Changes to Acute Coronary Syndrome Process to Decrease the Usage of Oxygen Administration
A1&2 - Currently at Mercy San Juan Medical Center there is a policy in place regarding the care of patients presenting with Acute Coronary Syndrome (ACS). This Policy consists of four basic nursing treatments and a time sensitive intervention goal. The 4 nursing treatments are summarized by the acronym M.O.N.A (morphine, oxygen, nitroglycerin and aspirin). The goal is for every patient that is presenting with ACS is to be on the table in the cath lab undergoing intervention within one hour of presenting to the hospital with symptoms. In this paper we will address the acronym of M.O.N.A. As the protocol stands right now there are parameters for the administration of three out of the four treatments, these are morphine, nitroglycerin and aspirin. For example, the policy states we are not able to give nitroglycerin if the systolic blood pressure is below 90mm/mg or if the patient has taken any phosphodiesterase medications within 12 hours. However, there are no parameters for the administration of oxygen. Coronary heart disease is the leading cause of death within the US. Oxygen has long been advocated as standard treatment in the management of chest pain and myocardial ischemia, although, for over 60 years the scientific background for this has been questioned (Ripley, Riley, Shome, Awan, McCloskey, Murphy & DeBelder, 2012). Recent studies have shown possible negative reactions with the administration of pure oxygen with patients that were not presenting with hypoxia. The possibility for oxygen toxicity to those with ACS could cause more cardiac tissue injury due to vasoconstriction and decreased cardiac output (Williams, Gandy, & Grayson, 2013). The result of this could be poorer patient outcomes. The American Heart Association (AHA) has also been
