M.O.N.A. for MI, but what's the order for tx?

BSN_Studnt · Mar 28, 2017

I know that MONA is the mnemonic for treatment options for patient's with MI's. However, what order would I proceed in treating the MI pt ? Im thinking O2 first then Nitrates, Aspirin, and Morphine??

amoLucia · Mar 28, 2017

what are your WHYs?

Editorial Team / Moderator · Mar 28, 2017

I would do O2 (easy to apply), aspirin (quick to chew), get the IV started and prime a line (because goodness knows a dose of SL nitro will tank their BP if you don't have a line!), give morphine, then do the nitro last since you give that q5 minutes.

BSN_Studnt · Mar 28, 2017

WHYs? Im not sure I understand your response. Its for a pt with Acute MI

chare · Mar 28, 2017

WHYs? Im not sure I understand your response. Its for a pt with Acute MI

Understood. But I believe amoLucia is asking why you would perform the interventions in this order.

Esme12, ASN, BSN, RN · Mar 28, 2017

duplicate threads merged as per the Terms of service

Esme12, ASN, BSN, RN · Mar 28, 2017

WHYs? Im not sure I understand your response. Its for a pt with Acute MI

Here at AN we ask ALL students to post what their research has revealed to them. AN is committed to supporting nursing to be the best it can be.

So....what are your thoughts on what the order for M.O.N.A. is....This link may help.

MONA: Morphine, Oxygen, Nitroglycerin and Aspirin

amoLucia · Mar 28, 2017

to chare & Esme - you are correct. I was asking OP why she made her choices as she had. Hoping she had just not made a lucky guess.

Like other members here, I'll chime in when I see a student putting in original thinking effort & reasoning. Kind of like when one of us get stuck in charting, looking for the best-est word. We give a yell, but with explanation.

CCU BSN RN · Apr 15, 2017

Oxygen if needed. MONA doesn't always greet all chest pain at the door. Some are fine on room air and sat 100% on ambient air and we're discouraged from causing oxygen toxicity, but emergency med still does it.

Go to pyxis, grab ASA and NTG. They chew the NTG, then start giving nitrosx3. MSO4 if not relieved. If ASA and NTG fix it, then bam, down to 2 interventions and my life is easier.

bgxyrnf, MSN, RN · Apr 22, 2017

The truth is, of those four interventions, the only one that's proven to reduce mortality is the ASA and should be the first thing done (and, as Pixie pointed out, takes no time at all nor any skill).

Oxygen, for a normoxic patient, really provides no proven benefit and some evidence indicates that it can be harmful... but, it also takes very little time and the reasoning for its use is logical and firmly established in the minds of many providers.

The IV line is a high priority, both to obtain labs as well as to have access for ACLS meds if needed. Once you've got the line, morphine can be helpful though it's often not given if the patient isn't in substantial pain. What is typically given is a loading dose of heparin through the IV.

If s/he's ordered SL nitro, and I'm the only nurse, and the BP is ok, then I'd give the first dose of nitro prior to establishing IV access simply to minimize the total duration. For an acute STEMI, nitro is given sometimes and sometimes not - it really seems to be a cardiologist-preference thing unless the patient is severely hypertensive or suffering from pulmonary congestion.

In addition to the above, patients usually get a loading dose of Plavix or Brilinta.

In most cases, this stuff is happening nearly simultaneously because multiple nurses are involved.

Also, the IV is often the first thing because we do it without an explicit order so, if morphine is ordered, it will be pulled and given along with the PO meds... and literally simultaneously... as in 1 mg of morphine, chew the aspirin, push in a little bit more morphine, slap on the cannula, push in a little bit more, hand them the nitro, push in the rest.

The morphine push needs to be slowwww because it can (a) cause hypotension and (b) cause nausea/vomiting in these patients who are likely to already be nauseated... which brings up another point... I generally get an order for some Zofran right out of the gate and would give it before the morphine.

Lev, MSN, RN, NP · Apr 23, 2017

I think MONA can be performed in any order. I think that is just how the mnemonic ended up because that is how it is easiest to say. Not every patient gets every aspect of MONA. For example, nitroglycerin is contraindicated in patient with a right sided MI because of the risk of severe hypotension from vasodilation coupled with the already impaired right (ventricle) heart.