An older client with chronic pain is newly prescribed transdermal fentanyl. What will the nurse do when providing this medication? Select all that apply.

Question

1. Teach the client to avoid other narcotics after 72 hours with the patch.
2. Start with the lowest possible dose of the medication patch.
3. Anticipate and treat side effects such as nausea or constipation.
4. Apply the patch to clean, dry, hairless skin in a fatty area.
5. Administer other pain medications the first day the patch is used.

Answer 1

2. Start with the lowest possible dose of the medication patch.
3. Anticipate and treat side effects such as nausea or constipation.
4. Apply the patch to clean, dry, hairless skin in a fatty area.
5. Administer other pain medications the first day the patch is used.

Explanation: 1. The client does not need to exercise caution if using fentanyl with other narcotics, but clients often need two or more simultaneous narcotics to achieve adequate pain relief, particularly if breakthrough pain is an issue.
2. The lowest possible dose should be used when starting transdermal fentanyl, even if previous narcotics have been used. It can be titrated up every few days until the desired effect is reached.
3. Side effects should be anticipated and managed aggressively for any narcotic.
4. The nurse should apply the transdermal fentanyl patch to clean, dry, hairless skin. The medication absorbs best in an area with subcutaneous tissue, such as the abdomen.
5. Since the peak effects of the first dose of transdermal fentanyl take 24 hours, the client should be covered with oral pain medications the first day of application.