors
Here are some common causes of ineffective peripheral tissue perfusion, which could be “related to” your nursing diagnosis declaration for extended bed rest
- Incomplete venous flow that occurs during prolonged inactivity
Defining Characteristics
The most frequently used objective and subjective data or nursing assessment indicators (signs and signs) can be used as your “as evidenced by” for this care plan.
- Skin discoloration and skin color fade with the elevation of the limb, and standard color doesn’t return when lowering the limb.
- Calf discomfort at the dorsiflexion point on the sole of your foot (positive Homan’s sign)
- Tenderness and swelling in one leg
- The temperature of the skin changes
Desired Outcomes
Expected outcomes or patient goals for ineffective peripheral tissue perfusion nursing diagnosis:
- At least 24 hours before discharge, the patient should be able to maintain adequate peripheral perfusion, as evident with the standard color of the skin and temperatures, as well as sufficient diaphragmatic impulses (more significant than 2+, on a scale of 0-4+) in the extremities of the peripheral limbs.
- The patient is expected to perform the exercises at their own pace, follow the treatment plan, and consume 3 to 4 liters daily of fluid unless it is contraindicated.
Nursing Assessment and Rationales
- Examine the calf or groin for any signs of redness, pain, or warmth in the affected area, unilateral swelling of the leg, or coolness or abnormal color. External venous dilation distal the affected area.
The pain in the calf triggered by dorsiflexion of the feet (positive Homan’s Sign), together with these signs of the clinical ailment, could indicate the presence of deep vein thrombosis (DVT) or vein blood clots.
- Check for vital signs and read the ESR (ESR) results as soon as they become available.
Other indications and symptoms of deep vein thrombosis can include tachycardia, fever, and an increased ESR. The typical ESR range is between 0 and 15 millimeters per hour. For a male under 50, and 0-20 millimeters/per hour. For males older than 50 years old. The range for females younger than 50 is 0-20 millimeters/hour. For those who are over 50, it is 30 milliliters/hour.
- Take note of how much circumference is on your leg and the leg that is not affected.
If the circumference of the leg affected is greater than that of the other leg, it indicates deep vein thrombosis (DVT) or vein blood clots.
- Review laboratory results such as prothrombin times (PT), the international normalized ratio (INR), and the partial thromboplastin times (PTT).
If a patient receives anticoagulant therapy, the reference values for PTT are 60 to 70 minutes or 1.5-2.5 for control values and an INR value of 2.0-3.0. Higher values indicate a higher chance of bleeding.
Nursing Interventions and Rationales
Notify the doctor of any significant findings on the patient’s part.
When a patient shows indications of deep vein embolism (DVT), Additional evaluation and tests are needed to prevent an embolus in the lungs that could cause leg pain.
Educate the patient on deep vein thrombosis (DVT) symptoms and signs.
Anyone who can recognize these signs will be more inclined to notify the health professional immediately for prompt intervention.
Train the patient in ankle dorsiflexion, plantar ball flexion (calf-pumping), and ankle-circling exercises.
Aids in promoting blood flow. Every movement the patient performs must be repeated ten times every hour for long periods of inactivity, for as long as the patient doesn’t exhibit any symptoms from deep vein blood clots (DVT) or vein blood clots.
Remind the patient to avoid crossing feet at knees or ankles when in bed.
These causes can cause the formation of blood pools in the veins.
Recommend practicing deep breathing exercises.
Diaphragmatic breathing raises negative pressure in the lung and thorax, which facilitates the drainage of large veins, thus increasing peripheral tissue perfusion.
The foot portion on the mattress is 10° if there is a risk of DVT.
The elevation of the foot of the bed will encourage the return of venous blood.
Instruct the patient to wear an anti-embolism hose, sequential compression stockings, pneumatic foot pump devices, or thromboembolism-deterrent (TED) hose unless contraindicated by peripheral vascular disease (PVD).
These devices decrease the risk of vein stasis. The pneumatic devices, which provide more compression than anti-embolism hose, are beneficial in preventing deep vein thrombosis for patients who are not mobile.
The rest of the pain caused by using a foot pump, TED hose devices, or pneumatic compression stocks could be experienced by patients suffering from peripheral blood vessel disease.
Take off the pneumatic sequential compress stockings every 10 to 20 minutes for 8 hours. Reapply the hose following the elevation of the patient’s legs by about 10 degrees for 10 minutes.
Removal of pneumatic sequential compression stockings allows for inspection of the underlying skin to determine if there is evidence that there is a breakdown or irritation. Lifting the legs before applying these stockings encourages venous blood return and reduces edema, which would otherwise persist and cause discomfort after reapplying the hose.
If you are not a patient with a restricted condition, Increase fluid intake to a minimum of 2 Liters daily. Instruct the patient on drinking massive quantities of fluid (9-14 8-ounce glasses) daily. Check intake and output levels to ensure the patient follows the guidelines.
A higher hydration level decreases hemoconcentration, possibly contributing to developing DVT/VTE.
Use anticlotting medications as directed.
Patients who are at risk of developing DVT/VTE, such as those who suffer from ongoing infections and have a background of PVD and smoking, and those who are obese, elderly, or feeble, may need an anticoagulant to decrease the risk of bleeding.
These include aspirin, sodium warfarin, and phenindione derivatives. Heparin or heparin with a low molecular weight is available. Most patients are taught to administer LMWH injections following discharge from the hospital.
Inform the patient to self-monitor and be aware of any indication of bleeding.
Anticoagulant drugs increase the chance of bleeding. Patients must be aware of the symptoms of bleeding to be able to report the signs promptly when they become identified to allow for prompt intervention. Some possible types of bleeding are epistaxis, bleeding gums, hemorrhagic, Hematochezia, hematemesis, hemoptysis, and ecchymoses: Melena and menometrorrhagia.
- Instruct the patient on the importance of not eating foods or herbal remedies that can interfere with anticoagulant treatment.
Certain food items and herbal supplements available over the counter may cause bleeding to increase, such as Devil’s Claw, Coenzyme Q-10, Echinacea, fenugreek and garlic, and ginger. Ginko Biloba Goldenseal the passion flower, green tea quinine, red clover saw palmetto St. John’s wort and Valerian.
- Inform the patient about the foods and medications that can reduce the effectiveness of anticoagulants.
Foods and medicines include azathioprine and antithyroid drugs such as carbamazepine, dicloxacillin, griseofulvin, glutethimide, and nafcillin.
They are also oral contraceptives such as phenobarbital vitamin C, rifampin, dark green leafy vegetables lettuce, spinach, kale, asparagus, broccoli, cauliflower, and Brussels sprouts.
Recommended Resources
Nursing diagnosis, nursing care plan books, as well as other resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We are awestruck by this book for its research-based approach to the nursing process. This care plan manual follows a simple three-step method for guiding you through client assessment, diagnosis of nursing, and the process of planning care.
It provides step-by-step directions on how to carry out the care plan and assess the results. It also helps to develop skills in analytical decision-making and critical thought.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
It includes more than two hundred health plans based on the most recent evidence-based guidelines. The additions to this Edition include ICNP diagnoses, plans for care on LGBTQ health issues, and acid-base balance and electrolytes.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The most comprehensive guidebook for nursing diagnoses has been evaluated and approved by NANDA International. This new Edition of this groundbreaking text includes all the introductory chapters.
They have been revised to give nurses the most critical information to understand assessment, its connection to the diagnosis process and clinical reasoning, and the function and application of taxonomic structure at the patient’s bedside. The book contains 46 new nursing diagnoses and 67 updated nursing diagnoses.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
The quick-reference tool has everything you need to know about the correct diagnosis for an effective plan of care for patients. The 16th Edition features the latest nursing diagnoses and interventions of NANDA-I 2021-2023 and an alphabetized list of nursing diagnoses covering more than 400 diseases.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Determine the best ways to design, and personalize the treatment plan, and record it for over 800 illnesses and conditions. Only within the Nursing Diagnosis Manual will you discover each condition… Objectively and subjectively – examples of clinical procedures, prioritized interventions accompanied by rationales, a document section, and more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
This book contains over 100 care plans to treat maternity/OB, medical surgery, pediatrics, and psychiatric and mental health. The interprofessional “patient problems” focus familiarizes you with the skills to talk to patients.
Also,
Other websites that are recommended to support this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
- More than 150 nursing plans for various ailments and diseases. Our simple-to-follow guide on designing the nursing plans you want from scratch is included.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
- This comprehensive guide will show you how to make diagnostic labels. Includes detailed nursing care plan guidelines for the most common medical diagnostics labels for nurses.
Additional care plans that are related to nursing fundamentals:
Cancer (Oncology Nursing) | 13 Care Plans
End-of-Life Care (Hospice Care or Palliative)
Geriatric Nursing (Older Adult)
Prolonged Bed Rest
Surgery (Perioperative Client)
Systemic Lupus Erythematosus
Total Parenteral Nutrition
References and Sources
Here are the references and resources in this plan of care for nurses. Plan for Prolonged bed rest:
- Carpenito-Moyet, L. J. (2009). Care plans for nurses and documentation for collaborative issues. Lippincott Williams & Wilkins.
- Donaldson, C. L., Hulley, S. B., Vogel, J. M., Hattner, R. S., Bayers, J. H., & McMillan, D. E. (1970). Effects of bed rest for a long time on bone minerals. Metabolism, 19(12), 1071-1084.
- Knight, J., Nigam, Y., & Jones, A. (2019). The effects of restorative bedrest: hematological and respiratory systems. Nursing Times, 115(1), 44-47.