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Chapter 5: Problem 144

A home health nurse is preparing to apply a fentanyl (Duragesic) transdermal patch for pain management. Which of the following criteria would contraindicate the application of the patch to a client鈥檚 upper arm? 1\. The client had surgery on both upper arm areas. 2\. The client has minimal hair distribution to this area. 3\. The client has intravenous catheters placed in the hand. 4\. The client uses an overhead trapeze bar for mobility.

Short Answer

Expert verified
Option 1: The client had surgery on both upper arms is the contraindication.

Step by step solution

01

Analyze the Contraindications

To determine when not to apply a fentanyl transdermal patch, we must identify factors that would either hinder the patch's effectiveness or cause patient complications. Surgical areas may not be optimal for patch application due to healing skin, potentially impaired absorption, or risk of infection.
02

Evaluate the Options

Let's evaluate each option: 1. Client had surgery on both upper arms: Post-surgical sites may be sensitive or healing, making them unsuitable for patch application. 2. Minimal hair distribution: This is favorable, as the patch requires direct contact with the skin for effective absorption. 3. Intravenous catheters in the hand: This doesn't directly affect patch placement on the upper arm. 4. Use of overhead trapeze bar: Using this bar could interfere with the patch if it's on an area frequently in motion or stressed.
03

Identify the Correct Contraindication

Since areas that have undergone surgery can be sensitive and are still healing, this makes option 1 a suitable contraindication. The other options (2, 3, and 4) do not directly contraindicate placing the patch on the upper arm based on the given context.

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Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Nursing Contraindications
When applying any medical treatment, understanding contraindications is essential for ensuring patient safety and treatment efficacy. Contraindications are scenarios where a particular treatment or procedure should not be used because it may be harmful or ineffective. In the context of applying a fentanyl transdermal patch, nursing contraindications must be carefully considered:
  • Post-Surgical Sites: If the patient has undergone surgery on the potential area for patch application, it's typically contraindicated due to the skin's healing process. The skin may be too delicate, reducing the patch's adherence or altering the drug's absorption.
  • Skin Integrity: Patches require intact skin to ensure proper contact and absorption. Any intrasite complications like skin infections or lesions can contraindicate use in specific areas.
  • Risk of Interference: Activities that might disrupt the patch's placement, like using an overhead trapeze bar, could be potential contraindications based on the patient's specific mobility patterns.
Transdermal Patch Application
Transdermal patches are a non-invasive method of delivering medication directly through the skin. This approach bypasses the digestive system and allows for controlled, sustained drug release over extended periods. Applying a transdermal patch effectively requires attention to specific factors:
  • Clean and Dry Skin: The area of skin should be clean, dry, and free of oils or lotions. This ensures maximum contact and absorption.
  • Site Selection: Optimal sites are areas with minimal hair and no swelling or damage, ensuring better adhesion and consistent absorption rates.
  • Patching Technique: Once the correct site is chosen, the patch should be applied with firm pressure to improve adherence, avoiding the edges which may lift over time.
  • Rotating Sites: To prevent skin irritation, it's recommended to rotate the application site with each new patch.
Patient Assessment
Patient assessment is a foundational component of nursing, guiding decision-making and care. Proper assessment involves collecting comprehensive information about the patient鈥檚 health status and using it to plan care effectively:
  • Medical History Review: Before applying the patch, understanding the patient's surgical history is crucial, as recent surgeries might dictate alternative application areas.
  • Inspecting Skin and Physical Examination: Assess the skin condition where the patch will be applied. Look for signs of healing, infection, or damage that could impede patch efficacy.
  • Understanding Mobility and Dexterity: Evaluating how a patient moves or uses different aids lets nurses know if a patch might be dislodged or damaged, affecting drug delivery.
  • Regular Monitoring: After application, regular checks ensure that the patch remains in place and is functioning properly, allowing for timely actions if issues arise.

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Most popular questions from this chapter

While discussing sleep patterns of school-age children with a group of parents, which of the following would be appropriate for the nurse to include in the teaching plan? School-age children: 1\. often have difficulty sleeping through the night. 2\. may require less sleep during growth spurts. 3\. generally sleep 8 to 10 hours each night. 4\. enjoy staying up late and sleeping late in the morning.

Which statement represents successful client teaching with regard to morphine administration via patientcontrolled analgesia (PCA)? 1\. 鈥淚 will probably use less morphine this way than with taking injections in my hip.鈥� 2\. 鈥淢y family can push the button when I鈥檓 asleep so I will rest better.鈥� 3\. 鈥淯sing this device will keep me comfortable at all times.鈥� 4\. 鈥淚f I push the control button too often, I may get more medicine than needed.鈥�

Which documented statement reflects the most important nursing action to prevent skin breakdown? 1\. 鈥淎ll bony prominences massaged.鈥� 2\. 鈥淣o reddened areas noted during bath.鈥� 3\. 鈥淗eels supported on a foam donut.鈥� 4\. 鈥淩epositioning side-back-side q2h.鈥�

When administering a narcotic with a non-narcotic to relieve severe cancer pain, the nurse must remember: 1\. this combination enhances pain relief. 2\. this combination treats pain both centrally and peripherally. 3\. the narcotic potentiates action of the non-narcotic. 4\. each drug works in its own right.

A client is placed on a low residue diet. The nurse evaluates that the client understood dietary instructions given if the client states that she will refrain from eating which of the following favorite food items? 1\. orange juice 2\. baked potatoes 3\. toasted white bread 4\. milk
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