M18 · Muscle wasting from bed rest
Risk Movement and self-care
Definition
Long inactivity may cause weakness, stiffness, and loss of muscle.- Long bed rest
- paralysis
- severe illness
- no exercise
- Weak muscles
- thin limbs
- stiff joints
- pressure sores
📋 Scenario
A patient has been on bed rest in ICU for five days with severe illness.
Subjective (S): "I am too weak to move."
Objective (O): Day 5 in ICU; lightly sedated; no exercise yet; muscle bulk normal; joints move freely; skin intact.
Assessment tools for this scenario: CP-MOVE Movement & Self-Care Score CP-SKIN Skin & Wound Score
Validated scales to consider: Barthel Index, Katz ADL, Braden Scale, TIME wound chart
**CarePath diagnosis:** Muscle wasting from bed rest related to long bed rest and severe illness (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Mobilize early. | Getting the patient moving early, as soon as it is safe, keeps muscles working and circulation active, which slows the weakness and stiffness that long inactivity causes. |
| Exercise. | Regular active or assisted exercise loads the muscles and joints, which helps preserve muscle bulk and joint range even while the patient is critically ill. |
| Give protein nutrition. | Muscle needs enough protein to repair and maintain itself during severe illness, and inactivity speeds muscle loss, so adequate protein supports strength and healing. |
| Turn often. | Changing position often relieves pressure on bony areas and keeps blood flowing to the skin, which helps prevent pressure injury in a patient who cannot easily move. |
| Physiotherapy. | Physiotherapists can design safe, graded movement and strengthening for a lightly sedated ICU patient, which reduces the chance of lasting weakness. |
**Expected outcomes**
- Sits out of bed daily.
- Muscle strength improves.
- No new pressure injury.
- Protein targets met.
**Linking the data to the diagnosis**
The patient has been on bed rest in ICU for five days with severe illness and says, "I am too weak to move." This is a risk diagnosis because the problem has not happened yet: muscle bulk is normal, joints move freely and skin is intact. The diagnosis rests on risk factors, namely day 5 in ICU, light sedation and no exercise so far. The plan aims to prevent wasting by sitting out of bed daily, improving strength, meeting protein targets and avoiding any new pressure injury.
CarePath diagnosis
Muscle wasting from bed rest related to long bed rest and severe illness (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Mobilize early. | Getting the patient moving early, as soon as it is safe, keeps muscles working and circulation active, which slows the weakness and stiffness that long inactivity causes. |
| 2. Exercise. | Regular active or assisted exercise loads the muscles and joints, which helps preserve muscle bulk and joint range even while the patient is critically ill. |
| 3. Give protein nutrition. | Muscle needs enough protein to repair and maintain itself during severe illness, and inactivity speeds muscle loss, so adequate protein supports strength and healing. |
| 4. Turn often. | Changing position often relieves pressure on bony areas and keeps blood flowing to the skin, which helps prevent pressure injury in a patient who cannot easily move. |
| 5. Physiotherapy. | Physiotherapists can design safe, graded movement and strengthening for a lightly sedated ICU patient, which reduces the chance of lasting weakness. |
Expected outcomes
- Sits out of bed daily.
- Muscle strength improves.
- No new pressure injury.
- Protein targets met.
Linking the data to the diagnosis
The patient has been on bed rest in ICU for five days with severe illness and says, "I am too weak to move." This is a risk diagnosis because the problem has not happened yet: muscle bulk is normal, joints move freely and skin is intact. The diagnosis rests on risk factors, namely day 5 in ICU, light sedation and no exercise so far. The plan aims to prevent wasting by sitting out of bed daily, improving strength, meeting protein targets and avoiding any new pressure injury.