What client teaching will the nurse provide prior to electroconvulsive therapy?
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After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, “I can’t even remember eating breakfast, so I want to stop the ECT.” Which is the most appropriate nursing reply? Show
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone. Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects. ECT is much safer today. Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks. Products & Services
Why it's doneElectroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:
ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:
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You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. It is typically administered by a team of trained medical professionals that includes a psychiatrist, an anesthesiologist, and a nurse or physician assistant. Extensive research has found ECT to be highly effective for the relief of major depression. Clinical evidence indicates that for individuals with uncomplicated, but severe major depression, ECT will produce substantial improvement in approximately 80 percent of patients. It is also used for other severe mental illnesses, such as bipolar disorder and schizophrenia. ECT is sometimes used in treating individuals with catatonia, a condition in which a person can become increasingly agitated and unresponsive. A person with catatonia can seriously injure themselves or develop severe dehydration from not eating or drinking. ECT is typically used when other treatments, including medications and psychotherapy, haven’t worked. ECT is also used for people who require a rapid treatment response because of the severity of their condition, such as being at risk for suicide. ECT’s effectiveness in treating severe mental illnesses is recognized by the American Psychiatric Association, the American Medical Association, the National Institute of Mental Health, and similar organizations in Canada, Great Britain and many other countries. Although ECT can be very effective for many individuals with serious mental illness, it is not a cure. To prevent a return of the illness, most people treated with ECT need to continue with some type of maintenance treatment. This typically means psychotherapy and/or medication or, in some circumstances, ongoing ECT treatments. Before beginning a series of ECT treatments, a patient should receive a thorough psychiatric assessment, including a medical examination and sometimes a basic blood test and an electrocardiogram (ECG) to check heart health. Informed consent is another important part of the process. A patient must provide written informed consent before ECT is administered. In situations where a person is too ill to make decisions for him or herself, the consent process is governed by state law (for example, a court-appointed guardian). Patients and their families should discuss all options for treatment with the psychiatrist before making a specific treatment decision. They should be provided with sufficient information to fully understand the procedure and the potential benefits, risks, and side effects of each treatment option before providing written consent. A patient typically receives ECT two or three times a week for a total of six to 12 treatments, depending on the severity of symptoms and how quickly the symptoms respond to the treatment. At the time of each treatment a patient is given general anesthesia and a muscle relaxant and electrodes are attached to the scalp at precise locations. The patient's brain is stimulated with a brief controlled series of electrical pulses. This causes a seizure within the brain that lasts for approximately a minute. The patient is asleep for the procedure and awakens after 5-10 minutes, much as from minor surgery. Most insurance plans offering coverage for psychiatric disorders at least partially reimburse the cost of ECT. What are the Risks and Benefits?Like any medical procedure, ECT is has some risks. ECT treatment has been associated with short-term memory loss and difficulty learning. Some people have trouble remembering events that occurred in the weeks before the treatment or earlier. In most cases, memory problems improve within a couple of months. Some patients may experience longer lasting problems, including permanent gaps in memory. The risks of general anesthesia, which is needed for ECT, are similar to the risks when anesthesia is used for other procedures such as minor surgeries. The most common side effects of ECT on the day of treatment include nausea, headache, fatigue, confusion, and slight memory loss, which may last minutes to hours. These risks must be balanced with the consequences of ineffectively treated severe psychiatric disorders. For some patients, the risks of ECT may be less than those of ongoing treatment with medications. ECT can work more quickly than medications. It can be especially useful if a patient is suicidal, is not responding to medications or cannot tolerate the side effects of medication. Other Brain Stimulation TreatmentsTranscranial Magnetic Stimulation (TMS) is used to treat depression that has not responded to other therapies. It involves the use of rapidly alternating magnetic fields to stimulate specific areas of the brain. Unlike ECT, TMS does not cause a seizure and the patient remains awake through the noninvasive process. TMS typically only has mild side effects including headaches, muscle twitches and pain at the stimulation site. TMS is usually administered four or five times a week for four-to-six weeks. Vagus Nerve Stimulation (VNS) was developed as a treatment for seizure disorders but can also be used to treat depression that has not responded to other therapies. It involves implanting an electrical pulse generator under the skin in the patient’s chest that provides intermittent electrical stimulation to the vagus nerve in the neck. Which of the following is important for the nurse to obtain before electroconvulsive therapy?Before beginning a series of ECT treatments, a patient should receive a thorough psychiatric assessment, including a medical examination and sometimes a basic blood test and an electrocardiogram (ECG) to check heart health.
What should be done prior to ECT?Before having your first ECT treatment, you'll need a full evaluation, which usually includes:. Medical history.. Complete physical exam.. Psychiatric assessment.. Basic blood tests.. Electrocardiogram (ECG) to check your heart health.. Discussion of the risks of anesthesia.. What was the nurse's role in the ECT therapy?The nurse serves as a liaison between the psychiatry and anesthesia departments and the outpatient and ECT treatment team. This facilitates obtaining necessary medical evaluations or preparations prior to treatments. This may involve coordinating blood tests, EKGs, x-rays, or medical consultations.
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