Electroconvulsive Therapy Nursing Care Plan

Patients with affective disorders are normally treated with electroconvulsive therapy (ECT) because it is more effective than antidepressant drugs. ECT is also considered as a primary treatment for patients exhibiting syndromes such as acute mania, catatonia, severe depression, and mood disorders with psychotic episodes.

Since it is a highly technical and delicate procedure, a team composed of an anesthetist, a psychiatrist, and psychiatric and recovery nurses are needed to perform electroconvulsive therapy. A modified and controlled ECT is also performed when a seizure is induced in an anesthetized patient to produce the important therapeutic effect.

Considered as a minor surgical procedure, nurses need to observe preoperative preparation and postoperative care that includes four major nursing care components:

1. Educational and emotional support

The nurse should explain the entire procedure and course of action to the patient. They have to obtain an informed consent from the patient that the nurse and healthcare personnel will conduct ECT on them. Nurses should consider the patient’s concerns and feelings before proceeding with the therapy.

2. Pre-treatment planning and assessment

Before starting the therapy, the nurses must make sure that the treatment room is already ready including:

* adjustable height stretcher trolley is already set up

* pre-treatment checklist is already accomplished

* the patient has his/her identity bracelet

* the patient’s valuables are safely secured

The NPO should be a minimum of 4 hours before treatment so that possible aspiration during anesthesia would be prevented. The nurse will then check if the patient’s hair is clean and dry to allow electrode contact. All metal objects such as hairpins, bracelets, and any form of body piercing should be removed to prevent severe burns. The patient will also be required to remove his/her dentures, hearing aids, prosthesis, glasses, and contact lenses.

Before the treatment, the patient is encouraged to provide urine to avoid incontinence during the ECT. Nurses should keep reassuring the patient by providing support in order to minimize fear and anxiety. Finally, standard practices will be observed with regards to general anesthesia care.

3. Patient preparation and monitoring

The patient will be transferred on a trolley to the ECT room in a well-padded bed where he/she will be placed in a comfortable dorsal position while a pillow is placed under the lumbar curve. Slowly but surely apply the electrocardiogram electrodes, blood pressure cuff, and pulse oximetry sensor to the patient then give them a short-acting anesthetic agent but make sure you give them the right dosage as prescribed by the doctor.

As per treatment specifications, prepare EEG, scalp and stimulus ECT electrodes. Provide support to the patient’s arms and shoulders and provide restraint on the thighs. Administer oxygen so that proper respiration will be ensured. Apply jelly to the electrodes.

The initial tonic stage lasts for 10-15 seconds is then followed by clonic stage that lasts for 25-30 seconds. There is a phase of muscular relaxation with stertorus respiration i.e. flaccid stage. Make observations of the convulsions.

4. Post-treatment care and evaluation

Make a detailed observation and record of the vital data. Place the patient on a side-lying position and then clean the secretions. After that, the nurse would then transfer the patient to the recovery room and maintaining a close watch on the patient’s condition by recording their vital signs for every 15-30 minutes until he/she recovers to the normal stage. Make sure the patient rests for 30 minutes to one hour.

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