elevated troponin levels and my care plan

[SamanthaHope85]

hey all.... im working on my respirator care plan and i have a few questions... my patient has elevated troponin thats not r/t an mi... his diagnoses are as follows...

• pneumonia
  
• elevated troponin
  
• hx: of htn
  
• hx: of asthma
  
• hx: of gerd
  
• hx: of glaucoma

he was admitted from the er with chest pain and shortness of breath. dx studies done were: u/s of bilateral lower extremities to r/o dvt (which came back negative for dvt), and a lung perfusion test was done to explore the chest pain and to r/o pulmonary embolism (which came bach with intermediate possibility for pe). that possibility of pe is the only reason i can come up with as to why his troponin was elevated...

i know that troponin levels can be effected by other conditions such as sepsis, hypovolemia, atrial fibrillation, congestive heart failure, pulmonary embolism, myocarditis, myocardial contusion, thrombotic coronary artery occlusion, and renal failure.

also i was wondering what the typical signs and symptoms a person with elevated troponin has... i cant find them anywhere....

am i making it too hard on myself? are the s/s angina, sweating, redness of skin, (etc) and mi? could it really be that simple??

[Daytonite, BSN, RN]

Troponins are elevated when there is angina (chest pain). The elevated troponins would indicate that there was some degree of cardiac ischemia going on.

[Natingale, EdD, RN]

ok i start NS in the fall but I work in a ER and usually an elevated troponin gets a EKG and a repeat of cardiac enzymes q8h x's 2 (8 hours from the first set but if its been more then u start all over and do 3) oh and repeat ekgs -- just my from what i gather being in there

i dont even know where meds get mixed into the recipe, but im trying to help

[UM Review RN, ASN, RN]

he was admitted from the er with chest pain and shortness of breath. also i was wondering what the typical signs and symptoms a person with elevated troponin has...

there are your two biggies. good luck on your care plan.

[jjjoy, LPN]

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?

[RN-Student]

I also am a NS and working on a careplan. My patient was admitted with a UTI, has history of CAD (2000),CABG, HTN, and does have a pacemaker(2000). She has an elevated troponin of 0.20 with no chest pain no ischemia, negative GXT. I did read that troponins can be elevated with Kidney disease and severe infection so am going with that since she was in for a UTI. Has anyone else heard troponin increase for that reason? I believe I found that on medlineplus.gov Good luck on your care plan...I am on page 12 of mine it usually averages 25 pages.