Electroconvulsive Therapy

Electroconvulsive Therapy (ECT)

  • Definition: Induction of a grand mal (generalized) seizure through the application of electrical current to the brain.

  • Treatment Frequency:

    • Most clients need an average of 6 to 12 treatments, some may require up to 20 treatments.

    • Treatments are usually conducted three times per week.

  • Seizure Phases:

    • Tonic phase of the seizure lasts 10 to 20 seconds, identifiable by rigid plantar extension of the feet.

Nursing Interventions for ECT

Pre-treatment Interventions

  • Ensure informed consent has been obtained and signed permission is included in the chart.

  • Confirm availability of the latest laboratory reports (CBC, urinalysis), ECG, and x-ray results.

  • Record vital signs about 1 hour before treatment and ensure the patient voids.

  • Instruct the patient to remove dentures, glasses, jewelry, and change into appropriate clothing.

  • Administer pretreatment medication (usually atropine sulfate or glycopyrrolate) intramuscularly 30 minutes before treatment.

  • Stay with the patient to alleviate fears and anxiety.

During the Treatment

  • Ensure airway patency and provide suctioning if necessary.

  • Assist the anesthesiologist with oxygenation.

  • Monitor vital signs and cardiac functioning.

  • Support the patient’s limbs during the seizure.

  • Observe and document the type and amount of movement during the seizure.

Post-treatment Interventions

  • Monitor vital signs every 15 minutes for the first hour. Patient should remain in bed.

  • Position the patient on their side to prevent aspiration.

  • Orient the patient to time and place, describing what has occurred.

  • Provide reassurance that confusion will fade and memories will return.

  • Allow the patient to verbalize fears and anxieties.

  • Remain with the patient until fully awake and oriented.

  • Offer a structured schedule of routine activities as support.

Causes of Depression

Demographic Factors

  • Age & Sex: Higher prevalence in women than men.

Socioeconomic Factors

  • Effects of poverty and unemployment.

Cultural Influences

  • Public policy impacts.

  • Marital Status: Stressful situations due to lack of social interactions.

Seasonal Changes

  • Increased incidence observed in fall and winter.

Types of Depression

  • Persistent Depressive Disorder: Characterized by a chronically depressed mood without psychotic symptoms.

  • Premenstrual Dysphoric Disorder: Markedly depressed mood and anxiety occurring before menstruation.

  • Substance/Medication-Induced Depressive Disorder: Depression linked to substance effects during intoxication or withdrawal.

  • Depressive Disorder Due to Another Medical Condition: Major depressive episode stemming from a physiological consequence of another health issue.

Non-Pharmacological Therapies

For Depression

  • Group Therapy: Facilitates a sense of perspective and belonging among those experiencing similar conditions.

  • Family Therapy: Aims to restore adaptive family functioning.

  • Cognitive Behavior Therapy (CBT): Focuses on altering harmful automatic thoughts contributing to depression.

Common Cognitive Distortions

  • Personalizing: Thinking "I’m the only one who failed."

  • All or Nothing: Believing "I’m a complete failure."

  • Mind Reading: Assuming others think negatively of oneself.

  • Discounting Positives: Underestimating personal achievements.

Pharmacological Therapy: Lithium Interventions

  • Advise patients with bipolar disorder to consistently take lithium to prevent symptom return.

  • Caution against driving or operating machinery until stabilized.

  • Emphasize maintaining adequate sodium intake and hydration.

Safety Protocols: SEA Method

  • Safety: Ensuring patient safety during therapy.

  • Express Emotion: Allowing patients to express their feelings.

  • Assessment: Assessing for impaired social interaction and developing appropriate nursing diagnoses.

Nursing Diagnosis for Impaired Social Interaction (Bipolar)

Goals

  • Short-Term: Patient identifies appropriate vs inappropriate interaction behaviors within 1 week.

  • Long-Term: Demonstration of appropriate interaction skills with reduced manipulative behaviors.

Interventions

  • Recognize the purpose of manipulative behaviors and set limits.

  • Avoid engaging in arguments about behaviors.

  • Provide positive reinforcement for non-manipulative interactions.

  • Assist patients in acknowledging consequences of behaviors.

Prioritizing Nursing Diagnoses for Depression

  • Risk for Suicidal Behavior: Indicators include depressed mood, hopelessness, and suicidal ideation.

  • Social Isolation/Impaired Interaction: Characteristics include withdrawal and discomfort in social situations.

  • Disturbed Thought Processes: Involves inappropriate thinking and confusion.

  • Imbalanced Nutrition: Indicators include weight loss and poor muscle tone.

Patient Medication Education for Antidepressants

  • Importance of continued medication intake despite persistent symptoms.

  • Avoid driving until aware of effects; refrain from alcohol consumption.

  • Utilize sunscreen and report concerning symptoms to a physician.

  • Caution against consuming specific foods while on MAOIs to prevent hypertensive crisis.

Nursing Diagnosis: Maladaptive Grieving

Goals

  • Short-Term: Patient verbalizes behaviors associated with normal grieving.

  • Long-Term: Patient identifies their position in the grief process.

Interventions

  • Establish trust; exhibit empathy and positivity.

  • Encourage expression of feelings, particularly anger.

  • Engage patients in physical activities to channel emotions.

  • Educate on the stages of grief and express that feelings of guilt and anger are natural.

  • Facilitate spiritual support as needed.