Pain Assessment and Management in Pediatric Oncology Flashcards

A nurse is assigned to a 7-year-old who has returned from a bone marrow aspiration under moderate sedation 30 minutes ago. The child's respiratory rate is 11 breaths/minute, SpO2 is 95% on room air, and they are only arousable to voice. The most appropriate nursing action is:

Answer: Apply supplemental oxygen, stimulate the child, notify the provider, and prepare reversal agents per protocol

SpO2 of 95% and only arousable to voice 30 minutes post-sedation with RR of 11 suggests residual sedation/respiratory depression requiring intervention: supplemental oxygen, stimulation, provider notification, and possible reversal agent (flumazenil for benzodiazepines; naloxone for opioids).

Which statement correctly describes the difference between physical dependence and addiction in the context of opioid use for pediatric cancer pain?

Answer: Physical dependence is an expected physiologic adaptation causing withdrawal if opioids are abruptly stopped; addiction involves psychological craving and compulsive drug-seeking despite harm — addiction is very rare when opioids are used appropriately for cancer pain

Physical dependence (predictable withdrawal upon abrupt cessation) is an expected pharmacologic phenomenon in any patient on chronic opioids; it requires gradual dose tapering. Addiction (compulsive craving and harmful use) is extremely rare when opioids are used appropriately for genuine pain.

A child with ALL and mucositis rates her oral pain as 9/10. She is currently on scheduled oral oxycodone. The nurse recognizes that oral administration is problematic given the mucositis and should advocate for:

Answer: Conversion to an IV or transdermal opioid route that bypasses the painful, compromised oral mucosa

Severe mucositis makes oral medication swallowing extremely painful and unreliable for absorption. IV patient-controlled analgesia or transdermal fentanyl provides consistent analgesia without requiring oral administration through damaged mucosa.

A CPHON nurse reviews a newly prescribed opioid order: oral hydromorphone 2 mg every 4 hours for a 15 kg, 5-year-old child. The nurse's concern is based on which calculation?

Answer: The dose is higher than the recommended starting dose of 0.03–0.08 mg/kg, which would be 0.45–1.2 mg for this child — a dose of 2 mg may be unsafe without prior opioid tolerance

For a 15 kg child, the recommended pediatric starting dose of oral hydromorphone (0.03–0.08 mg/kg) is 0.45–1.2 mg per dose. A dose of 2 mg represents 0.13 mg/kg and exceeds the recommended opioid-naïve starting dose, requiring safety review before administration.

A child undergoing a lumbar puncture for ALL staging will receive topical EMLA cream applied 60 minutes before the procedure. Which additional pharmacologic intervention most effectively reduces procedural pain for lumbar punctures in children?

Answer: Moderate procedural sedation with midazolam and a short-acting opioid (fentanyl) or ketamine

While topical anesthetics address skin puncture pain, LP involves deeper dural puncture and positioning discomfort best managed by procedural sedation/analgesia, which has been shown to significantly reduce distress, improve success rates, and reduce long-term procedure-related trauma.