ECT is passing of an electric current through electrodes applied to one or both temples to artificially induce a grand mal seizure

for the safe and effective treatment of depression.

ECTs mechanism of action is unclear at present

Advantages: Quicker effects than antidepressants; Safer for elderly; 80 % improvement rate of major depressive episode with vegetative aspects - Best therapy for major depression (last resort) - Invasive - Induction of 70-150 volts of electricity in).5-2secs. Then, it is followed by a grand-mal seizure lasting 30-60 secs. - 6-12 treatments, every other day

- Before ECT a major depressed client undergo the ff meds: 1. SSRi (Selective Serotonin Reuptake Inhibitor inhibitor) 2 wks 2. Antidepressants TCA 2nd Generation 2-4 wks 3. MAOi 2 wks 4. ECT (last resort)

Side Effects: 1. Temporary RECENT Memory Loss ANTEROGRADE amnesia Intervention: Re-orient client to 3 spheres 2. confusion/disorientation (usually hours) 3. Headache 02 demand, cerebral 4. Muscle spasm 5. Wt. gain (stimulate thalamic/limbic appetite)

24 hypoxia

Contraindicated:
1. PPPP Post MI, Post CVA, pacemaker, pregnant women 2. Neurologic problem Alzheimers, degenerative disorder 3. Brain tumor, weakness of lumbosacral spine

Legal/Pre-Nursing Responsibilities: Preparation: Similar to preparing a client for surgery:

1. Informed Consent if client is coherent, if not a guardian may sign the consent forms. 2. No metallic objects 3. No nail polish to check peripheral circulation 4. No contact lenses it may adhere to the cornea 5. Wash & dry hair

6. Give following medications BEFORE ECT: a. Atropine sulfate anticholinergic PRIMARY purpose to dry secretions and prevent aspiration SECONDARY purpose to prevent bradycardia (vagolytic) b. Phenobarbital (Luminal), Methohexital (barbiturate Na)- minor tranquilizer also an anticonvulsant c. Succinylcholine (Anectine) muscle relaxant 7. Priority vs. to focus ABC; check RR 12 less; LOC 8. Before ECT supine position; after ECT side-lying 9. Have patient VOID before giving ECT

Nursing Diagnosis:
1. Risk for Airway Obstruction/aspiration
2. Risk for Injury 3. Impaired/Altered Cognition/LOC

Nursing Intervention
5 S in Seizure 1. Safety (#1 objective) 2. Side-lying (#1 Position) 3. Side rails up 4. Stimulus (no noise & bright lights) 5. Support the head with a pillow AFTER the seizure