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:
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
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
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.
- Complementary Therapy
- Supportive Measures
- Family/Support System Care
Education
Overview
risk factors
signs/symptoms
When to Seek Medical Attention
Self Management
coping strategies
resources for support
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
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]
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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.