A 2-year-old child presents to the clinic with a complaint of abdominal pain. The nurse decides to use the FLACC scale to assess the child's pain. Which components of the FLACC scale should the nurse observe in this child?
Explanation & Rationale
Rationale: A. This option includes some general indicators of discomfort (crying, feeding, mobility), but it does not reflect the standardized components of the FLACC scale. Sleep patterns and feeding habits are not part of the tool. Therefore, this is incorrect. B. While facial expression and vocalization are relevant, this option incorrectly includes physiological parameters such as heart rate, blood pressure, and temperature. The FLACC scale is a behavioral pain assessment tool, not a physiological one, so this option is incorrect. C. The FLACC scale stands for Face, Legs, Activity, Cry, Consolability. This option correctly lists all five components used to assess pain in young children who cannot verbalize their pain. Therefore, this is the correct answer. D. Although leg movement and behavioral changes may relate to pain, parental report and hydration status are not components of the FLACC scale. This option does not accurately reflect the standardized tool, making it incorrect.