MONA Protocol
The initial intervention sequence for acute coronary syndrome
Definition
MONA is the mnemonic for the initial medical interventions in suspected acute coronary syndrome (ACS), including myocardial infarction. Although the order of administration is not strict, all components should be considered.
Components
- M - Morphine: For unrelieved chest pain. Reduces pain, anxiety, and myocardial oxygen demand. Monitor for hypotension and respiratory depression.
- O - Oxygen: Apply if SpO2 less than 90% or if patient is dyspneic. Current AHA guidelines limit routine oxygen in normoxic ACS patients.
- N - Nitroglycerin: Sublingual 0.4 mg every 5 minutes up to 3 doses for chest pain. Hold if SBP less than 90 mmHg. Contraindicated with sildenafil (severe hypotension).
- A - Aspirin: 162 to 325 mg CHEWED for rapid antiplatelet effect.
Extended MONA (MONA-B)
Adds Beta-blocker to reduce heart rate and myocardial oxygen demand. Avoid in cardiogenic shock, severe bradycardia, or acute heart failure.
Priority After MONA
- Obtain 12-lead ECG within 10 minutes
- Draw troponin
- For STEMI: PCI within 90 minutes (door-to-balloon)
- For NSTEMI: antiplatelet (clopidogrel), anticoagulation (heparin), cardiology consult
Nursing Considerations
Establish IV access, continuous cardiac monitoring, and frequent vital signs. Ensure informed consent for PCI. Prepare for potential complications such as cardiogenic shock or arrhythmia.
NCLEX Relevance
MONA is one of the highest-yield mnemonics for NCLEX. Know each component's indication, contraindication, and nursing priority.