A client with terminal cancer is prescribed fentanyl patches for pain management while receiving hospice care at home. Which instructions related to this medication should the nurse provide? Select all that apply. A)Apply a heating pad over the patch to aid drug absorption B)Cut the patch in half before application if less medication is needed C)Fold the used patch in half so that the edges adhere and immediately discard D)Place the patch 1 in (2.5 cm) from the source of pain for maximal effectiveness E)Remove the old patch when applying a new patch every 72 hours

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Fentanyl, a potent opioid analgesic, is administered IV to treat acute pain and as a transdermal patch (Duragesic) dosed in mcg/hr to treat chronic pain. When given via transdermal patch, fentanyl is absorbed systemically through the skin to provide continuous analgesia. Patches are replaced every 72 hours, and the used patch must be removed before applying a new one (Option E). Used patches must be folded and discarded immediately, as some medication remains in a used patch. Opioid medications must be stored and disposed of securely (eg, flushed down the toilet, discarded in a sharps container) as accidental exposure is potentially fatal for children, pets, and caregivers (Option C). (Option A) Heat (eg, heating pad) should not be placed over a patch as this accelerates absorption. (Option B) Cutting a transdermal patch damages the drug-delivery system, results in administration of an imprecise dose, and risks exposure to the person cutting the patch. (Option D) Transdermal patches should be applied to an area of flat, intact skin (eg, upper back, chest) to prevent accidental removal. The site should be clean, with little hair. Unlike transdermal patches, topical analgesic patches (eg, lidocaine, capsicum) deliver drug locally and are placed near the site of pain. Educational objective: Fentanyl patches are changed every 72 hours, and used patches must be folded and discarded securely before a new one is applied. Patches should be applied to flat, intact skin to prevent accidental removal. Patches should not be cut, and heat should not be placed over them.

A Client with Terminal Cancer Is Prescribed Fentanyl Patches for Pain