Prevention of delirium after open heart surgery

INTERVENTION: After sampling in the control group, preventive measures are done by researcher in the intervention group from the first day after surgery till the end of the fifth day such as: Installation of clock and calendar at the room, informing time, place and the last event to the patient three times a day, using proper lighting during the day and night, providing glasses, hearing aids and dentures to the patients who already used these devices, Prevention from dehydration (drinking enough liquids in case of dehydration and no contraindications), Encouraging the patient to move out of bed and helping him/her to do personal activities in order to maintain his independence, Preparations for a proper sleep (not using coffee, tea and dairy products before sleep time, enough exercise during the day, Reducing or eliminating unwanted extra noise around the bed and gentle massage on the back of the patient), preventing constipation (enough drinking, proper food diet with enough fiber and exercise Intervention 1: After sampling in the control group, preventive measures are done by researcher in the intervention group from the first day after surgery till the end of the fifth day such as: Installation of clock and calendar at the room, informing time, place and the last event to the patient three times a day, using proper lighting during the day and night, providing glasses, hearing aids and dentures to the patients who already used these devices, Prevention from dehydration (drinking enough liquids in case of dehydration and no contraindications), Encouraging the patient to move out of bed and helping him/her to do personal activities in order to maintain his independence, Preparations for a proper sleep (not using coffee, tea and dairy products before sleep time, enough exercise during the day, Reducing or eliminating unwanted extra noise around the bed and gentle massage on the back of the patient), preventing constipation (enough drinking, proper food diet with enough fiber and exercise during the day) not using physical limitations if possible, using local languages in the care of patients with diverse language and culture, using replaced oxygen to keep content of arterial oxygen above 95% and regular scheduled visit of the family and friends twice a day, each time for 30 minutes. The role of family and close friends at the patient bedside: (1) informing the patient about the place, time and recent events, providing the patient's favorite music or radio program or provide a cassette that recorded the voices of family members) 2( present the familiar objects in the room by their patients (photos, books, newspapers, pillows or soft pillows). Intervention 2: The researcher selects control group patients among all eligible patients who participate in this study. The control group received the usual nursing care and haloperidol injection. Prevention The researcher selects control group patients among all eligible patients who participate in this study. The control group received the usual nursing care and haloperidol injection. CONDITION: Delirium, not induced by alcohol and other psychoactive substances Delirium. ; Delirium, not induced by alcohol and other psychoactive substances SECONDARY OUTCOME: ‐. Timepoint: ‐. Method of measurement: ‐. INCLUSION CRITERIA: INCLUSION CRITERIA: no record of delirium before open heart surgery; Age of over 18 years; an elective open heart surgery Exclusion criteria: PRIMARY OUTCOME: The incidence of delirium. Timepoint: Patients of open heart surgery should be evaluated for delirium incidence during the day before surgery between 16 to 20 p.m. then, they have to be evaluated one day after surgery until the end of the fifth day of hospitalization once a day, at the same time. This evaluation is due to an increase of the delirium incidences in this period. Method of measurement: The measure of the delirium incidence is based on Neecham questionnaire. Impairment of consciousness; stroke; using psychological drugs; having a depressive disorder; Recent use of opiate drug and alcohol; absolute blindness and deafness; aphasia due to the inability to fill the questionnaire; having delirium on the first day after surgery; emergency heart surgery; having intubation more than 24 hours after surgery; died during surgery or during investigation; and Patients refuse to cooperate with preventive nursing measure during the study