Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
48
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Nursing care of postoperative myocardial
revascularization patients in the Intensive
Care Unit: A case study
Ángela Patricia Dávila Gamboa1
Julieth Ximena Guerrero Córdoba2
Norma Viviana Moreno Montenegro3
Claudia Amanda Chaves4
To reference this article / Cómo citar este artículo
/ Para citar este artigo: Dávila-Gamboa, Á. P.,
Guerrero-Córdoba, J. X., Moreno-Montenegro, N. V.,
& Chaves, C. A. (2025). Nursing care of postoperative
myocardial revascularization patients in the Intensive
Care Unit. Revista Criterios, 32(1), 48-62. https://doi.
org/10.31948/rc.v32i1.4152
Reception date: May 15, 2024
Review date: August 23, 2024
Approval date: October 11, 2024
Abstract
Acute myocardial infarction is considered one of the leading causes of mortality
at the regional, national, and global levels; risk factors become the causal agent
of this pathology. Therefore, when a patient becomes ill, he/she requires surgical
treatment, such as myocardial revascularization, where care and management
are performed in the Intensive Care Unit (ICU) to ensure his/her survival. A
trained multidisciplinary team is required to ensure the patient’s successful
recovery. In this context, the nurse becomes an indispensable component,
who must have a thorough knowledge of the pathology and the established
treatment to provide the appropriate care with clinical judgment. The purpose
of this study was to determine the nursing care process for critically ill patients
undergoing postoperative myocardial revascularization after acute myocardial
infarction in the intensive care unit. The methodology used was an observational
and descriptive case study with application of the nursing care plan according to
1 Nurse, Hospital Universitario Departamental de Nariño. E-mail: patricia17davila98@gmail.com
2 Nurse, Unidad Cardioquirúrgica de Nariño. E-mail: julieth2211@hotmail.com
3 Master in Health Administration; Nurse Specialist for the Care of the Critically Ill Patient. Professor Universidad Mariana. E-mail:
nomoreno@umariana.edu.co.Código
4 Master in Nursing, Universidad del Valle; Specialist in Health Promotion and Disease Prevention Management; Nurse, Universidad
Mariana. Director of Graduate Programs in Health, Universidad Mariana; Member of the research group GIESUM. E-mail: cchaves27@
gmail.com
Case report article, result of research conducted for the Nursing Specialization in the Care of Critically Ill Patients. The research was
developed in the ICU of a Level IV care clinic in Pasto from April 21 to May 5, 2023.
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
49
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
the NANDA-NIC-NOC taxonomy (North American Nursing Diagnosis Association,
Nursing Interventions Classification, & Nursing Outcomes Classification). The
case study was performed on a patient who was admitted to the hospital with
‘severe chest pain’; after identifying electrocardiographic changes and positive
troponin results, cardiac catheterization was performed, followed by myocardial
revascularization. Thanks to the support of the multidisciplinary team, the
patient showed a satisfactory evolution. Therefore, nursing care in a patient
with this pathology should be personalized, focused on achieving hemodynamic
stability and comfort, considering the magnitude of the procedure, its complexity,
surveillance, and clinical monitoring.
Keywords: infarction; myocardial; myocardial revascularization; attention;
nursing; care; postoperative; intensive care
Cuidado de enfermería en paciente
posoperatorio de revascularización
miocárdica en la unidad de cuidados
intensivos: estudio de caso
Resumen
El infarto agudo de miocardio es considerado una de las primeras causas
de mortalidad a nivel regional, nacional y mundial; los factores de riesgo se
convierten en el agente causal de esta patología. Por ello, cuando un paciente
enferma, requiere de un tratamiento quirúrgico, como la revascularización
miocárdica, donde la atención y manejo se hace en la unidad de cuidados
intensivos (UCI), con el fin de garantizar su supervivencia. Para lograr la
recuperación exitosa del paciente, se debe contar con un equipo multidisciplinario
entrenado. En este contexto, el profesional de enfermería se convierte en el
componente necesario e indispensable, que debe conocer a fondo la patología
y el tratamiento establecido para realizar con juicio clínico el cuidado de
estos pacientes. El objetivo del estudio consistió en determinar el proceso de
atención de enfermería en paciente críticamente enfermo en posoperatorio de
revascularización miocárdica secundaria a infarto agudo de miocardio atendido
en UCI. La metodología utilizada fue estudio de caso observacional y descriptivo,
con aplicación del plan de cuidados de enfermería según la taxonomía NANDA-
NIC-NOC (North American Nursing Diagnosis Association, Nursing Interventions
Classification y Nursing Outcomes Classification). El caso de estudio se realizó
con un paciente que ingresó y refirió «dolor de pecho intenso»; después de
identificar cambios electrocardiográficos y resultados positivos en las pruebas
troponinas, se realizó un cateterismo cardiaco, seguido de revascularización
miocárdica. Gracias al apoyo del equipo multidisciplinario, el paciente presentó
una evolución satisfactoria. Por lo tanto, el cuidado de enfermería en un paciente
con esta patología debe ser personalizado, centrado en lograr su estabilidad
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
50
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
hemodinámica y su confort, teniendo en cuenta la magnitud del procedimiento,
su complejidad, vigilancia y monitorización clínica.
Palabras clave: infarto; miocardio; revascularización miocárdica; atención;
enfermería; cuidados; posoperatorios; cuidados intensivos
Cuidados de enfermagem de
pacientes com revascularização
miocárdica pós-operatória na Unidade
de Terapia Intensiva: Um estudo de
caso
Resumo
O infarto agudo do miocárdio é considerado uma das principais causas de
mortalidade em nível regional, nacional e global; os fatores de risco tornam-se o
agente causal dessa patologia. Portanto, quando um paciente adoece, ele precisa
de tratamento cirúrgico, como a revascularização do miocárdio, onde o cuidado e
o manejo são realizados na Unidade de Terapia Intensiva (UTI) para garantir sua
sobrevivência. É necessária uma equipe multidisciplinar treinada para garantir a
recuperação bem-sucedida do paciente. Nesse contexto, o enfermeiro se torna
um componente necessário e indispensável, que deve ter um conhecimento
profundo da patologia e do tratamento estabelecido para prestar o atendimento
adequado com julgamento clínico. O objetivo deste estudo foi determinar o
processo de assistência de enfermagem para pacientes criticamente enfermos
submetidos à revascularização do miocárdio pós-operatória após infarto agudo
do miocárdio na unidade de terapia intensiva. A metodologia utilizada foi um
estudo de caso observacional e descritivo com aplicação do plano de cuidados
de enfermagem de acordo com a taxonomia NANDA-NIC-NOC (North American
Nursing Diagnosis Association, Nursing Interventions Classification e Nursing
Outcomes Classification). O estudo de caso foi realizado em um paciente
que entrou no hospital com ‘dor torácica intensa’; após identificar alterações
eletrocardiográficas e resultados positivos de troponina, foi realizado um
cateterismo cardíaco seguido de revascularização do miocárdio. Graças ao apoio
da equipe multidisciplinar, o paciente apresentou uma evolução satisfatória.
Portanto, os cuidados de enfermagem em um paciente com essa patologia
devem ser personalizados, com foco na obtenção de estabilidade hemodinâmica
e conforto, levando em conta a magnitude do procedimento, sua complexidade,
vigilância e monitoramento clínico.
Palavras-chave: infarto; miocárdio; revascularização do miocárdio; assistência;
enfermagem; cuidados; pós-operatório; terapia intensiva
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
51
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Introduction
Acute myocardial infarction is currently
considered one of the most prevalent and
rapidly increasing pathologies. It is one of
the most common acute coronary syndromes
(Fundación Española del Corazón, 2019).
According to the American Heart Association
(2022), heart disease was the leading cause of
death in the United States by 2019. Every 40
seconds, someone suffers an acute myocardial
infarction, and the direct and indirect costs
of treating this condition are high due to its
recurrence.
In Colombia, cardiovascular diseases are
responsible for one-third of deaths in men
and women over 64 years of age, as well as
approximately one-fifth of deaths in the 45–64
age group. Not only does acute myocardial
infarction top the list of circulatory system
diseases that were overreported during the
entire pandemic period, it also accounts for 60%
of cardiovascular deaths, exhibiting behavior
similar to that of COVID-19 (Ministerio de Salud
y Protección Social, 2022).
In 2021, the Departamento Administrativo
Nacional de Estadísticas (DANE, 2022)
estimated an increase in deaths due to ischemic
pathologies. Acute myocardial infarction was
the cause of 91.1% of deaths due to ischemic
heart disease.
In 2021, ischemic heart disease was the leading
cause of death and hospitalization in Nariño,
with a mortality rate of 49.88 per 100,000
people. The highest rates occurred in 2016 and
2018. Circulatory system diseases are more
prevalent among men, with a rate of 55.08 per
100,000 people (Instituto Departamental de
Salud de Nariño [IDSN], 2022).
This pathology has manifested in young
populations due to lifestyle changes that favor
the development of atherosclerosis at earlier
stages, resulting in premature cardiovascular
events. Among the risk factors, the most
common are modifiable. In older adults, non-
atherosclerotic etiologies such as spontaneous
coronary dissection, anatomical alterations,
embolisms, and coronary spasms have been
identified with greater prevalence. Angiographic
findings, treatments, and resolution of
pathologies differ according to age group and
sex (IDSN, 2022).
Navarro and De Carlos (2020) argue that
myocardial revascularization is one of the
greatest clinical challenges in treating this
pathology. This treatment improves the quality
of life for patients with coronary artery disease
as long as they receive the necessary care
to prevent complications and readmissions to
hospitals. They also report that the quality of
life for patients who underwent this procedure
improved significantly. The authors also
showed that, after the procedure, factors
such as age, female sex, and having a SCORE
>4% influenced mortality. These factors were
associated with an increased risk of short-term
cardiovascular events.
Similarly, nursing care during a hospital stay
is fundamental to survival. It must be carried
out through assessment, diagnosis, planning,
execution, and evaluation. Professionals should
be guided by the Nursing Care Plan (NCP), as
Moguel-Palma et al. (2023) point out , for whom
the PAE is a scientific method that facilitates the
nurse’s autonomy to generate care innovations
for these patients.
Given the high prevalence of cardiac diseases
in Nariño, Colombia, and around the world,
as well as the successful use of myocardial
revascularization as a treatment, this study
aims to determine the nursing care required for
critically ill patients undergoing postoperative
myocardial revascularization due to acute
myocardial infarction. This care requires
frequent, complex interventions to restore
heart function, ensure survival, and improve
quality of life.
Methodology
This is an observational, descriptive, longitudinal
case study. It was conducted with a patient
in the intensive care unit of a fourth-level
hospital in Pasto, Nariño, Colombia. The study
was based on the Virginia Henderson model,
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
52
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
which provides comprehensive nursing care
during the postoperative period of myocardial
revascularization. A nursing care plan (NCP)
was developed, and the results were recorded
using the NANDA, NOC, and NIC taxonomies
(Butcher & Moorhead, 2021).
Results
Description of the case
Male patient, 53 years old, diagnosed with
diabetes mellitus six years ago. He is currently
being treated with Galvus Met 50 mg/1000
mg every twelve hours. He reported smoking
cigarettes approximately nine months ago and
having other bad habits and lifestyles. On April
21, 2023, he went to a primary care center
for a consultation because he experienced
severe chest pain (on an 8/10 scale according
to the Eva scale); the pain did not subside
with analgesics, spread to his left arm and
jaw, and was accompanied by diaphoresis and
breathing difficulties. Due to these symptoms,
an electrocardiogram was performed at the
health institution, which revealed ST-segment
elevation. Therefore, the diagnosis was acute
myocardial infarction. Based on this result, the
healthcare personnel initiated anti-ischemic
treatment, administered morphine, and
referred the patient as a vital emergency.
On April 22, 2023, the patient was admitted to
the ICU, remained stable, modulating chest pain,
with positive troponins and electrocardiogram
(ECG) report with ST-segment elevation. Due
to his diagnosis, he underwent hemodynamic
clinical monitoring without cardiovascular
support. He required oxygen through a nasal
cannula at a rate of three liters per minute and
maintenance fluids with a 0.9% normal saline
solution. His blood sugar levels were checked
every shift, and he had elevated troponin levels.
A cardiac catheterization and a transthoracic
echocardiogram were also requested. On
the same day, a cardiac catheterization was
performed, revealing severe macrovascular
alterations in multiple coronary arteries,
evidence of moderate microvascular coronary
artery disease, dilated mixed cardiomyopathy,
and severe systolic dysfunction with a left
ventricular ejection fraction (LVEF) of 25%.
Consequently, an evaluation by a cardiovascular
surgery was requested.
On April 23, 2023, the patient remained in
the ICU with hemodynamic monitoring in
postoperative left heart catheterization, plus
coronary angiography and thoracic aortogram.
He was subsequently transferred to the
cardiovascular surgery unit. Due to the patient’s
comorbidities and significant myocardial
weakness, hemodynamic management was
recommended, as well as treatment at a
center with balloon counter pulsation and the
ability to connect to extracorporeal membrane
oxygenation (ECMO).
On April 24, 2023, the cardiologist performed
an echocardiogram and requested the opinion
of the hemodynamicist, due to the need and
feasibility of performing angioplasty plus stent
placement. The patient did not present episodes
of chest pain, without ventilatory support, but
hemodynamically the blood pressure figures
were inclined towards hypotension; therefore,
the dose of carvedilol was reduced to 6.25 mg
orally daily; vasopressor support was started
with norepinephrine 0.03 mcg/kg/min to
maintain the mean blood pressure above 65
mmHg.
On April 25, 2023, the intensivist on duty
requested a medical meeting with the
hemodynamics and cardiovascular surgery
services. At a medical meeting on April 26,
2023, myocardial revascularization surgery
was confirmed. Since initiating the surgical
plan, clopidogrel was suspended. Due to an
LVEF of 27%, it was indicated to continue with
vasopressor support. It was also considered to
administer a levosimendan loading dose of 0.1
mcg/kg/minute for 24 hours. Antigen testing
for SARS-CoV-2 and control laboratories was
also indicated.
On May 1, 2023, the patient underwent a
myocardial revascularization procedure. The
physician explored the posterior descending
artery, performing a distal lateral anastomosis
from the saphenous vein to the posterior
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
53
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
descending artery. Also explored the
intermediate ramus artery, performing a distal
lateral anastomosis from the saphenous vein
to the intermediate ramus artery. Additionally,
explored the anterior descending artery,
performing a distal lateral anastomosis from
the left internal mammary artery to the
anterior descending artery. Lastly, the physician
inserted a right ventricular epicardial electrode
due to supraventricular tachycardia. Finally,
the physician performed a synchronous shock
of 10 joules with return to sinus rhythm and
transfusion of one unit of red blood cells and
six units of platelets; pump time was 65 min;
clamp time, 35 min; and active clotting time,
109 seconds.
After surgery, the patient was transferred to
the ICU; he was left on mechanical ventilation
with Fi02 of 70%, saturation of 100%, with
vasopressor support, prophylactic antibiotics;
he was placed on a bladder catheter, right
pulmonary artery catheter, peripheral access
arterial line. Similarly, pulmonary artery
catheter monitoring was performed with
wedges of less than 10 cm. The orotracheal
tube remained at 8 cm, the commissure at
22 cm. The transesophageal echocardiogram
output was 31% LVEF in stable surgery
requiring minimal vasopressor support. The
pump output was supported with milrinone
and noradrenaline on the first attempt. Also,
an echocardiographic scan was performed
with adequate qualitative contractility without
pericardial effusion , normal acid-base status,
and stable glycemia.
On May 2, 2023, the patient was extubated
without complication. There was adequate
diuresis, negative fluid balance, no fever,
controlled pain, minimal mediastinal bleeding,
normal acid-base status and lactic acid levels,
and adequate renal function and urine output.
Inotropia was suspended, and paraclinical
monitoring continued every six hours for 24
hours.
On May 3, 2023, the patient presented an
adequate respiratory pattern and normal
oxygenation, dependent on norepinephrine
titrated to 0.2 mcg/kg/min, improved cardiac
output, no pathological bleeding, no local chest
complications related to the surgery performed,
afebrile and without clinical signs of infection;
he tolerated the diet without difficulty and was
metabolically stable.
On May 4, 2023, the patient had elevated blood
glucose levels outside the target range despite
taking insulin. Therefore, dapagliflozin was
prescribed, and carvedilol was discontinued
due to the risk of hypotension. A selective beta-
blocker, metoprolol succinate, was added, and
the pulmonary artery catheter was removed.
On May 5, 2023, the patient was transferred to
the floor due to his satisfactory progress. He
presented an adequate respiratory pattern and
normal oxygenation, eliminating the need for
an active vessel.
On May 8, 2023, the cardiovascular surgeon
decided to discharge the patient with
medication and instructions for monitoring, an
electrocardiogram, a chest X-ray, an elastic
bandage, and postoperative care.
Theoretical foundation of nursing care
Nursing professionals need to align the nursing
care process with a theoretical model that
validates care and practice. In this case study,
Dr. Virginia Henderson’s model was adopted as
the central framework for nursing action. This
model emphasizes human needs for life and
health.
Hernández (2016) argues that:
Henderson believes that the fundamental
role of nursing is to help individuals, whether
healthy or sick, preserve or recover their
health, or assist them in their final moments.
This involves fulfilling needs that they would
otherwise perform themselves.
For Henderson, a nurse is someone who
helps patients with basic activities of daily
living, promotes health, aids in recovery
from illness, and ensures a peaceful passing.
For an individual to develop independence
with the help of nursing, it is necessary to
consider all external influences affecting a
person’s life and development. (p. 6)
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
54
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Virginia Henderson’s model is based on
a variety of care settings and is easily
applicable to patients undergoing myocardial
revascularization surgery. Since patients lose
complete autonomy during this procedure,
nurses are responsible for providing all
postoperative care and assisting with all
patient needs. In this sense, nursing plays a
fundamental role before, during, and after
interventions, especially in the recovery of
post-surgical patients, who are cared for in the
ICU. Based on this rationale, the clinical case
study addressed the following post-coronary
revascularization needs outlined in Henderson’s
theory:
• Breathing normally: During the
postoperative period of coronary
revascularization, the patient required
mechanical ventilation and was connected to
VCV mode with a FiO2 of 30% and a PEEP of
5, with saturations above 90%. Additionally,
he was connected to a pleurovac in the
mediastinum, through which he drained 15
cc of bloody fluid.
• Feeding and hydration: In the post-surgical
period, considering the short intubation
period, the patient was hydrated via the
peripheral route with Ringer’s lactate at 80
cc/h for maintenance. Additionally, he was
introduced to a liquid diet orally, progressing
according to his tolerance until adequate
feeding with the current hypoglycemic diet
was achieved.
• Eliminate by all body routes: Patient
with Foley catheter number 16 connected to
cystoflo, with urine of normal characteristics.
• Moving and maintaining appropriate
postures: Patient under sedation, with
Glasgow scale 3/15, Rass scale of -4, and
Braden 9; completely dependent on nursing
staff to meet this need.
• Sleep and rest: Patient permanently
subjected to noise caused by equipment
used in the ICU and frequent procedures at
any time of the day.
• Choosing appropriate clothing, dressing,
and undressing: The patient is completely
dependent on the staff to assist him during
the hospital stay.
• Maintain hygiene and skin integrity:
Patient totally dependent on the care staff.
This need was at risk because he was sedated,
with invasive monitoring, a mediastinal tube,
the presence of surgical wound and probes,
and limited mobility.
• Communicating with others to express
emotions and fears: sedated patient, in a
non-home environment, under restriction to
family members.
• To be occupied with something that
gives a sense of personal fulfillment:
monitored patient. This need was affected
by his clinical condition.
• Participate in recreational activities: this
need was affected by his clinical condition.
• Avoid environmental hazards and
injury to others: the patient presented an
increased risk of infection and complications
due to his pathology and clinical condition.
Nursing care plan in the postoperative
period after myocardial revascularization
The NCP was developed based on the nursing
diagnosis, focusing on problems and risks. Next,
NOC outcomes were planned to classify NIC
interventions and describe activities performed
on the patient. Finally, the patient’s response
was evaluated (see Table 1).
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
55
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Table 1
Nursing care process (NCP) of the myocardial revascularization postoperative patient
Domain class
diagnosis NOC (results) NIC
Intervention Activity
Need 01: To
breathe normally
Pattern 04:
Activity-exercise
Domain 04:
Activity/rest
Class 04:
Cardiovascular
pulmonary
responses
Code:
00200
Diagnosis: Risk of
decreased cardiac
tissue perfusion
related to cardiac
surgery
0405
Tissue perfusion:
cardiac
Domain 02:
Physiological health
Class e :
Cardiopulmonary
Pattern 01:
Perception
of health
management
4062
Circulatory
care, arterial
insufficiency
406201 Perform a thorough assessment
of the peripheral circulation
406203 Evaluate edema and peripheral
pulses
406204 Examine the skin for the presence
of ulcers
406207 Administer antiplatelet agents or
anticoagulants
406208 Perform postural changes of the
patient every two hours
406215 Maintain adequate hydration to
decrease blood viscosity
406217 Heal wounds, as required
4044 Cardiac
Care: Acute 404401 Assess chest pain
404403 Monitor heart rate and rhythm
404404 Auscultate heart sounds
404407 Monitor neurological status
404409 Select the best ECG lead for
continuous monitoring
404414 Control electrolytes that may
increase the risk of arrhythmias
404419 Monitor the efficacy of oxygen
therapy
404426 Administer medications to relieve
or prevent pain and ischemia
4044227 Monitor the effectiveness of the
medication
404430 Perform a thorough evaluation
of cardiac status, including peripheral
circulation.
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
56
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Domain class
diagnosis NOC (results) NIC
Intervention Activity
Need 01: To
breathe normally
Pattern 04:
Activity-exercise
Domain 04:
Activity-rest
Class 04:
Cardiovascular
and pulmonary
responses
Diagnosis:
Impairment of
spontaneous
ventilation
0403 Respiratory
status: Ventilation 3310 Weaning
from mechanical
ventilation
33102 Observe the patient to ensure
that he does not have serious infections
before weaning
331003 Observe if the hydric status is
optimal
33105 Position the patient in the best
possible way to use the respiratory
muscles and optimize diaphragmatic
descent
331006 Vacuum, if necessary
331009 Alternate periods of weaning trials
with periods of sucient rest and sleep
331013 Observe for signs of muscular
fatigue
331014 Administer prescribed
medications that promote airway patency
and gas exchange
331028 Determine patient readiness
for weaning (hemodynamic stability,
resolution of the disorder that required
ventilation, current optimal status)
331030 Initiate weaning with trial periods
(e.g., 30-120 minutes of ventilator-
assisted spontaneous breathing)
1872 Thoracic
drainage care 187201 Monitor for signs and symptoms
of pneumothorax
187202 Ensure that all tubing connections
are properly attached
187203 Keep the drain pan below chest
level
187207 Document chest tube water seal
oscillation, collected drainage, and air
leaks
187211 Observe for signs of intrapleural
fluid accumulation
186213 Observe for signs of infection
187237 Document the patient’s response
to coughing, deep breathing, postural
changes, including fluctuation, water seal
column sway, and bubbling in the chest
tube and drainage system
187239 Instruct the patient and family on
proper chest tube care
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
57
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Domain class
diagnosis NOC (results) NIC
Intervention Activity
Need 08: Hygiene/
skin
Pattern 02:
Nutritional-
metabolic
Domain 11: Safety/
protection
Class 02: Physical
injury
Code: 00047
Diagnosis: Risk
of deterioration
of skin integrity
related to impaired
circulation
1101
Tissue integrity:
skin and mucous
membranes
Domain 02:
Physiological health
Class l: Tissue
integrity
Pattern 02:
Nutritional-
metabolic
3660 Wound care 366003 Monitor wound characteristics,
including drainage, color, size, and odor
366006 Clean with physiological saline
solution or a non-toxic cleaner, as the
case may be
366008 Administer incision site care,
when necessary
366016 Inspect the wound each time the
bandage is changed
Need 04: To move
Pattern 04:
Activity-exercise
Domain 04:
Activity-rest
Class 05: Self-care
Code: 00182
Diagnosis:
Willingness to
improve self-care
1617: Self-
management of
heart disease
5510: Health
education 5510004 Determine the patient’s
knowledge, behaviors, and lifestyles.
Typical day and living conditions are
investigated to identify risk factors and
protective factors
551010 Identify personal resources,
such as space, equipment, and money,
to generate a care and education plan,
accessible to the patient and his family,
that allows meeting the objectives
established for home care
551008 Prioritize learning needs. So
far, the emphasis is on postoperative
care, surgical wound care, and feeding
to achieve early recovery and avoid
complications related to the disease
551005 Determine the current knowledge
of the patient and his family
First, family members are identied,
as well as their level of knowledge
regarding care. Then, the pharmacological
management, medical indications, and
administrative procedures for scheduling
appointments are explained, along
with other necessary care to ensure
the patient’s successful recovery and
adequate quality of life.
Note. PAE Model from Butcher and Moorhead (2021).
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
58
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Evaluation
Following the surgical procedure and his stay
in the ICU, the patient made a successful
recovery. Post-surgical tests confirmed
adequate cardiac function. His hospitalization
period was relatively short, and he was
discharged satisfactorily, with instructions to
undergo periodic outpatient checkups, and a
follow-up was initiated to ensure his continued
improvement. He maintains a good quality of
life and has adopted healthy habits.
Discussion
Case report of a 53-year-old male patient
who was admitted with a diagnosis of acute
myocardial infarction. Given this situation,
the treating physicians performed myocardial
revascularization to prevent death. According
to DANE (2022), in 2021, this disease affected
20.1% of the age group between 45 and 60
years, and was the cause of death. For its
part, the Ministerio de Salud y Protección
Social (2022) states that this condition is
«responsible for one-third of deaths in people
over 64 years of age and approximately one-
fifth of deaths in people between 45 and 64
years of age» (p. 28).
The study patient’s disease was caused by
an inadequate lifestyle: poor diet, medically
managed type II diabetes, a sedentary lifestyle,
and cigarette smoking, all of which depended
solely on him for the most part. This case is
related to the research conducted by Dattoli-
García et al. (2021), who point out that the most
predisposing risk factors for suffering a coronary
syndrome are those of a modifiable type, such
as smoking, since it causes complications in
patients suffering from an underlying disease
such as diabetes. Consequently, when coronary
syndrome occurs, the damage is much more
complex and requires surgical intervention to
save the patient’s life (Figueroa-Casanova et
al., 2022).
On the other hand, the main symptom presented
by the patient was ‘intense chest pain’, which
did not stop with analgesics and radiated to the
left upper limb, and jaw and was accompanied
by diaphoresis and shortness of breath. These
symptoms are related to an article by the
Fundación Clínica Shaio (2021), which mentions
that the main symptoms of a heart attack
include pressure, pain, or discomfort in the
chest and arms that can radiate to the neck,
jaw, and back; difficulty breathing; diaphoresis;
and fainting. According to the American Heart
Association (2022), the symptoms commonly
presented in coronary syndrome, evidenced in
80%, correspond to characteristic chest pain
accompanied by sweating, arm or shoulder
pain, shortness of breath, nausea, vomiting ,
neck and jaw pain (Urgencias y Emergencias,
2023). In the event of these symptoms, the
patient should go immediately to the medical
center for prompt treatment.
It is well-known that diagnosing and managing
acute myocardial infarction requires a
multidisciplinary approach. The most important
criteria for diagnosing this disease include
clinical symptoms, a physical examination
indicating cardiac ischemia, characteristic
electrocardiographic ndings, elevated markers
of myocardial necrosis, and imaging tests.
Over the past two decades, the management
of myocardial infarction has improved
signicantly. Consequently, after treatment,
patients have less extensive necrotic lesions,
a better prognosis, and a better quality of life
(Villalobos-Espinosa, & Vázquez-Nava, 2022).
Considering the patient’s condition and according
to medical assessments, it was necessary to
perform myocardial revascularization to correct
the damage generated at the arterial level. This
surgical procedure is frequently performed in
other countries, as indicated by the Navarro
and De Carlos (2021) study, which reports
more than 70,000 successful short- and long-
term revascularizations. In terms of mortality,
survival at one year of life of the patients was
90%, who, in addition, did not present a second
cardiovascular event during this period. Ten
years after surgery, 73.1% of them survived;
therefore, the invasive procedure is frequently
performed; its eectiveness and reliability
have improved the health status of patients
and prevented a new coronary episode.
This procedure is frequently performed in
Colombia and has shown optimal results, as
stated by Castellano et al. (2022). They point out
the risk factors, symptoms, and determinants
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
59
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-62
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
that determine the appropriate treatment,
which is usually myocardial revascularization
because it is a safe procedure that provides
excellent results. According to Sainz-Cabrera
(2020), this procedure is often used to detect
coronary pathologies in younger patients.
A ve-year postoperative follow-up showed
that these patients had an optimal quality of
life. These data are related to the research of
Espinoza et al. (2022), who followed up patients
who underwent myocardial revascularization;
approximately 96.2% had dierent risk factors,
and now have ten years of survival after the
procedure.
Considering the magnitude of the procedure,
the multidisciplinary team that acts must be
fully trained. Therefore, Nursing, in the surgical
act, plays a fundamental role, especially given
their specialty: Perfusionist, since they are in
charge of performing extracorporeal circulation
and intraoperative care, vital during surgery.
These trained nurses allow the attending
physician to properly perform the procedure
and keep the patient alive while cardiac
function is restored during revascularization.
In the words of Vázquez et al. (2022):
The perfusionist nurse is in charge of leading
the extracorporeal circulation (ECC), an act
generally used to perform cardiac surgery,
whose main function is the substitution of
cardiac and pulmonary activity that allows
the dierent surgical techniques to be
performed on the heart. (p. 3)
The nursing professional, through care,
should be able to reduce the incidence of
complications and provide greater safety to
the person (Vázquez et al., 2022). From this
point of view, it is evident the importance of
a qualied nursing sta, which performs such
interventions and provides intraoperative and
postoperative care in the ICU, considering that
these procedures ensure, at least, 50% of the
patients’ recovery.
The study by Cortez et al. (2020) mentions
that through specic and patient-focused care,
optimal results are achieved that lead to a
reduction in hospital stay. This is also related
to the study by Rueda and Torres (2020),
which states that the primary objective of
postoperative intensive care in cardiac surgery
is to recover homeostasis, which is aected
by the pathophysiological changes caused
by the use of extracorporeal circulation,
ischemia-reperfusion phenomena in the heart,
hypothermia, coagulation disorders, and the
adverse eects of transfusions and bleeding.
In this case study, the nurse played a key
role in the patient’s recovery, providing direct
postoperative care and comprehensive ICU
management, ensuring hygiene and safety,
comfort, and well-being. In this sense, the
process of caring as a professional action is linked
to the nursing sta, requiring a commitment
that goes beyond the mere performance of a
series of caring actions. The above is related to
what is described by Rueda and Torres (2020),
who state that the commitment reaches the
disciplinary development, since there must
be solid knowledge on the management of
these pathologies to oer nursing care that
provides safety to patients and families during
hospitalization, ensuring quality care in the
procedures derived from the pathology.
It is important to highlight that the care
provided by the nursing sta was essential to
the patient’s recovery. The patient experienced
a brief postoperative period with favorable
progression and was discharged at an optimal
time.
Conclusions
The patient developed coronary artery disease
due to inadequate modifiable risk factors. In
this case, the main symptom was chest pain.
As a result, the surgical treatment consisted
of myocardial revascularization. Nursing care
was essential for a short hospital stay and a
satisfactory recovery.
The nursing care plan for patients with
coronary artery disease undergoing myocardial
revascularization focuses primarily on achieving
hemodynamic stability and comfort, based
on the patient’s care needs, considering the
magnitude of the procedure and its complexity.
These treatments require clinical surveillance
and monitoring to detect changes, alert the
medical team, and provide immediate solutions
to ensure the success of the procedure and an
optimal recovery.
Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
60
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
https://doi.org/10.31948/rev.criterios
Conict of interest
The authors declare that they have no conicts
of interest regarding the presented work.
Ethical Responsibilities
The study was based on Resolution 8430 of 1993
and had the patient’s consent before sharing
any information related to the case study.
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Nursing care of postoperative myocardial revascularization patients in the Intensive
Care Unit: A case study
62
Ángela Patricia Dávila Gamboa
Julieth Ximena Guerrero Córdoba
Norma Viviana Moreno Montenegro
Claudia Amanda Chaves
Revista Criterios - vol. 32 n.o 1 Enero-Junio 2025 - pp. 48-82
Rev. Criterios ISSN: 0121-8670, e-ISSN: 2256-1161
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Contribution
All the authors participated in preparing the
manuscript and approved it.
