Careplan

    Anxiety (Pediatric Inpatient)

    Oct.01.2020

    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 care

    A. The patient will achieve the following goals:
    • Anxiety Reduction or Resolution

    B. Patient, family or significant other will teach back or demonstrate education topics and points:
    • 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

    • 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]
    • 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]
    • 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]
    • 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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    • 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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