MONA

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.

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.

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

during our school days, our instructor taught us that always

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

does this make sense???

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!

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.

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

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.

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.

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. "

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.

That's what gets me...certain schools teach certain things differently. Kaplan might say morphine first, the NCLEX people might think differently..I still want to know what the NCLEX people say because they make the question that may determine if I fail or not...because you know they love MASLOW...and pain is PSYCHological...not PHYSiological. I don't really agree with Maslow in all cases. Sex is physiological...that's more important than a safe environment. So if I have a patient who wants to stick his finger in a light socket, sex and food are more important than providing an evironment with covers over the plugs. I missed that question in Kaplan about a manic pt who was doing all kinds of crazy things that would kill her. She was on an airplane wing! But it said the PRIORITY is to give her food and rest since she hasn't eaten in 3 days instead of the answer I picked....provide a safe environment. Back to the light socket or plug, if she wants to stick her finger in a light socket because she's manic..I think that would kill her faster than if she waited a few hours to eat while I make her surroundings safe.

*** i found the above question ***

I received a book from KAPLAN 2010 Strategies for NCLEX-RN exam, yesterday. i found the confusing question in page 85.

"A client with a hx of bipolar d/o is admitted to the psychiatric hospital. She was found by the police attempting to climb onto the wing of a plane at the airport. Her husband reports that she has not eaten or slept in 2 days, and he suspects she has stopped taking lithium. On admission, the nurse should place the highest priority on which of the following client care need?"

1. Teaching the client about the importance of taking lithium as prescribed.

2. Providing the client with a safe environment with few distractions.

3. Arranging for food and rest for the client.

4. Setting limits on the client's behavior.

Rationale: Eliminate all answer choices that are psychological-(1)&(4)

Focus on physiological,

"Whats takes highest priority?" Providing for a safe environment or providing for food and rest? According to Maslow, food and rest take highest priority. The correct answer is (3).

For my own little understanding and opinion, i would say the answer is (2), if there's no continuation of "few distractions". Hence, that makes wrong (2), because it is not really/fully a safe environment.

What do you think guys?

Again, accdg to our clinical instructor, SAFE is the highest priority in PSYCHIATRIC clients, exceptions to Maslow's. i just forgot to ask his source!

Aside from that, this book is really great! Strategies are different from Saunders, so we can apply both approach in taking NCLEX exam. I like KAPLAN book along with my SAUNDERS!

Anyway, i haven't seen a book that is perfect, it doesn't exist! The authors of the book and editor are all human being! We are not GOD! who is the only 1 perfect!

I also saw in Saunders book, maybe 2 typical errors, the rationale is contradicting the answer. i saw in La Charity Prioritization&Delegation book, maybe 3-5 typical errors, e.g. instead of factor VIII, they type factor something, other than VIII.

But in general, all these 3 books are awesome! GOD BLESS US test takers!

We should be thankful to the Authors, otherwise we will not become a NURSE!