American Medical Association Family Medical Guide - American Medical Association [143]
The person’s doctor may suggest that the person start exercising in bed to increase his or her strength and endurance enough to get out of bed. Always check with the person’s doctor first before starting an exercise program. These simple exercises may include range-of-motion exercises (see next page), turning from side to side in bed, and sitting on the edge of the bed for short periods of time. If the person’s heart rate goes below 50 beats per minute or above 110 beats per minute, call his or her doctor right away. A heart rate below 50 beats per minute could indicate problems such as dehydration, anemia (see page 610), or heart failure (see page 570). A heart rate above 110 beats per minute could indicate problems such as an arrhythmia (see page 580) or high blood pressure (see page 574).
In the carotid artery
In the radial artery
Checking a pulse
To check a person’s heart rate, place your index and middle fingers on the artery inside his or her wrist or along the artery at the side of the neck. (Do not use one of your thumbs to take a person’s pulse because you could mistake your own pulse in an artery in your thumb for the person’s pulse.) You should be able to feel blood pulsing in the person’s artery as his or her heart beats. Count the number of beats that occur in exactly 20 seconds and multiply this number by 3. The resulting number is the person’s heart rate.
Maintaining Lung Function
Being immobile reduces lung function and increases the risk of pneumonia, so it is important to maintain lung function in a person who is confined to bed. If the person’s doctor has recommended it, encourage the person to cough and do deep breathing exercises every hour while awake to expand his or her lungs. Encourage the person to breathe through his or her nose as deeply as possible and then breathe out through the mouth slowly but forcibly.
If possible, obtain a device called a spirometer (which is used to measure air expulsion) from a respiratory therapist and have him or her show you how to help the person use it.
WARNING!
Difficulty Breathing
Call the person’s doctor immediately if the person you are caring for has difficulty breathing or coughs up green, gray, yellow, or brown phlegm. He or she may have pneumonia.
Preventing Deep Vein Thrombosis
Blood clots are another potential complication of immobility. They usually develop in the veins of the legs. If the person cannot bear his or her own weight or walk, ask the doctor if the person should move his or her legs while in bed to prevent blood clots. Also, ask the doctor about using special elastic stockings that can help prevent blood clots from forming in the legs. Don’t massage the person’s legs unless told to do so by the doctor.
WARNING!
Pulmonary Embolism
Never massage the legs of a person who is confined to bed. Massaging an immobile person’s legs (especially the calves) can dislodge a blood clot, which can then travel through the bloodstream to the lungs, causing a life-threatening blockage of an artery (pulmonary embolism; see page 606). Symptoms of pulmonary embolism include difficulty breathing, pain in the chest, rapid pulse, sweating, slight fever, and a cough that produces blood-tinged phlegm. If these symptoms occur, call 911 or your local emergency number, or take the person to the nearest hospital emergency department right away.
Keeping the Arms and Legs Strong
A person begins to lose muscle strength after being confined to bed for just 1 day; after 1 week in bed, he or she may be too weak to stand up. A period of bed rest often is required after surgery or a major illness. A person who is confined to bed for any reason must be encouraged to change positions frequently to prevent joint stiffness, loss of muscle tone, and contraction of the limbs from prolonged inactivity.
To help prevent