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 Slide 5: no absolute contraindications
works like medications
goal is to complete series & maintain
taper off before stopping Slide 6: 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 Slide 7: III. Patients cannot have too much ECT.
no brain damage
over 100 treatments
no top age limit Slide 8: Patients with dementia still have emotions.
ECT cannot help dementia
ECT can help with emotions Slide 10: rarely, pt. will not respond
reported cases of permanent memory loss Slide 11: IV. ECT is given by a psychiatrist in a controlled setting with an anesthesiologist administering oxygen.
electrode placement – bilateral & unilateral
sleep = Brevital, paralysis = Anectine Slide 13: bite block used
current causes seizure
ECT machine gives print out Slide 14: 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 Slide 16: 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 Slide 17: 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 Slide 18: 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 Slide 21: 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 Slide 22: 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 Slide 24: normal VS
encourage fluid intake Slide 25: II. After ECT, patients may be confused & have short-term memory impairment which are unfortunate side effects of ECT.
normal side effects
change in behavior or LOC
if in doubt, shout Slide 26: III. Patients may complain of headache, jaw pain, muscle aches &/or nausea a day or two after ECT (all possible side effects).
report pain or N&V to ECT nurse Slide 27: anesthesia & paralytic agent
masseter muscles Slide 28: IV. Patients will have discharge instructions sent back with them after ECT, which will include the next appointment date & time.
put on staff calendar Slide 30: schedule transportation ASAP