Alzheimer’s Delirium and Dementia Q 37
Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
A. General anesthesia
B. Cardiac stress testing
C. Neurologic examination
D. Physical therapy
Correct Answer: A. General anesthesia
The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. ECT utilizes general anesthesia. Anesthetic induction medications used include barbiturates such as thiopental and methohexital and nonbarbiturate agents such as propofol and etomidate. Seizure-induced by ECT should last longer than 30 seconds. Methohexital is the most commonly used induction agent due to its quick onset, effectiveness, low cost, and minimal effect on seizure duration. Propofol and thiopental have been shown to reduce seizure duration. Etomidate has correlations with myoclonus and increased seizure duration.
Option B: Vital signs, including blood oxygen saturation, ECG, and EEG activity are recorded continuously. EMG is recorded on the right foot to measure the motor component of seizure activity. A nerve stimulator is utilized to monitor succinylcholine, a depolarizing muscle relaxant used to reduce tonic-clonic contractions during the procedure. As an alternative to EMG, a blood pressure cuff is inflated on the patient’s ankle to prevent succinylcholine from entering the foot, allowing a visual monitor of seizure activity with measurement of tonic-clonic contractions.
Option C: A complete history and physical examination may expose significant risk factors including cardiac ischemia or arrhythmia, heart failure, or intracranial pathology. History should also include the use of herbal medications such as Ginkgo biloba, ginseng, St. John’s wort, valerian, and kava, all of which may interfere with ECT. There is a risk of status epilepticus in patients on theophylline. Short-acting intravenous beta-blockers may reduce ECT-related hypertension and tachycardia, but may also shorten seizure duration and reduce ECT efficacy.
Option D: ECT is a relatively safe and low-risk procedure that is helpful in the treatment of depression, suicidality, severe psychosis, food refusal secondary to depression, and catatonia. It requires interprofessional care coordination among anesthesiologists, psychiatrists, and nurses. Most patients require several sessions to see a durable effect. The stigma associated with ECT is largely due to the lack of anesthesia with early treatments resulting in significant injury and severe memory loss.