absolute bed rest [abbreviated ABR] , restriction of a patient’s activities, either partially or completely. A person on absolute or strict bed rest must remain in bed at all times. Bed rest may be prescribed to maintain a pregnancy, in cases of severe pain associated with movement, or with orthopedic conditions in which it would be unsafe to be out of bed. It is associated with many hazards of immobility. Numerous research studies have demonstrated that bed rest is a greater stressor to the patient in many conditions than a less restrictive activity prescription would be. ▪ PATIENT CARE CONSIDERATIONS: The cardiovascular, pulmonary, gastrointestinal, and musculoskeletal systems all suffer from inactivity and the recumbent position. Cardiac output and capacity, depth of respiration, and peristalsis decrease, while the risk of orthostatic hypotension, thromboembolism, and pulmonary disorders increases. Muscle tone, strength, and endurance decrease. Losses of muscle strength of as much as 10% to 15% have been demonstrated after only 1 week of bed rest. Over extended periods of immobility, collagen components of soft tissues begin to rearrange, resulting in joint capsule tightening and muscle contracture and atrophy. Osteoporotic changes with loss of bone density result from lack of weight bearing and reduction of muscular forces on the bones. Measures to offset the deleterious effects of immobility are indicated for those confined to bed rest, specifically bed mobility and exercise. ▪ OUTCOME CRITERIA: Activities and exercises condition not only the musculoskeletal system, but also other body systems stressed by bed rest. Frequent range-of-motion exercises prevent stiffness in muscles and joints and provide sensory and proprioceptive stimulation. Conditioning exercises enhance cardiac, pulmonary, and gastrointestinal function. A coordinated effort by the health care team to provide instruction and assistance with an appropriate program to maintain mental and physical health can do much to promote the well-being of a patient immobilized by bed rest.
