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Form of treatment that is used for severely depressed patients who have not responded to psychotropic medications. ECT passes an electric current through the brain to produce a tonic-clonic (grand mal) seizure. Most mental health professionals belie ve ECT stimulates an increase in circulating levels of the neurotransmitters serotonin, norepinephrine, and dopamine in the brain (much like antidepressants).
Takes place in RR or area where emergency equipment is available. 30 min prior to procedure, med is given to dry secretions and counteract stimulation of vagus nerve, can cause bradycardia & syncope. Pt also given short-acting anesthetic & smooth muscle relaxant before tx. BP cuff is placed on lower limbs and inflated to monitor seizure activity. BP & pulse carefully monitored before & after tx. The patient is oxygenated with pure oxygen during and after the seizure until spontaneous respirations return. During treatment, an electrical stimulus is delivered to the brain via unilateral or bilateral electrodes. The amount of electrical energy used is individualized to the patient. The seizure activity is monitored with an electroencephalogram (EEG) and also in the cuffed limb.
Side effects of ECT can be unpleasant but are usually temporary. The patient may feel confused and forgetful immediately after the treatment. Muscle soreness can be a result from seizure activity.
ECT is not used indiscriminately. It is used when other therapies have not been helpful and is usually reserved for treatment-resistant depression.
Nursing Care
The patient should receive nothing by mouth (NPO) for at least 4 hours before a treatment. Remind the patient to empty his or her bladder and to remove dentures, contact lenses, hairpins, and other items on the body. Following ECT, carefully monitor vital signs and document the patient's subjective and objective responses to the treatment. Stay with the patient until he or she is oriented and able to care for him or herself. Withhold oral medications and food until the gag reflex returns. Ensure that the patient is kept safe after ECT therapy.