Transcript Nursing Education for Electroconvulsive Therapy

Nursing Education
for
Electroconvulsive Therapy
By:
Alisha J Dancy MSN RN
https://www.youtube.com/watch?v=DCUmINGae44
Learning Objectives

Identify diagnosis for ECT

Identify equipment needed

Explain electrode placement

Seizure duration

Explain mini mental exam

Identify post procedure monitoring

Describe discharge requirement

List 3 contraindications

List 3 common ECT side effects

Medications contraindicated for ECT
History of Electroconvulsive
Therapy

Observation of spontaneous seizure benefit on
Schizophrenia

1938 start of using Medications

1939 Italian doctor use of electric stimulation

1939 1st United States ECT

Decline in popularity in the 1970
Purpose for This Education

Inform nurses of evidence based
recommendations

Educate the nurses on the actual
procedure

Inform or reeducate nurses of ECT
complications

Improve nurses clinical practice
Definition of ECT
ECT is a method where electric currents are passed through
the brain, deliberately triggering a momentary seizure. Through
this electrical stimulation of the brain, ECT appears to produce
alterations in brain chemistry that can enable a rapid reduction in
the signs and indicators of selected psychiatric and mental health
disorders, e.g., severe depression and bipolar disease.

Mayo Clinic, 2013
Mechanism of Action

The mechanism of action is unknown

Research determined that ECT increase monoamine
transmitters (dopamine & serotonin)

ECT increase the release of central neuro peptide, the
neuro endocrine hypothesis suggest insufficiency of the
hypothalamic mood maintaining peptide

MRI revealed reduction in global connectivity
Ultimately, our brain and CNS is so complex there is no
clear, definitive answer on exactly how ECT works
Indications for ECT
Patients who are resistant to pharmacological interventions
and present with:

Major Depressive Disorder (MDD)

Bipolar Disorder

Schizophrenia

Parkinsonism, not responding to medication
Equipment /Supplies
Nurses responsibility is to ensure availability
and set-up of:

ECT machine

Electrodes

Gel

Cardiac monitor

Pulse oximetry

Bite Block

Blood pressure
machine

Suction machine
Mini Mental Exam
The MMSE is a reliable tool that takes 5 minutes to
complete the focuses on
Appearance
Behavior
Cognition
Thought Process
Ballas, C. (2012)
Stages of nursing process
ECT patients sequence process
Pre Procedure Area
Treatment Room
Recovery Room
Phase II
Kavanagh & McLoughlin (2009)
Pre-Procedure
Pre-Op Nurses
Completes the pre- ECT checklist consisting
of:

Verification of NPO status

Removal of jewelry/clothing etc.

Verifying allergies

Verifying patient awareness of the
procedure
Pre-Procedure cont.

Obtaining baseline vital signs

Verifying medical clearance

Existence of Laboratory results

Verify existence signed consents

Obtain intravenous access
Additionally, the nurse must be
knowledgeable of medications and
conditions with increased risk
Pre Procedure cont.

The anesthesia provider will verify and
assess the patient pre procedure for
necessary components essential for
anesthesia
e.g.: airway , allergies, NPO status, medication for anesthesia

The psychiatrist is the healthcare
provider who administers the ECT
e.g. diagnosis, treatment dosage
The ECT Procedure

Anesthesia is administered

Electrodes place either unilaterally, bilaterally and bifrontal

The electrical impulse of 70 - 150 V

The desired seizure duration of 15-50 seconds

Chemical changes occur
Series lasting 6 to 12 therapeutic sessions
Followed by ECT maintenance
Phase I/ Recovery
Nurse Responsibility

The patient is assessed and monitored according to best
practice standards and facility guidelines as follows:

Provide continuous cardiac monitoring

Blood pressures every 15 minutes or less

Continuous Pulse Oximetry

Assess LOC /Mini Mental Exam
Discharge Criteria

Blood pressure within 20% of baseline

room air saturation at baseline,

follows commands,

no post op nausea/ headache

oriented to person place & time
Phase II/ Recovery



Once discharge criteria is met the patient
then transitions to the next level of care
Inpatient room
Outpatient –home with responsible adult
D/C Criteria Includes:
Oriented x 3
Tolerating food and drink
No nausea, headache
Side Effects/Adverse Reactions

memory loss- anterograde and retrograde

nausea

headaches

muscle aches

Tardive seizure – rare potentially fatal
Considered safe for children, pregnant women and elderly
ECT current death rate is approximately 2 per 100000
treatments
Condition with increased Risk/
Contraindications





Vascular aneurysms
Central nervous system conditions
associated with ↑ intracranial pressure
Some brain tumors
Recent cerebral infarct
Severe pulmonary or other organ
system disease presenting ↑ anesthesia
risk
No true contraindications for ECT
Contraindications cont.
Increased risk of complications
from electrical stimulation

Recent myocardial infarction

Congestive heart failure

Valvular heart disease
Medication Contraindications

Anticonvulsants
Interfere with seizure production

Antieleptic mood stabilizers
Tapered and stopped before ECT

Benzodiazepines
Potential anticonvulsant

Lithium
Neuro toxicity & poor outcome
https://www.youtube.com/watch?v=-T0mwzXHgvI
Conclusion
ECT is a safe treatment for patients who are
resistant to other forms of therapy
The continued success of ECT patients
outcomes are dependent on the ECT team
especially the nurses who care for the
patients and are knowledgeable in their
assessment and care pre and post
procedure.
Thank You