Some people have elevated troponins without symptoms. One could have had trauma to the heart muscle yesterday (eg hit strongly in the chest) and have no symptoms today, although the troponins may be elevated temporarily due to the damage. Keep in mind that even something as physiologically traumatic as an acute MI doesn't always have symptoms ("silent" MIs).
You infer that MI has been ruled out but don't indicate why. Was an ECG done? Echo? Was there a cardiac consult? Assuming that both MI and PE have been ruled out, the issue of the elevated troponin drops in priority of concern since other causes aren't potenitally indicative of am immediately life-threatening crisis already in progress (such as MI & PE) and there would likely be other symptoms/lab tests to indicate what needs to be addressed (eg if sepsis or renal failure were the cause of elevated troponins).
As a nursing student writing a care plan, though, focus less on the pathophys and more on the immediate nursing concerns. Has there been more than one troponin level drawn so far? If yes, is there a trend? Are there more pending troponins to be drawn? If the trend is decreasing levels and there are no more orders for this lab to be drawn, then it may be old news that you needn't focus on in your care plan. If they are still monitoring it, then your job is to make sure the lab is drawn and to follow up on the results. I don't think there's much else nursing-care-plan-wise at this point given the data you've presented. Any other opinions?
Last edit by jjjoy on Apr 30, '08