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Difficulty: MediumPharmacological Therapies

A practical nurse is preparing to administer a scheduled fentanyl transdermal patch to a client managing chronic pain. The client has an existing patch on their right upper chest that was applied 72 hours ago. Which sequence of actions by the nurse demonstrates the safest medication administration technique?

  1. Remove the existing patch, fold the adhesive sides together, discard it in a secured receptacle, and apply the new patch to a different hairless area.Answer
  2. B
    Apply the new patch to a hairless area on the left upper chest, and then immediately remove the existing patch to prevent a gap in pain control.
  3. C
    Remove the existing patch, cleanse the new application site vigorously with an alcohol swab, allow it to dry, and apply the new patch.
  4. D
    Remove the existing patch, discard it in the bedside wastebasket, and apply the new patch to the exact same location to maintain consistent absorption.

Answer

The safest technique is to remove the existing patch, fold the adhesive sides together, discard it securely, and apply the new patch to a new, clean, hairless site.
Safe administration of transdermal fentanyl requires a strict sequence to prevent toxicity and diversion. The old patch must be removed first to ensure the client does not receive a double dose. Folding the patch in half with the adhesive sides together seals in the remaining active medication. Secure disposal (often in a sharps container or pharmaceutical waste bin, per facility policy) is required to prevent accidental exposure to staff or visitors. Finally, rotating to a new, hairless site prevents skin breakdown and ensures consistent absorption.

Step-by-Step Solution

1
Remove and properly dispose of the old patch.
The old patch is folded adhesive-side together and placed in a secure receptacle.
Fentanyl patches contain residual active medication even after 72 hours. Removing the old patch prevents an accidental overdose, and secure disposal prevents unauthorized access or accidental exposure to others.
2
Prepare a new application site.
A different, flat, hairless area of skin is selected and cleansed gently with water if needed.
Site rotation prevents skin breakdown. Avoiding alcohol or vigorous rubbing prevents increased skin permeability, which could cause rapid, dangerous absorption of the opioid.
3
Apply the new transdermal patch.
The new patch is applied and pressed firmly in place for 30 seconds.
Firm application ensures proper adhesion and consistent delivery of the medication.

Key Concept

Safe Administration of Transdermal Opioids
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Topics

Pharmacological Therapies

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