Alzheimer’s Delirium and Dementia Q 39
Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:
A. Permanent short-term memory loss and hypertension.
B. Permanent long-term memory loss and hypomania.
C. Transitory short-term memory loss and permanent long-term memory loss.
D. Transitory short and long-term memory loss and confusion.
Correct Answer: D. Transitory short and long-term memory loss and confusion
ECT commonly causes transitory short and long-term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long-term memory loss. The most persistent adverse effect is retrograde amnesia. Shortly after ECT, most patients have gaps in their memory for events that occurred close in time to the course of ECT, but the amnesia may extend back several months or years. Retrograde amnesia usually improves during the first few months after ECT.
Option A: Paradoxically, patients with heart block or underlying arrhythmias are less likely to develop asystole. The clonic phase of the seizure correlates with a catecholamine surge that causes tachycardia and hypertension, which lasts temporally with seizure duration. Hypertension and tachycardia resolve within 10 to 20 minutes of the seizure, although some patients exhibit persistent hypertension that requires medical intervention.
Option B: According to the American Psychiatric Association, patients receiving ECT are at higher risk if they show evidence of unstable or severe cardiovascular disease, a space-occupying intracranial lesion with evidence of elevated intracranial pressure, history of an acute cerebral hemorrhage or stroke, an unstable vascular aneurysm, severe pulmonary disease, or qualify as American Society of Anesthesiologists (ASA) Class 4 or 5.
Option C: A major concern regarding ECT as a treatment option is generally not whether it is effective but whether it is associated with long-term cognitive changes, particularly in various memory systems. The effect of ECT on memory continues to be studied, discussed, and debated. Perhaps the most controversial issue is whether ECT results in long-term (usually defined as greater than 6 months) changes in anterograde or retrograde memory performance; this is also an issue of clinical relevance.