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Download Nursing Education for Electroconvulsive Therapy
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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
