priority question about MI patient

[anon456, BSN, RN]

I am so confused on this one. Typical question-- and I've seen different versions of this-- a pt comes into the ER with chest pain and probably MI. Orders are O2, EKG, morphine, labs, etc. What do you do first?

My teacher says EKG, O2, labs, morphine, and other drugs

My textbook says O2, EKG, labs, morphine and other drugs

My NCLEX book has the choices of morphine, EKG, IV start, labs. It says morphine is the correct choice.

So, what does the NCLEX consider the right answer??

I just passed my last class final and just have preceptorship and NCLEX to do.

Thanks!

[caliotter3]

You would have to get feedback from the authorities that write NCLEX to find out what they want for the answer. I have always gone with morphine, but that doesn't mean it is the right answer.

[JenniBeth]

When I was studying I learned it was Morphine first. MONA (Morphine, Oxygen, Nitro, Asa)

[anon456, BSN, RN]

When I was studying I learned it was Morphine first. MONA (Morphine, Oxygen, Nitro, Asa)

Ah yes, MONA. Only our teacher pointed out that it was not necessarily in that order. I think I'll just answer it in order since that's what you guys would do-- I'll double check that more also.

[healthcarestudent]

NCLEX is an ivory-tower world and I believe textbook answers always the right answers not the way it is done "in the real world." So I would say look up your textbook.

[JSTARZ]

RIGHT! "MONA" is only a way to remember the tx. Personally, I would say Oxygen. Yes! they are all very important but if you consider that myocardial Ischemia is pretty much the "underlying" etiology of a MI I would say go with that first. Besides that is the ONE intervention you would be able to carry out the QUICKEST!!! O2 decreases the strain and workload of the heart. However, thats just my 0.02 cents..

[CCL RN, RN]

O2 first please :)

Never withhold o2 or other drugs to get an ekg first-the best picture will be in the cath lab so don't worry about the ekg as a priority. We need it, but does the pt need it asap? Knowing what you know about a STEMI, does a pt NEED a 12 lead EKG over treatment?

Morphine is important, but o2 is more important.

Most times when I come in the night for a STEMI, the pt has only received the asa and o2. These days, most are missing the MS.

[2126]

In saunders on pg 868, its states to deliver O2 first, then nitro, then EKG......I've heard ONAM and MONA....so confused myself.

[MunoRN, RN]

MONA is more of a checklist than an order in which to do things. Preferably, it's better to get the EKG prior to Morphine or NTG since that will alter the EKG, potentially to the point where you can't accurately isolate the location of the infarct. This is important since treatment of a right sided infarct is different than that of a left sided infarct, and the type of ST changes determine if a patient goes to the cath lab now or in the morning, or at all, as well as what treatments are indicated prior to an angiogram. If a patient is too unstable, then you would need to weigh the benefit of getting an EKG that is unaffected by the Morphine or Nitro with the effect that time delay might have on the patient, although if a patient is really that unstable then the EKG changes should still be evident on the EKG even after the initial doses of Morphine and NTG. For patients with manageable symptoms (reasonable BP, no flash pulmonary edema, etc) I always try and get the EKG first with morphine and NTG ready to give as soon as the EKG is printed, and also get another EKG after symptoms have disappeared following treatment to confirm a return to baseline in the EKG.

[kajh20]

I was wonderig if anyone has tried getting clairification from those who write the boards (NCSBN) re: questions like which intervention is best for a MI PT admitted to the ER? Many say to follow MONA which is to give morphine first but others say different. I know that the wordig in the question provides different sceneros but for the simplicity of it I was curious.

Thanks

[MunoRN, RN]

The correct order for MONA, according to the American Heart Association, is Oxygen then Aspirin then Nitro, then Morphine if needed. Can't guarantee that the NCLEX people are knowledgeable of that, but that should be the correct answer.

[jjjoy, LPN]

I can't say for the NCLEX, but in class, sometimes it seemed that questions like that were primarily as evidence of how difficult nursing school was since even the best students could get that kind of question wrong. Ugh!

Another not-quite-as-cynical thought is that real world health care often isn't black-or-white but you still are called upon to make a judgement which may or may not be deemed as the best judgement by another. A health care provider has to live with some ambiguity and deal with a very less-then-ideal world... why not start getting students used to it in school?

Anyway, back to the question at hand...