# 情境 70歲慢性穩定癌痛、鴉片類耐受個案開始fentanyl透皮貼片25 mcg/小時q72h。哪個個案陳述顯示正確理解?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375158&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 70歲慢性穩定癌痛、鴉片類耐受個案開始fentanyl透皮貼片25 mcg/小時q72h。哪個個案陳述顯示正確理解?

## 選項

1. 疼痛加重時在貼片上敷熱敷以增強效果。
2. 若覺得劑量太強就把貼片剪一半。
3. 為控制突發痛同時貼兩片。
4. 貼於清潔、乾燥、完整的軀幹上部皮膚；每72小時更換部位；使用過的貼片黏面對黏面對折後沖入馬桶；避免熱源以免吸收量增加。 **✔ 正確答案**

**正確答案: 4**

## 解析

Fentanyl透皮貼片用於慢性穩定的重度疼痛且具鴉片類耐受性的病人。基質或儲存型貼片在72小時內持續釋放fentanyl。首次貼片與調整劑量後24小時達穩定濃度，初期止痛漸進，移除後仍有12~24小時殘留庫。重點教學：(1) 胸、背、側腹或上臂的清潔、乾燥、無傷、無毛皮膚 — 修剪不可剃；每72小時更換部位並記錄；按壓30秒；(2) 熱會增加釋放造成過量 — 避免熱敷、電毯、熱浴、三溫暖、劇烈運動與高燒，發燒須回報；(3) 除非明示可剪，否則不可裁剪(雖原duragesic為基質型，作法是改用最低劑量而非裁剪)；(4) 使用過貼片仍可使兒童或寵物致命 — 黏面對黏面對折後沖入馬桶(高風險鴉片貼片FDA flush list)，不可整片丟入垃圾；(5) 突發痛以速效鴉片處理，不可加貼；(6) 貼片部位過敏或皮膚反應應移除並回報；(7) 鎮靜加重、混亂、呼吸減慢、跌倒須回報。加熱、裁剪、重複貼皆不安全。

## 深入解析

貼片用於慢性穩定且鴉片耐受疼痛。"勿加熱"為fentanyl貼片最常考的安全要點，黏面對黏面銷毀為次。

## 重要概念

- **fentanyl transdermal patch** — 鴉片耐受、慢性穩定痛、72h、殘留庫、matrix/reservoir
- **heat-induced overdose** — 熱敷、熱浴、三溫暖、發燒會增加吸收，可致命，需教導避免
- **patch disposal** — 黏面對黏面對折後沖馬桶，列入FDA flush list，保護兒童與寵物

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