title: Nurses' diagnoses and treatment decisions regarding care of the agitated child.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, Ann Arbor, MI 48109-0211, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.forename: Constance
authors.initials: C
authors.lastname: Burke
authors.forename: Sue M
authors.initials: SM
authors.lastname: Hadden
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.forename: Shobha
authors.initials: S
authors.lastname: Malviya
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000768:Anesthesia, General / Q000009:adverse effects; D001007:Anxiety / Q000150:complications; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards; D003663:Decision Trees; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000592:standards; D009733:Nursing Diagnosis / Q000592:standards*; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology / Q000592:standards; D010149:Postoperative Pain / Q000150:complications; D010347:Patient Care Planning / Q000592:standards*; D016528:Postanesthesia Nursing / Q000193:education / Q000592:standards*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000451:nursing*; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology / Q000451:nursing*; D020377:Self Efficacy