MONA

kgh31386, BSN, MSN, RN · Jul 25, 2009

I checked my Med/surg book just now. It said give Oxygen first to prevent further ischemia of the cardiac tissue. BUT it also says on another page to give the Sublingual nitro first to accomplish the same thing. It said both come first bascially lol. And I've seen countless places that said regarding drugs....you do Sublingual Nitro every 5 minutes for 15 minutes BEFORE Morphine. Nitro will decrease preload and afterload and it works immediately, plus treats the pain.....morphine is given for pain UNRELIEVED by Nitro.

BabyLady, BSN, RN · Jul 25, 2009

I checked my Med/surg book just now. It said give Oxygen first to prevent further ischemia of the cardiac tissue. BUT it also says on another page to give the Sublingual nitro first to accomplish the same thing. It said both come first bascially lol. And I've seen countless places that said regarding drugs....you do Sublingual Nitro every 5 minutes for 15 minutes BEFORE Morphine. Nitro will decrease preload and afterload and it works immediately, plus treats the pain.....morphine is given for pain UNRELIEVED by Nitro.

You may need to go back and do further review.

There is a different set of steps for being at home versus in the emergency room....our med-surg textbook goes into detail on both.

When you are at home and you are having a major attack of angina....all you are going to have is Oxygen (if prescribed) and nitro...you aren't going to have morphine.

The emergency room is going to follow MONA.

Remember...the ENTIRE REASON you are going to the ER is because if nitro relieved your pain...you wouldn't be in the ER at all.

Some schools, like ours, teach a section on "Emergency Nursing"...it is the "exceptions" to things like the ABC's...Maslow's, etc.

kgh31386, BSN, MSN, RN · Jul 25, 2009

I was under the impression it was a person who just randomly fell out with an MI(somewhere out in public and 911 was called). They had no previous history, no prescribed nitro or anything. All you were given is "a patient presents to the emergency room having an MI", what's your first intervention sort of thing. My book had it broken down into different scenarios as well, and it still claimed O2 to prevent further ischemia, as well as nitro before morphine. I've seen MONA too, but not in this book is what I'm getting at.

morte, LPN, LVN · Jul 25, 2009

sooo, you are going to walk away from a person having chest pain...go get the MSO4, comeback, push that .....THEN put the O2 on?.......hmmmmm

joycee8 · Jul 25, 2009

during our school days, our instructor taught us that always

SAFETY first in Psychiatric ward/clients, exceptions to MASLOWS.

does this make sense???

joycee8 · Jul 25, 2009

The schools are supposed to be structuring their entire nursing curriculum around the NCLEX Blueprint...which is published every year and is what not only nursing schools teach....but it also determines what publishers is going to publish in the textbooks for nursing school.
The NCLEX Blueprint isn't even a mystery...it's available to the general public.
In regards to your question...I can't answer for Kaplan, but I would wager that Kaplan had that question wrong.
She isn't going to be eating much if her behavior kills her first.
SAFETY always takes priority over physiological needs.
As my instructor put it...."below the Maslow's triangle...you have DEAD".

I agree, our Clinical Instructor taught us that in Psychiatric Ward/Client's ALWAYS SAFETY COMES FIRST, exceptions to MASLOWS!

kgh31386, BSN, MSN, RN · Jul 25, 2009

Well someone should inform Kaplan of these exceptions. I put provide a safe environment is the highest priority for the manic pt...no they said food and rest is highest.

25seaturtles · Jul 25, 2009

As nurses we give morphine for Chest pain and O2, for people at home they are given nitro.

+one · Jul 25, 2009

On the NCLEX, do you think morphine or oxygen comes first for an MI?
I just encountered a Q about this on Kaplan.
I put oxygen because I thought "airway".
But the right answer was morphine FIRST. O2 2nd.
So I guess for the purpose of the NCLEX, we use MONA in that order??

that is because morphine's action decreases myocardial oxygen demands for an MI patient so morphine is given first. But I guess it depends on the situation you are given. I would go for the umbrella choice on this question, that is giving morphine first.

kgh31386, BSN, MSN, RN · Jul 25, 2009

My argument was that Nitrostat(sublingual nitro) works immediately and decreases O2 demand as well. Plus my book said treat with nitro x3, then morphine if that doesn't work.

kgh31386, BSN, MSN, RN · Jul 26, 2009

By the way, I'm not saying my textbook is the absolute correct source. HOWEVER lol, THISSS is my final....argument, point, whatever you wanna call it haha, that Nitrates are the choice over Morphine. I vote for Nitrates q 5 min for 15 min., THEN morphine if that doesn't work. Plus I still say Oxygen BEFORE nitrates. So my order would by O2 @ 4-6 L, run and get a nitro tab, pop that under their tongue, if 3 of those don't work, THEN get some morphine. ACLS actually teaches this currently(found that from when I asked bout this previously). My rationale is, 02 is quick to hook up, it helps to prevent the ischemia from worsening, then the nitro is fast acting and does the same thing as morphine(decrease workload on the heart). Just like others are saying in another thread, there are exceptions to Maslow and ABC's..like the manic pt we're talking about in another thread, Kaplan said food and rest are more important than giving her a safe environment, she was found on an airplane wing...covering the light sockets may take 10 minutes, but according to them...feeding her and giving her rest(and access to a light socket or anything that can kill her in 2 seconds)...is more important. Kaplan may NOT be correct in ALL cases. Back to the point, here are a link and a section from a research article on this very topic that say what I'm saying in another way about the Nitro and Morphine. I don't even know if they'll ask me about this on the NCLEX. But who knew one question would give so many answers? I hope others chime in

https://allnurses.com/general-nursing-discussion/what-order-do-338848.html

"While patients hospitalized for a heart attack have long been treated with morphine to relieve chest pain, a new analysis by researchers from the Duke Clinical Research Institute has shown that these patients have almost a 50 percent higher risk of dying.

The researchers call for a randomized clinical trial to confirm their analysis. Meanwhile, they advise cardiologists to begin treatment with sufficient doses of nitroglycerin to relive pain before resorting to morphine.

In their analysis of the clinical data and outcomes of more than 57,000 high-risk heart attack patients -- 29.8 percent of whom received morphine within the first 24 hours of hospitalization -- the researchers found that those who received morphine had a 6.8 percent death rate, compared to 3.8 percent for those receiving nitroglycerin. The increase in mortality persisted even after adjustment for the patients' baseline clinical risk. "

chare · Jul 26, 2009

although the aha coined the acronym mona, this was not a recommendation that this be the ordered that the interventions were applied. if you review the 2005 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8: stabilization of the patient with acute coronary syndromes the administration of these 4 medications is discussed in several sections.

the following was copied from the acute coronary syndromes algorithm:

ems assessment and care and hospital preparation:

- administer oxygen, aspirin, nitroglycerin, and morphine if needed.

immediate ed general treatment

- start oxygen at 4/min; maintain o2 sat >90%

- aspirin 160 - 325 mg (if not given by ems)

- nitroglycerin sublingual, spray, or iv

- morphine iv if pain not relieved by nitroglycerin

the following was copied from initial general therapy for acs section:

morphine sulfate: 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

furthermore, in 3 years in the emergency department as well as 3.5 years doing critical care transport, i have never administered morphine as the first intervention, nor have i ever heard of it being done.

i hope this information is helpful. :specs: