"Following the stent placement, the nurse should monitor the patient’s blood pressure, apicalheart rate and respirations for 24 hours. The patient should be advised to be in supine positionfor two to six hours after the procedure as it helps the artery to heal from the insertion of thecatheter. The nurse should assess the puncture site to check the signs of bleeding, hematoma,infection or ecchymosis. Swelling, redness, and pain are the signs of hematoma it indicatesinternal bleeding in the thigh, pelvic or retroperitoneal space. The nurse should assess for potential complications such as retroperitoneal bleeding,arrhythmias, and thrombus. The nurse should pay attention to the peripheral vascularassessment of the lower extremities. The nurse should check the neurovascular observationsby assessing the color of the limbs, warmth, CRT, pulse strength, sensation, movement, andpain.In case the patient has clot at the arterial access then the affected limb appears pale,cool and diminished or absence of a pulse at the distal side of the insertion site. Patient hasdecreased sensation and delayed CRT due to lack of arterial blood supply. A Dopplerultrasound can be used to assess the pulse on the left foot. Neurovascular observations shouldbe performed with every set of observations (Hamon, et al., 2012).The nurse should assess the puncture site for every 30 minutes for the first 4 hours post- surgery than for every 60 minutes until ambulation.Reassess the puncture site after the firstambulation and then minimum 4 hours before discharge. The nurse should provide regularanalgesia as ordered and ensure that the head of the patient’s bed is not higher than 30degrees during bed rest. The nurse should notify the physician if the patient has changed in neurovascularobservations. A +- Ultrasound should be performed to confirm clot. If the patient has clotformation, then the physician will order Antithrombotic agent usually heparin infusion isused as first line treatment for an occluded blood vessel.A saline flush is a used to clear intravenous line or central lines to keep the tubes clean andsterile, flushing with saline is usually painless if the cannula is intact and properly place. Apainful flush indicates phlebitis or tissuing, and it suggests the need to relocate the cannula.In the given case study, the patient complains of severe pain when the RN flushes thecannula. Pain is the early symptom of phlebitis so the nurse should follow measure toalleviate pain and should remove the catheter. The nurse should follow the institutional procedure for caring for sheaths applied during thecardiac catheterization. Some institutions require physicians to remove the sheath while someallow the nurses to remove the sheath (Schiks, et al., 2007). ACT may be necessary in someinstitutions to check the patient’s clotting time before removing sheaths. The nurse shouldencourage the patient to drink at least 2 liters of fluid during the first 12 hours after cardiaccatheterization. It helps to prevent dehydration and hypotension. The patients with cardiac diseases should be recommended to cardiac rehab services as it is amedically supervised program which helps the patients to improve their cardiovascular healthespecially after undergoing an angioplasty or heart surgery. At cardiac rehab, the nurses andhealth care professionals teach exercises that enhance heart pumping and functioning ofentire CV system. Patients are educated how to manage the risk factors such as quittingsmoking, and they are trained to lead a healthy lifestyle and intake proper nutrition.Stressmanagement techniques are taught at cardiac rehab centers which help the patients to tackleeveryday sources of stress. The nurse should reinforce post-catheterisation teaching to the patient and family membersduring the discharge. The patient must be suggested to take adequate rest and drink plenty offluids. She should be advised to avoid lifting heavy objects and strenuous exercise for at least24 hours. The patient should be advised to check for the bleeding at the site of catheter insertion. The patient should be advised to lie down, apply pressure and call the physician ifbleeding begins at the catheter insertion site. The patient should be suggested to check andreport the physician immediately if there is a change in color of lower extremities, pain or awarm feeling in the area where the catheter was inserted. The patient should be suggested totake clopidogrel as prescribed to prevent the formation of blood clots at the site of treatmentduring healing. The nurse should provide emotional, spiritual and social support to the patient and familymembers.The nurse should provide complete information about the diagnosis, treatment,and procedure to the patient and develop a culturally competent care plan. Consulting withthe patient’s community health services and customizing the services to meet the needs andpreferences of patient’s cultural beliefs will help to provide culturally competent care (King,et al., 2012). It is important to follow therapeutic communication skills while caring for thepatients. It helps to build support and rapport with the patients. In the given case study, theregistered nurses followed the therapeutic communication skills while interacting with thepatients. They have given appropriate pieces of advice to the patient and family membersduring the hospital stay. In the given case study, Registered nurse where delegated to monitor, record and report thesymptoms of the patient. They maintained accurate and detailed reports and recorded thepatient’s vitals as per the cardiac protocol. Further, the sheath was removed by the RN as perthe institutional policy. Further, an RN during the shift has identified neurovascular changesand reported the physician. During the discharge, the RN has instructed the care guidelines tothe patient and her family members and also introduced to cardiac rehab nurse."