Careplan
Anxiety (Pediatric Inpatient)
Anxiety (Pediatric Inpatient)
Clinical Description
- Care of the hospitalized child experiencing feelings of apprehension, uneasiness, uncertainty or dread about possible future events and the ability to deal with the events.
Key Information
- Anxiety is a subjective, individual experience ranging from vague discomfort to feelings of panic. It is a normal response to threatening situations.
- Increased parental anxiety and concern has been directly correlated to increased anxiety and concern in children.
- Studies show a decrease in a child’s anxiety when provided with coping strategies prior to a procedure or surgery.
- Anxiety can become excessive and difficult to control; negatively affecting day-to-day living, physical comfort and medical diagnosis symptoms.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Anxiety Reduction or Resolution
- Education: Overview
- Education: When to Seek Medical Attention
- Education: Self Management
Correlate Health Status
Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
Anxiety
Signs/Symptoms/Presentation
- acting out
- agitation
- anger
- apprehension
- crying
- distress
- fear
- helplessness
- hypervigilance
- increased dependence
- irritability
- joking
- nervousness
- panic
- regressive behavior
- restlessness
- sense of impending doom
- social withdrawal
- worry
Physical symptoms
- dry mouth
- muscle tension
- shortness of breath
- skin flushed
- skin rash
- sleep disturbance
- urinary frequency
- urinary urgency
Vital Signs
- heart rate increased
Problem Intervention
Promote Anxiety Reduction
- Maintain a calm and reassuring environment; minimize noise; provide familiar items; offer choices; follow home routine.
- Encourage parent/caregiver presence and participation to enhance ability to support the child.
- Support expression and identification of feelings and worries; compassionately acknowledge and validate concerns.
- Utilize existing coping strategies and assist in developing new strategies (e.g., music, deep breathing, relaxation techniques, massage, diversional activity, play, pet therapy).
- Identify thoughts and feelings that led to current anxiety onset to enhance understanding of triggers.
- Reframe anxiety-provoking situations; provide a new perspective; engage in problem-solving.
- Utilize anticipatory guidance to enhance sense of control.
- Consider referral for a comprehensive assessment if there are concerns about the number, severity and duration of symptoms; degree of distress; functional impairment or excessive substance use.
Associated Documentation
- Complementary Therapy
- Supportive Measures
- Family/Support System Care
Education
CPG-Specific Education Topics
Overview
risk factors
signs/symptoms
When to Seek Medical Attention
unresolved/worsening symptoms
Self Management
coping strategies
resources for support
General Education Topics
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
References
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- Bert, F.; Gualano, M. R.; Camussi, E.; Pieve, G.; Voglino, G.; Siliquini, R. Animal assisted intervention: A systematic review of benefits and risks. European Journal of Integrative Medicine. 2016;8(5), 695-706. doi:http://dx.doi.org/10.1016/j.eujim.2016.05.005 [Metasynthesis,Meta-analysis,Systematic Review]
- Capurso, M.; Ragni, B. Psycho-educational preparation of children for anaesthesia: A review of intervention methods. Patient Education and Counseling. 2016;99(2), 173-185. doi:http://dx.doi.org/10.1016/j.pec.2015.09.004 [Metasynthesis,Meta-analysis,Systematic Review]
- Capurso, M.; Ragni, B. Psycho-educational preparation of children for anaesthesia: A review of intervention methods. Patient Education and Counseling. 2016;99(2), 173-185. doi:http://dx.doi.org/10.1016/j.pec.2015.09.004 [Metasynthesis,Meta-analysis,Systematic Review]
- Chow, C. H.; Van Lieshout, R. J.; Schmidt, L. A.; Dobson, K. G.; Buckley, N. Systematic review: Audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. Journal of Pediatric Psychology. 2016;41(2), 182-203. doi:10.1093/jpepsy/jsv094 [Metasynthesis,Meta-analysis,Systematic Review]
- Chow, C. H.; Van Lieshout, R. J.; Schmidt, L. A.; Dobson, K. G.; Buckley, N. Systematic review: Audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. Journal of Pediatric Psychology. 2016;41(2), 182-203. doi:10.1093/jpepsy/jsv094 [Metasynthesis,Meta-analysis,Systematic Review]
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- Cincinnati Children's Hospital Medical Center. (2013, August 13). Best evidence statement (BESt). Providing most effective child life care for patients having general anesthesia. (pp.5). Cincinnati, OH: Cincinnati Children's Hospital Medical Center. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
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- Tsitsi, T.; Raftopoulos, V.; Papastavrou, E.; Charalambous, A. Complementary and alternative medical interventions for the management of anxiety in parents of children who are hospitalized and suffer from a malignancy: A systematic review of RCTs. European Journal of Integrative Medicine. 2014;6(1), 112-124. doi:http://dx.doi.org/10.1016/j.eujim.2013.09.004 [Metasynthesis,Meta-analysis,Systematic Review]
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- Wang, Z.; Whiteside, S.; Sim, L.; Farah, W.; Morrow, A.; Alsawas, M.; Barrionuevo Moreno, P.; Tello, M.; Asi, N.; Beuschel, B.; Daraz, L.; Almasri, J.; Zaiem, F.; Gunjal, S.; Larrea Mantilla, L.; Ponce Ponte, O.; LeBlanc, A.; Prokop, L. J.; Murad, M. H. (2017). Anxiety in Children. Comparative Effectiveness Review No. 192. . Rockville, MD: Agency for Healthcare Research and Quality. doi:10.23970/AHRQEPCCER192 Source[Metasynthesis,Meta-analysis,Systematic Review]
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Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.
