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Elisabeth Fandrich
NURS 2516 Clinical Medications Worksheets
(You will need to make additional copies of these forms)
Generic Trade Classification Dose Route Time/frequency
Name Name opioid 25 mcg/hr patch Change q 72 hrs
Fentanyl Duragesic analgesics
citrate
Peak Onset Duration For IV meds, compatibility with IV drips and /or solutions
12-22hr 6 hrs 72hr N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Binds to opiate receptors in the CNS, altering the Contraindicated in:
response to and perception of pain Hypersensitivity to fentanyl or adhesives
Pain Known
intolerance
Acute pain (onset not rapid
enough)
Alcohol intolerance (small amounts of alcohol released
into skin)
Use Cautiously in:
Geri: Patients >60 yr, cachectic or debilitated patients (dose
reduction suggested because of altered drug disposition)
Diabetes
Patients with severe pulmonary or hepatic disease
CNS tumors
Increased intracranial pressure
Head trauma
Adrenal insufficiency
Undiagnosed abdominal pain
Hypothyroidism
Alcoholism
Cardiac disease (particularly bradyarrhythmias)
Fever or situations that increase body temperature
(increases release of fentanyl from delivery system)
Titration period (additional analgesics may be required)
Common side effects
confusion, sedation, weakness, anorexia, constipation, dry mouth,
nausea, vomiting, sweating
Interactions with other patient drugs, OTC or Lab value alterations caused by medicine
herbal medicines (ask patient specifically) May ↑ plasma amylase and lipase levels
None for this patient
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Elisabeth Fandrich
Be sure to teach the patient the following about this medication
Instruct patient in how and when to ask for pain
medication
Instruct patient in correct method for application and disposal of
transdermal system. Fatalities have occurred from children having
access to improperly discarded patches May be worn while bathing,
showering, or swimming
May cause drowsiness or dizziness. Caution patient to call for
assistance when ambulating or smoking and to avoid driving or other
activities requiring alertness until response to medication is known
Advise patient to change positions slowly to minimize dizziness
Caution patient to avoid concurrent use of alcohol or other CNS
depressants with this medication
Advise patient that fever, electric blankets, heating pads, saunas, hot
tubs, and heated water beds increase the release of fentanyl from the
patch
Advise patient that good oral hygiene, frequent mouth rinses, and
sugarless gum or candy may decrease dry mouth
Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this Check after giving
Assess type, location, and intensity of med? Decrease in severity of pain without
pain before and 24 hr after application Patient not in pain. Respiratory rate < a significant alteration in level of
and periodically during therapy. 10/min. consciousness, respiratory status, or
Monitor pain frequently during blood pressure
initiation of therapy and dose changes
to assess need for supplementary
analgesics for breakthrough pain.
Assess blood pressure, pulse, and
respirations before and periodically
during administration. If respiratory
rate is <10/min, assess level of
sedation. Physical stimulation may be
sufficient to prevent significant
hypoventilation. Dose may need to be
decreased by 25-50%. Initial
drowsiness will diminish with
continued use. Assess bowel function
routinely. Prevent constipation with
increased intake of fluids and bulk, and
laxatives to minimize constipating
effects. Administer stimulant laxatives
routinely if opioid use exceeds 2-3
days, unless contraindicated
