Description

Overview

1. Troponin I
   1. Normal value range
   2. Pathophysiology
   3. Special considerations
   4. Elevations in lab values

Nursing Points

General

1. Normal value range
   1. Typically, less than 0.035 ng/mL or less
   2. Can vary among institutions
   3. Has to be greater than the 99th percentile
2. Pathophysiology
   1. Troponin is released during myocardial cell damage
   2. Decreased perfusion causes myocardial cell damage
   3. Causes of myocardial cell damage
      1. Myocardial infarction
      2. Demand ischemia
         1. Cardiogenic
            1. ACS
         2. Noncardiogenic
            1. Sepsis
            2. Renal failure
            3. Extreme exercise
3. Special considerations
   1. Submitted in green top tube
   2. Value peak
      1. Detection 6-12 hours after acute injury
      2. Peaks 24 hours after injury
      3. Can stay elevated for a week
         1. Knowing patient history is critical
4. Increased values
   1. Any elevated value is typically considered critical
   2. Acute elevations warrant immediate investigation
      1. Typically PCI (percutaneous coronary intervention)/Angiography and EKG to rule out MI or ACS (acute coronary syndrome)
   3. Other elevations
      1. CABG
      2. Extreme exercise
      3. End Stage Renal Failure

Assessment

1. Assess for:
   1. Acute chest pain
   2. Symptoms of MI
      1. Nausea
      2. Vomiting
      3. Angina in any form
      4. Reflux (especially in women)

Therapeutic Management

1. EKG
2. Angiography or PCI
3. Management of non-cardiogenic etiology

Nursing Concepts

1. Lab Values
2. Perfusion

Patient Education

1. Educate patient on keeping history of elevated levels or cardiac disease for future reference
2. Educate patient on duration of elevated troponin levels, post injury