Pain Assessment and Management in Pediatric Oncology Flashcards

A 3-year-old with ALL is crying, holding her leg, and refusing to walk. The nurse should use which pain assessment tool?

Answer: FLACC scale (Face, Legs, Activity, Cry, Consolability)

The FLACC scale is validated for assessing pain in preverbal and young children (ages 2 months to 7 years) who cannot self-report, using behavioral and physiologic indicators across 5 domains.

A child with cancer reports a pain score of 8/10 from bone metastases. Current pain management includes acetaminophen 15 mg/kg PO every 6 hours. Per the WHO analgesic ladder for pediatric pain, the next appropriate step is:

Answer: Addition of an opioid analgesic (e.g., oral morphine or oxycodone) as the pain has not responded to non-opioid therapy alone

The WHO analgesic ladder calls for step-up to opioid analgesics (Step 2: mild opioids, or Step 3: strong opioids like morphine) when pain is not controlled by non-opioid analgesics. A pain score of 8/10 uncontrolled on acetaminophen requires opioid initiation.

A 10-year-old receiving IV morphine for cancer pain develops increased drowsiness, respiratory rate of 8 breaths/minute, and pinpoint pupils. The priority nursing intervention is:

Answer: Administer naloxone (Narcan) IV per protocol and prepare for airway support

Respiratory rate of 8 breaths/minute with pinpoint pupils and excessive sedation constitutes opioid-induced respiratory depression — a life-threatening emergency requiring immediate naloxone administration and airway readiness.

What is the primary advantage of using a patient-controlled analgesia (PCA) pump for pain management in pediatric oncology patients?

Answer: Allows the patient to self-administer small bolus doses on demand, improving pain control and sense of autonomy

PCA gives the patient direct control over administering small demand doses within safety lockout parameters, enabling timely analgesia matched to pain peaks (e.g., procedural pain, movement) while maintaining a sense of agency.

A nurse notes that a child's cancer pain is described as burning, shooting, electric-shock-like, and worsens at night. This presentation is most consistent with which type of pain?

Answer: Neuropathic pain from tumor invasion or chemotherapy-induced peripheral neuropathy

Burning, shooting, electric-shock, tingling, or allodynia pain descriptors are classic features of neuropathic pain — caused by nerve injury from tumor compression, chemotherapy (vincristine, platinum agents), or radiation.

Which non-pharmacologic intervention is most evidence-based for reducing procedure-related pain and anxiety in pediatric oncology patients during bone marrow aspiration?

Answer: Virtual reality (VR) distraction combined with guided imagery or hypnosis techniques

Virtual reality, guided imagery, and hypnosis are among the most evidence-based non-pharmacologic techniques for reducing procedure-related pain and anxiety in children with cancer, activating endogenous pain modulation pathways.