Nurses’ Diagnoses and Treatment Decisions Regarding Care of the Agitated Child

Voepel-Lewis, Terri; Burke, Constance; Hadden, Sue M.; Tait, Alan R.; Malviya, Shobha

doi:10.1016/j.jopan.2005.05.006

« Previous Next »Journal of PeriAnesthesia Nursing
Volume 20, Issue 4 , Pages 239-248, August 2005

Nurses’ Diagnoses and Treatment Decisions Regarding Care of the Agitated Child

Terri Voepel-Lewis, MSN, RN
- Address correspondence for all authors to Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, F3900 Mott Children’s Hospital, Box 0211, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0211.
Constance Burke, BSN, RN
- Address correspondence for all authors to Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, F3900 Mott Children’s Hospital, Box 0211, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0211.
Sue M. Hadden, BSN, RN
- Address correspondence for all authors to Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, F3900 Mott Children’s Hospital, Box 0211, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0211.
Alan R. Tait, PhD
- Address correspondence for all authors to Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, F3900 Mott Children’s Hospital, Box 0211, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0211.
Shobha Malviya, MD
- Address correspondence for all authors to Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, F3900 Mott Children’s Hospital, Box 0211, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0211.

Postoperative agitation has many potential etiologies and remains a significant clinical issue in the pediatric PACU setting. Caring for the agitated child requires a thorough assessment and calls for targeted interventions. This observational study evaluated nurses’ diagnoses and treatment decisions regarding care of the agitated child. Nurses were observed during their care of 194 agitated children over a 3-month period. Pain and anxiety were the most commonly identified sources of agitation in the pediatric PACU setting (27% and 25% of cases, respectively), and nurses’ targeted, primary interventions for these problems were fairly effective (48% and 67% effective, respectively). Anesthesia-induced agitation was less often identified as the etiology (11%), and primary interventions were more varied and less effective (38%). Physiologic abnormalities were identified as the source for agitation in only 3 cases, but went unrecognized for an extended period in 2 children. Results of this study underscore the complexity of assessment and treatment decisions when caring for agitated children. A decision algorithm based on this study is described as a potential aid toward differentiation of agitation and appropriate intervention.