intake of at least 2500 cc / day unless contraindicated, humidify inspired air ,assist with administration of mucolytic agents via nebulizer or IPPB treatment, instract and assist patient with effective coughing techniques every 1 - 2 hours unless contraindicated., tracheal suctioning. (41) . Maintain adequate systemic tissue perfusion by preventing peripheral pooling of blood by instructing patient in and assist with active foot and leg exercises for 5 - 10 minutes every 1 - 2 hours, discourage positions that compromise blood flow in lower extremities (e.g. crossing legs, pillows under kness),change positions slowly to allow time for autoregulatory mechanisms to adjust to position changes, avoid exposure to cold causes generalized vasoconstriction.(42). The incidence of gastrointestinal disturbances after open heart surgeries due to several causes such as infection, antibiotics and narcotics muscle relaxants and applying the principals of aseptic techniques for preparing food for nasogastric feeding decreases the incidence of these disturbances (43). Encourage patient to drink warm liquids to stimulate, apply heat to the abdomen for 20 minutes every 2 - 3 hours unless contraindicated, consult physician regarding insertion of a rectal tube, avoid gas-producing foods / fluids (e.g. carbonated beverages, baked beans) for abdominal discomfort.(44).Eliminate noxious sights and smells from the environment (noxious stimuli cause cortical stimulation of the vomiting center),also encourage patient to take deep ,slow breaths when nauseated ,instruct patient to change positions slowly