by ittybittynurse

The NCLEX Question:

A man comes to the ER complaining of retrosternal chest pain, SOB. BP 110/70, HR 100 and irregular, RR 28. After attaching the cardiac monitor which of the following orders are implemented first??

a. take ekg 12 electrocardiagram
b. Administer O2 per nasal prongs
c. Administer morphine sulfate SQ
d. restrict his fluid and sodium intake




Well, the answer according to *****, its b. Administer O2,because this ensures the adequate oxygenation; breathing issue. C. will reduce preload and afterload pressure and relieve pain, circulation issue, second after O2.

I understand this completely, is just that I read in previous threads that MORPHINE comes before O2...(MONA)? IS THIS TRUE???? IM confused now. Which one should I go by if I see this on my NCLEX?

Re: OXYGEN OR MORPHINE?

I think you need to look at the stem of the question, also ABC, airway always takes priority.
Hope this helps.

Re: OXYGEN OR MORPHINE?

For the patient with retrosternal chest pain, supplemental oxygen administration would always be my first choice.

MONA is an acronym to help you remember the four interventions for treating chest pain in the acute coronary syndrome; this does not reflect the suggested order of administration.

Part 8: Stabilization of the Patient with Acute Coronary Syndromes, Initial General Therapy for ACS briefly discusses these four interventions in the following order: oxygen, aspirin, nitroglycerin, and morphine sulfate. Again, I’m not personally convinced that this is the recommended order, although regarding morphine the article does include the following:

Morphine sulfate is the analgesic of choice for continuing pain unresponsive to nitrates, and it is also effective in patients with pulmonary vascular congestion complicating ACS. Morphine is a venodilator that reduces ventricular preload and oxygen requirements. For this reason it should not be used in patients who may have hypovolemia. If hypotension develops, elevate the patient’s legs, administer volume, and monitor for signs of worsening pulmonary vascular congestion. Start with a 2 to 4 mg IV dose, and give additional doses of 2 to 8 mg IV at 5- to 15-minute intervals.

I hope this information is helpful.

Re: OXYGEN OR MORPHINE?

Also remember administerng oxygen first will help with ischemia .

Re: OXYGEN OR MORPHINE?

Morphine wound come first if the patient didnt have a problem with breathing. Everything else wouldnt matter if the patient died from lack of oxyegen. Remember your ABC's. RESPIRATORY TAKES PRIORITY!

Re: OXYGEN OR MORPHINE?

A man comes to the ER complaining of retrosternal chest pain, SOB. BP 110/70, HR 100 and irregular, RR 28. After attaching the cardiac monitor which of the following orders are implemented first??

a. take ekg 12 electrocardiagram- can be done later
b. Administer O2 per nasal prongs. - Oxygen will come first because it will help dilate the vessels.
c. Administer morphine sulfate SQ- morphine can not be administer thru SQ
d. restrict his fluid and sodium intake- distractor

Hope am right........

Re: OXYGEN OR MORPHINE?

You already have a few rationales for why O2 would come first. I just wanted to add my two cents that O2 should come first and there are a few ways that it can be validated. Remember ABCs...