Psychiatric nursing HDN 314 Assignment 1: Electroconvulsion therapy a. Definition b. indication c.

nursing care for patient before, during and after ECT procedure d. complication of ECT

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Assessment structure Assessment type Overall mark

_________________________________________________________________________________________________ Coursework Assessment 10%

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Score Name ID/no Group Name of lecture Submission date

: : Lynnora Raynord : 01-200906-00536 : 5C : Mr. David Quek Sim Kee : 19/1/2012

Definition for Electroconvulsive therapy A procedure in which an electric current is passed through the brain to produce controlled convulsions (seizures) to treat patients with depression, particularly for those who cannot take or are not responding to antidepressants, have severe depression, or are at high risk for suicide. For patient how have depression, schizophrenia, Bipolar Disorder, dissociative identify disorder, dysthymia, mental illness.

Indication for patient who have Electroconvulsive therapy

Curative electroconvulsive therapy (ECT) remains a very useful treatment, still irreplaceable for some specific rare cases, as long as other brain stimulation methods, such as transcranial magnetic stimulation, remain experimental. ECT must be preceded by a rigorous evaluation of its therapeutic index, based on its advantages and risks compared with other potential treatments, in view of the patient's medical and psychiatric history. The principal indication is very severe depressive illness. In view of its efficacy and speed of action, ECT may be a first-line treatment for life-threatening depression and a second line treatment for patients with major depressive disorder who do not respond or respond incompletely to antidepressant drugs. ECT remains

an important treatment option for depression in the elderly, especially those with depression and reversible dementia. It has also been used in Parkinson's psychosis and drug-resistant epilepsy. Preventive or maintenance ECT is appropriate for a few depressed patients who respond to it and it alone.

Nursing care for patient before, during and after going to ECT

i.

ii.

providing education and emotional support - explain the procedure to the patient - Obtain an information consent form the patient and the carer. - Respond to patients concerns and feeling. - Educzte the patient concering the procedure on knowledge deficits. Pre-treatment planning and assessment. - Preparation of treatment suite for the ECT procedure - An adjustable height stretcher trolley - Complete the pre-treatment check list. - The checked identity patient. - Ensure keep patient valuable. - Nil by mouth minimum 4 hours before treatment to prevent possible aspiration during anaesthesia. - Patient hair should be clean and dry to allow the electrode contact. - Hair pin, bracelets, body piercing should be remove to avoid burns. - Patient should be encouraged to pass urine before the treatment to avoid incontinence during the procedure. - Prostheses, dentures, glasses, hearing aids, contact lenses should be removed.

- Minimise anxiety through anxiety management techniques, ensuring short waiting time and offering reassurance and support. - Standard practices should be practiced regarding general anaesthesia care.

iii.

Preparing and monitoring the patient during the actual procedure - Transfer the patient on a trolley the waiting room to the ECT room well padded bed and placed in a comfortable dorsal position or supine position. A small pillow is placed under the lumber curve. - Apply ECG electrodes, BP cuff, and pulse oximetry sensor not on same extremity as BP cuff. - Give a short acting anaesthetics agent. Thiopental. 25mg to 5mg, IV and apply paste to electrodes. - Prepare scalp and stimulus ECT electrodes unilateral vs bilateral and apply past to electrodes. - Support the shoulder and arms of patient. Restraint the patient with sheet. - Hyperextension of the head with support to the chin. - Administer oxygen - Apply jelly to the electrides - Make the observation of the convulsion. - The presence of inital tonic stage which last for 10-15 second followed by clonic stage which lasts for 25-30 second then there is a phase of muscular relaxation with setrtorus respiration example flaccid stage. - Do suction immediately - Restore respiration by giving oxygen if necessary.

iv.

Post ECT care - Observe and record the vital sign patient. - Place the patient on side lying position, clean the secretion. Transfer the patient from recovery room, record

vital sign every 15 minute for 30 minute and once in every 30 minute till the patient recover to normal stage. Allow the patient to sleep for 30 minute to one hour. Reassure the patient reorient to the ward Allow the patient to have tea or any drinks Record the procedure.

Complication The major complications from ECT are cognitive side effects. Immediate side effects from ECT are rare except for headaches, muscle aches or soreness, nausea, and confusion that usually disappear during the first few hours following the procedure. During the course of ECT, there may be difficulty remembering newly learned information, or profound confusion and hallucinations (delirium). The learning difficulty and delirium usually disappear within weeks of completing the ECT course.

Some individuals also report a partial loss of memory for events that occurred during the days, weeks, and months preceding ECT. While most of these memories typically return over a period of days to months, some individuals have reported longer lasting problems. Conversely, other individuals report improved memory capability following ECT, possibly because of improvement in forgetfulness (amnesia) sometimes associated with major depression.

The severity of memory deficit is related to the number of treatments, type of electrode placement, and nature of electrical stimulus. Unilateral electrode placement is preferred over bilateral electrode placement by many psychiatrists because of fewer effects on cognition.

Physical complications such as spinal or other fractures reported in the early days of ECT are almost never reported in present practice because of administration of anesthesia and muscle relaxants in a controlled environment. Other physical complications such as a change in normal heart rhythm (arrhythmias) or increased seizure-like activity on EEGare still occasionally reported.

Another possible complication is relapse within 6 months after treatment. Therefore, some type of maintenance treatment (e.g., antidepressants, antipsychotic drugs (neuroleptics), or ECT administered monthly or at 6week intervals) is often recommended to minimize relapse.

Reference - http://www.medterms.com/script/main/art.asp?articlekey=22586 - http://www.omh.state.ny.us/omhweb/ect/clinical_indications.html - http://www.ncbi.nlm.nih.gov/pubmed/18385009 - http://nursingplanet.com/pn/nursing_care_ECT.html - http://www.mdguidelines.com/electroconvulsivetherapy/complications