A nurse is performing discharge teaching to a client who was admitted for pyelonephritis.

Which of the following instructions related to the prevention of pyelonephritis should the nurse include in the teaching? Select all that apply.

Choice A rationale

This statement is incorrect because the primary protein responsible for transporting oxygen throughout the body is hemoglobin, which is found within red blood cells. Troponin is a complex of three regulatory proteins (C, I, and T) that are integral components of the contractile apparatus within cardiac and skeletal muscle fibers, not primarily an oxygen transporter.

Choice B rationale

Although elevated troponin levels are critical indicators of current myocardial injury, this protein's level is not used to reflect the long-term risk for coronary artery disease (CAD). Risk is assessed using factors like cholesterol levels, C-reactive protein (CRP), and clinical risk scores, while troponin specifically signals acute damage to heart muscle tissue.

Choice C rationale

This explanation is partially misleading because troponin is found in both cardiac and skeletal muscle, but the cardiac-specific forms (cTnI and cTnT) are released only when the heart muscle cells are damaged. Enzymes like Creatine Kinase (CK) and its MB isoenzyme (CK-MB) are less specific indicators because they are also released from general skeletal muscle and brain tissue injury.

Choice D rationale

Troponin is indeed a heart muscle enzyme that is highly specific to myocardial tissue injury, making it the preferred biochemical marker for diagnosing a myocardial infarction (MI). When ischemia causes cardiac cell death, the cardiac troponin I (cTnI) and troponin T (cTnT) are released into the bloodstream, where their levels rise significantly above the normal range (e.g., cTnI typically < 0.04 ng/mL).

Choice A rationale

Keeping the client flat and asking them to breathe deeper is inappropriate because the supine position increases abdominal pressure on the diaphragm, which can restrict lung expansion and worsen dyspnea and hypoxemia. Furthermore, simply asking a client with heart failure and a respiratory infection to breathe deeper does not address the underlying causes of their current oxygen desaturation.

Choice B rationale

Raising the head of the bed to a high Fowler's position (60 to 90 degrees) is the immediate priority intervention to manage the client's oxygen saturation of 92 percent, as this position significantly reduces venous return to the heart, decreasing preload and alleviating pulmonary congestion. This gravity-dependent effect also maximizes diaphragmatic excursion and improves overall lung ventilation and perfusion matching.

Choice C rationale

While administering supplemental oxygen may be necessary, raising the head of the bed is the most immediate and non-invasive action that the nurse can take independently to improve lung mechanics and gas exchange. The client's saturation of 92 percent (normal is 95 to 100 percent) indicates mild hypoxemia, making the position change the critical first step before or alongside initiating oxygen therapy.

Choice D rationale

Notifying the provider is an essential action after implementing immediate interventions to stabilize the client, such as repositioning and potentially administering oxygen, as per standing orders or protocol. The nurse must first address the hypoxemia and respiratory distress with independent nursing actions before seeking further orders or reporting the client's condition, unless the situation is immediately critical and life-threatening.