An 8-year-old child with advanced cancer has an order for oxycodone (OxyContin) PO, PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain

Question

What will the nurse do?
a. Administer the oxycodone at regular intervals around the clock.
b. Contact the provider to discuss using patient-controlled analgesia (PCA).
c. Reassure the child's parent that the child will ask for pain medication as needed.
d. Tell the child to notify the nurse when pain is present.

Answer 1

ANS: B
For a number of reasons, even children who can verbalize pain correctly often underreport it. The child may fear that reporting pain may lead to painful procedures or may worry caregivers, or the child may be unaware that pain can be alleviated. Children involved in activities such as computer games may actually be using the activity to distract themselves from the pain, so such an activity is not an indication that the child is comfortable. This child has advanced cancer and is likely to have severe pain. A PCA device would give the child control and provide adequate pain relief. The oxycodone order is for PRN dosing, so the nurse cannot administer it around the clock without a prescriber's order to do so. Also, because this child is more likely to have severe pain, a PCA would be more effective. Reassuring the parent that the child will report pain and asking the child to report pain do not take into account the fact that children often hide pain for the reasons previously mentioned.