Chapter 10 (ATI)- Electroconvulsive Therapy

ECT delivers an electrical current that produces a grand mal seizure. One theory suggests that ECT may enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain.

1. Severe Depression- Clients whose symptoms are not responsive to pharmacologic treatment. Client who is in her first trimester of pregnancy.
2. Certain types of schizophrenia that are less responsive to pharmacologic treatment.
3. Acute Manic Episodes- ECT is used for clients who have bipolar disorder with rapid cycling and very destructive behavior. Both of these respond poorly to lithium therapy so they have ECT and lithium therapy.

There are no absolute contraindications for this therapy if it is deemed necessary to save a client’s life. Higher risks for ECT:
A. Recent myocardial infarction
B. History of cerebrovascular accident
C. Cerebrovascular malformation
D. Intracranial mass lesion.

ECT has NOT been found useful in:
1. Developmental disabilities
2. Chemical dependence
3. Personality disorders
4. Situational depression

Preparation of the Client
The typical course of ECT treatment is three times a week for a total of 6-12 treatments.
Any meds that affect the client’s seizure threshold must be decreased or discontinued several days before the ECT procedure.
MAOIs and lithium should be discontinued 2 weeks before the ECT procedure.
A short period of hypertension occurs immediately after the ECT procedure.
30 minutes prior to the beginning of the procedure, an IM injection of atropine sulfate or robinul (Glycopyrrolate) is given to decrease secretions and counteract any vagal stimulation.

Ongoing Care
ECT is administered early in the morning after the client has fasted for 8 to 12 hours.
A bite guard should be used to prevent trauma to the oral cavity.
Electrodes are applied to the scalp.
Short-acting anesthetic is given then a muscle relaxant.
The electrical stimulus is typically applied for 0.2 to 0.8 seconds. Seizure activity is monitored, and the duration of the seizure, which is usually 25 to 60 seconds, is documented.

Post-Op Care
Client is positioned on his side to facilitate drainage and prevent aspiration.
Orient client frequently.

1. Memory loss
2. Reactions to Anesthesia
3. ECG changes- A client’s baseline heart rate is expected to increase 25% during the procedure and early recovery,
4. Headache, muscle soreness, and nausea.

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