MORPHINE OR OXYGEN?

[WEST1014, RN,BSN]

Can someone please tell me which to give first during an MI...the O2 or the Morphine? I'm looking over my notes from school, and I learned to always give oxygen first; but I've read a few places to give the Morphine first because it decreases the oxygen demand.

[Double-Helix, BSN, RN]

Oxygen is absolutely first.

Think about it logically. A patient comes into the ER with heart attack symptoms. In order to apply oxygen (which can be done without a doctor's order) you need to grab the mask from the wall and put it on the patient.

In order to give morphine you need to: 1. Start an IV. 2. Get an order. 3. Get the med from pharmacy or the Pyxis. 4. Draw it up and administer.

Yes, morphine decreases oxygen demand. But what is more effective? Increasing available oxygen or decreasing oxygen demand? If you decrease demand but don't have adequate circulating oxygen then you really aren't helping.

This original thread is from two years ago.

[yvfair]

I'm in agreement with Ashley! I work in a cath lab and the first thing we do is apply O2!!

[QuenymamiRN]

Always put oxygen on first not morphine.

[riclez]

if no knowledge at all, I think ill follow Kaplan strategy guide. Physical need first over Psychosocial need. the patient is receiving pain medication and pain is considered psychosocial in nclex NCLEX exam, so i will choose oxygen because it is a physical need.

[akulahawkRN, ADN, RN, EMT-P]

MONA is absolutely just a mnemonic to remind you what the MI patient needs, not the order that the meds must be given.

From a practical standpoint: Oxygen always 1st. It's the fastest way to increase the amount of oxygen in the blood.

[FattyMateo]

The answer is morphine. The worst thing you can do on the NCLEX is think about what you did in clinical or take advice from a nurse who has been practicing for years and years. If you take a Kaplan course before NCLEX your Kaplan instructor will tell you that NCLEX questions exist in a perfect-world vaccum. A specific example our instructor gave us was an order for a narcotic. She explained that on NCLEX, if there is an option that says "give morphine," by picking that you ALREADY KNOW you 1) have an order 2) have the morphine drawn up 3) have identified all risks/contraindications and 4) you have all your rights of med. admin. covered.So given the nature of NCLEX, you can see this question has nothing to do with logic, clinical practice or common sense. "Talking to ER nurses will get you a seat to NCLEX Part II" - that's a quote from my NCLEX instructor. So in this MI question, you have a needle with morphine in one hand and an oxygen mask in the other - which do you give?Well, do they have a saturation problem? Possibly, but not likely yet. A coronary artery blockage is depriving one portion of the heart from oxygen. Giving more oxygen to this person is not the priority because its unlikely the area at risk is being perfused, so how effective will high SPO2's be?So if you can't get extra oxygen to the heart, the next best thing is to decrease the oxygen the heart needs. In Kaplan's instruction, pain is psychosocial, that is true...but in this example, the pain reduction is secondary to the decreased o2 consumption that results from taking morphine.I'm picking morphine all day

[morte, LPN, LVN]

which proves the idocy that is NCLEX

The answer is morphine. The worst thing you can do on the NCLEX is think about what you did in clinical or take advice from a nurse who has been practicing for years and years. If you take a Kaplan course before NCLEX your Kaplan instructor will tell you that NCLEX questions exist in a perfect-world vaccum. A specific example our instructor gave us was an order for a narcotic. She explained that on NCLEX, if there is an option that says "give morphine," by picking that you ALREADY KNOW you 1) have an order 2) have the morphine drawn up 3) have identified all risks/contraindications and 4) you have all your rights of med. admin. covered.So given the nature of NCLEX, you can see this question has nothing to do with logic, clinical practice or common sense. "Talking to ER nurses will get you a seat to NCLEX Part II" - that's a quote from my NCLEX instructor. So in this MI question, you have a needle with morphine in one hand and an oxygen mask in the other - which do you give?Well, do they have a saturation problem? Possibly, but not likely yet. A coronary artery blockage is depriving one portion of the heart from oxygen. Giving more oxygen to this person is not the priority because its unlikely the area at risk is being perfused, so how effective will high SPO2's be?So if you can't get extra oxygen to the heart, the next best thing is to decrease the oxygen the heart needs. In Kaplan's instruction, pain is psychosocial, that is true...but in this example, the pain reduction is secondary to the decreased o2 consumption that results from taking morphine.I'm picking morphine all day

[JRich]

I just did the Hurst Review this past week and they told us Oxygen is first. Still use MONA, but in a different order. It goes

O- Oxygen

A- Aspirin (chewable)

N- Nitro

M- Morphine

[malaz]

UGH. I know this is an old thread but I'm losing it over here. Just found a Kaplan ? that says morphine is first (I picked O2 and got it wrong). But a LaCharity question said O2 was first. And someone posted a question about this over on Learning Ext, but the rep just refused to confirm that MONA is the right order. What is the answer????? :'-(