O RIGINAL ARTICLES Nurses’ Diagnoses and Treatment Decisions Regarding Care of the Agitated Child Terri Voepel-Lewis, MSN, RN Constance Burke, BSN, RN Sue M. Hadden, BSN, RN Alan R. Tait, PhD Shobha Malviya, MD 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, respec- tively). Anesthesia-induced agitation was less often identified as the etiology (11%), and primary interventions were more varied and less effective (38%). Physiologic abnor- malities were identified as the source for agitation in only 3 cases, but went unrecog- nized 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 differen- tiation of agitation and appropriate intervention. © 2005 by American Society of PeriAnesthesia Nurses. POSTOPERATIVE AGITATION is a common occurrence in children recovering from general anesthesia. Recent reports indicate that as many as 18% of children exhibit agitation on emer- gence, 1 and as many as 30% are agitated at some point during their PACU stay, 2 highlighting the significance of this clinical issue. Agitation places patients at risk for injury and may pro- long their stay in the PACU, 1 and challenges the nurse to carefully assess the child and identify the source of agitation and then intervene ac- cordingly. Terri Voepel-Lewis, MSN, RN, is a Clinical Nurse Specialist in the Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, Ann Arbor, MI; Con- stance Burke, BSN, RN, is a Clinical Care Coordinator in the Department of Anesthesiology, Section of Pediatrics, Univer- sity of Michigan Health Systems, Ann Arbor, MI; Sue M. Hadden, BSN, RN, is a Staff Nurse, Pediatric Post Anesthesia Care Unit, in the Department of Anesthesiology, Section of Pediatrics, University of Michigan Health Systems, Ann Ar- bor, MI; Alan R. Tait, PhD, is a Professor of Anesthesiology in the Department of Anesthesiology, Section of Pediatrics, Uni- versity of Michigan Health Systems, Ann Arbor, MI; Shobha Malviya, MD, is an Associate Professor of Anesthesiology in the Department of Anesthesiology, Section of Pediatrics, Uni- versity of Michigan Health Systems, Ann Arbor, MI. 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. © 2005 by American Society of PeriAnesthesia Nurses. 1089-9472/05/2004-0003$30.00/0 doi:10.1016/j.jopan.2005.05.006 Journal of PeriAnesthesia Nursing, Vol 20, No 4 (August), 2005: pp 239-248 239