A nurse is planning care for a client who is receiving internal brachytherapy. Which of the following interventions should the nurse include in the plan of care?

Anticipated:
• Administer an iron supplement.
• Refer for a nutritional consult.

Nonessential:
• Place the client on a low sodium diet.

Contraindicated:
• Restrict fluid intake.

Rationale:

• Administer an iron supplement: The client has iron deficiency anemia, indicated by low hemoglobin, hematocrit, RBC count, and ferritin levels. Iron supplementation is essential for replenishing iron stores and improving oxygen-carrying capacity.

• Refer for a nutritional consult: The client follows a vegan diet, which increases the risk of iron and vitamin B12 deficiencies. A nutritionist can provide dietary guidance to improve iron and vitamin intake through plant-based sources or supplementation.

• Place the client on a low sodium diet: Sodium restriction is typically necessary for conditions like hypertension, heart failure, or renal disease. There is no indication that

• Myocardial infarction: The rising troponin levels (Troponin T increasing from 0.08 ng/mL to 0.2 ng/mL and Troponin I rising from 0.01 ng/mL to 0.1 ng/mL) indicate myocardial injury. Persistent chest tightness, shortness of breath, diaphoresis, and anxiety suggest ongoing ischemia. The lack of complete pain relief after nitroglycerin further supports myocardial infarction rather than stable angina.
• Pulmonary embolism: Shortness of breath is a symptom of pulmonary embolism, but the absence of acute hypoxia, pleuritic chest pain, or significant coagulation abnormalities makes this less likely. The client's symptoms and laboratory findings more strongly support a cardiac etiology.
• Bleeding: While thrombolytic therapy increases bleeding risk, the aPTT (32 seconds) and platelet count (350,000/mm³) are within normal limits. There are no reported signs of active bleeding, such as hypotension, bruising, or hematuria, making this a less relevant immediate concern.
• Shortness of breath: Often present in myocardial infarction due to decreased cardiac output and pulmonary congestion. The combination of chest pain, diaphoresis, and dyspnea suggests worsening ischemia rather than a primary pulmonary process. However, it is a nonspecific symptom that can also indicate pulmonary embolism or respiratory distress.
• aPTT levels: Normal at 32 seconds (reference: 30–40 seconds), which suggests no immediate risk of abnormal clotting or excessive anticoagulation. This finding does not directly indicate myocardial infarction but is important in monitoring bleeding risk with thrombolytic therapy. A significantly elevated aPTT could raise concern for hemorrhagic complications.
• Elevated troponin levels: A highly specific marker for myocardial injury. The rise in Troponin T and Troponin I over time confirms myocardial damage, distinguishing acute coronary syndrome from stable angina. This trend is critical in diagnosing myocardial infarction, as troponin elevation correlates with the extent of cardiac muscle injury.