A nurse is performing chest percussion on a client who has severe COPD. Which of the following actions should the nurse take?

Rationale for correct choices:

• Myocardial infarction: Elevated troponin levels are a specific biomarker for myocardial injury. The client’s Troponin T rose from 0.08 to 0.2 ng/mL, and Troponin I from 0.01 to 0.1 ng/mL, both exceeding normal limits, suggesting ongoing cardiac muscle damage consistent with a myocardial infarction.
• Troponin levels: Troponins are proteins released into the bloodstream when cardiac muscle is injured. A marked rise in both Troponin T and I over a short period indicates acute coronary syndrome progressing to myocardial infarction, especially in a client with chest pain unrelieved by nitroglycerin.

Rationale for incorrect choices:

• Bleeding: The client’s aPTT is 32 seconds and platelet count is 350,000/mm³, both within normal ranges. These do not suggest any coagulopathy or increased bleeding risk, especially prior to thrombolytic therapy.
• Pulmonary embolism: While shortness of breath and anxiety can be symptoms of a pulmonary embolism, the primary lab indicator—rising troponins—points toward cardiac injury. Additionally, pulmonary embolism is typically diagnosed with D-dimer, CT angiography, or V/Q scan, not troponin trends.
• Shortness of breath: Though concerning, shortness of breath is a nonspecific symptom and can occur in multiple conditions including angina, anxiety, and myocardial infarction. It is not the primary diagnostic indicator in this case and does not support a specific risk like the troponin trend does.
• aPTT levels: The client’s aPTT is 32 seconds, which is within the normal reference range of 30–40 seconds. This does not suggest impaired clotting and therefore does not indicate a bleeding risk at this time.

A. Nosebleed: A nosebleed is not typically associated with dialysis disequilibrium. It may be related to other factors like dry air or blood pressure changes, but it is not a classic symptom of dialysis disequilibrium.

B. Malaise: Malaise can occur after hemodialysis due to various reasons, such as fluid shifts, but it is not a specific indicator of dialysis disequilibrium.

C. Headache: Headache is a common symptom of dialysis disequilibrium, which occurs due to rapid changes in fluid and electrolyte balance during hemodialysis. This can lead to cerebral edema, which manifests as a headache.

D. Elevated temperature: An elevated temperature is not a typical sign of dialysis disequilibrium. It could indicate an infection or other issues related to dialysis, but it is not directly related to disequilibrium.