Dealing with an MI

[kjbsn2008]

In school we learned:

1. Stop Activity

2. O2

3. EKG (preferably before NTG but if you don't have time then give NTG)

4. Nitroglycerin sublingual

5. Morphine IV

6. Nitroglycerin IV

Now I'm studying and I see people saying "choose Morphine first". What's the NCLEX stance on this?

[suzanne4, RN]

If you are not in a hospital setting or have the medics there, then you are not going to be able to administer morphine. You are also missing a very big item that is needed on your list and that is aspirin.

NTG IV is not a primary treatment for acute MI.

What would you do first if a patient presented having an MI? That is how you need to think of it, what you would be doing. Not what the patient would be doing. Look at it from that angle and then think it thru. You are not always carrying NTG in your pocket so what would you be thinking of doing first?

[kjbsn2008]

I personally gave my patient 02 the first time I experienced someone having an MI in the clinical setting because I couldn't run to the pyxis straight away and leave my patient to get morphine.

If I were a lay person I would have the pt stop activity, call 911, and administer aspirin if anyone had any, if, in fact, they did not have NG.

However, they say NCLEX is ivory tower nursing and we are to assume we have everything we need at the bedside. Which means that all of the above would be there.

And I have seen many write down MONA. Which puts morphine first.

I, however, disagree and would give my patient Oxygen first.

This is why I'm scared because I'm taking the NCLEX tomorrow! So please tell me if my rationale is incorrect! Thanks!

[NY2008]

In school we learned:

1. Stop Activity

2. O2

3. EKG (preferably before NTG but if you don't have time then give NTG)

4. Nitroglycerin sublingual

5. Morphine IV

6. Nitroglycerin IV

Now I'm studying and I see people saying "choose Morphine first". What's the NCLEX stance on this?

I agree with you! First O2.

[sxybuttrfly]

mona is a useful acronym in dealing with mis, but that does not necessarily mean that they must be administered in that order (morphine, o2, nitrates, asa). i would apply o2 first.

[Rainbow-BSN]

We were always taught MONAB:

Morphine

Oxygen

Vitals, including 12 lead

Nitro

Aspirin

Beta Blocker (with exceptions)

I did an internship and practicum on a tele floor and this was practiced there as well. Of course, you pretty much do what is available given the situation. For example...at home, you would have a family member chew aspirin because morphine and O2 are not available immediately.