Electroconvulsive Therapy

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Electroconvulsive Therapy : 

Electroconvulsive Therapy What You Should Know – What You Should Do – What You Should Expect

About ECT : 

About ECT I. ECT is a medical treatment for a psychiatric condition. Convulsive tx around many years safer than some psychotropic meds more effective than medications requires medical clearance not just for depression

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no absolute contraindications works like medications goal is to complete series & maintain taper off before stopping

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II. Patients can have too few ECT treatments to be therapeutic. missed treatments = sub-clinical response POA’s & guardians often sabotage stopping early – restarting later not good idea

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III. Patients cannot have too much ECT. no brain damage over 100 treatments no top age limit

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Patients with dementia still have emotions. ECT cannot help dementia ECT can help with emotions

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rarely, pt. will not respond reported cases of permanent memory loss

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IV. ECT is given by a psychiatrist in a controlled setting with an anesthesiologist administering oxygen. electrode placement – bilateral & unilateral sleep = Brevital, paralysis = Anectine

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bite block used current causes seizure ECT machine gives print out

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recovery period must meet criteria for discharge

Before ECT : 

Before ECT I. Patients must be NPO before having anesthesia for ECT. nothing to eat or drink reschedule ECT if patient raids fridge give cardiac & B/P meds with sip of water only

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II. Patients should be sent to ECT in short sleeves or clothing that opens down the front. monitor before, during & after ECT cold weather, dress in layers send in clean, dry undergarments

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III. Patients who are agitated, combative or an elopement risk must be accompanied by a staff person or family member. keep in mind patient safety cannot observe 1:1

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IV. Patients’ paperwork needs to be accurate, complete, dated & signed when they arrive for ECT. requested info. vital to patient safety report helps psychiatrist with scheduling no signature, no ownership blank reports useless

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V. Call the ECT nurses when patients are ill as treatment may need to be rescheduled. 100 degree or higher fever congested lungs or shortness of breath describe symptoms to ECT nurse reschedule missed treatment

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VI. Patients refusing ECT should be strongly encouraged to go for treatment. short of physical force legality vs. reality ask for PRN

After ECT : 

After ECT I. Patients will likely be sleepy & unsteady on their feet the day of ECT & possibly the day after. let them rest initiate fall precautions

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normal VS encourage fluid intake

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II. After ECT, patients may be confused & have short-term memory impairment which are unfortunate side effects of ECT. emotional support normal side effects change in behavior or LOC if in doubt, shout

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III. Patients may complain of headache, jaw pain, muscle aches &/or nausea a day or two after ECT (all possible side effects). treat discomfort report pain or N&V to ECT nurse

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anesthesia & paralytic agent masseter muscles

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IV. Patients will have discharge instructions sent back with them after ECT, which will include the next appointment date & time. read carefully put on staff calendar

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schedule transportation ASAP missed treatments

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