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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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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.

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