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Nursing Education for Electroconvulsive Therapy
By: Alisha J Dancy MSN RN Thanks for invite Remind Questionaire Backgroud on self Mention about movie
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https://www.youtube.com/watch?v=DCUmINGae44 After video
History of ECT- Early video
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Learning Objectives Identify equipment needed
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
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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
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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 Thanks for invite Remind Questionaire Backgroud on self History of ECT
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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
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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
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Indications for ECT Major Depressive Disorder (MDD) Bipolar Disorder
Patients who are resistant to pharmacological interventions and present with: Major Depressive Disorder (MDD) Bipolar Disorder Schizophrenia Parkinsonism, not responding to medication ECT is indicated for all age ranges including the elder who have great success even better that the younger populations, adolescence and children even though controversial, and pregnant women who present with
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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 The nurse ensures proper function availability and set up of the following supplies and any additional supplies deemed by the ECT doctors
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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) The Mini Mental Status Examination (MMSE) represents best nursing practice standard for assessment mental status of patients in a variety of settings. The nurse along with any member of the ECT team can perform the MMSE in 5 minutes or less to establish a documentation of the patient cognitive changes if any. This is a valid and reliable tool that assess the ECT patient before the procedure and following the ECT procedure. The MMSE allows the nursing assessment components in four areas following the Mnemonic:
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Stages of nursing process
ECT patients sequence process Pre Procedure Area Treatment Room Recovery Room Phase II Kavanagh & McLoughlin (2009) Evidence supports the patients transition through a ECT process to ensure privacy and adequate time for the ECT team to assess and perform pre ECT care in a timely manner. These areas include
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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
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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
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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
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The ECT Procedure Anesthesia is administered
Electrodes place either unilaterally, bilaterally and bifrontal The electrical impulse of V The desired seizure duration of seconds Chemical changes occur Series lasting 6 to 12 therapeutic sessions Followed by ECT maintenance The nurse during this stage of the ECT process is to assist the anesthesia doctor / psychiatrist with medication administration electrode placement and as needed. Additonally the nurse can assist in the monitoring of the patient during the ECT
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Phase I/ Recovery Discharge Criteria 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
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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 Nurses responsibility in this area includes monitoring the patient for at least 30 minutes with their primary focus being on the patient meeting discharge requirements.
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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 treatments Tardive seizure even though extremely rare nurses need to aware of the existence to monitor their patients appropriately. Tardive seizures according to case studies in literature can occur after the Ect and the after the patients return to orientation
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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
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Contraindications cont.
Increased risk of complications from electrical stimulation Recent myocardial infarction Congestive heart failure Valvular heart disease
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Medication Contraindications
Anticonvulsants Interfere with seizure production Antieleptic mood stabilizers Tapered and stopped before ECT Benzodiazepines Potential anticonvulsant Lithium Neuro toxicity & poor outcome
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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.
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Thank You
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