Psychiatric Medications Q 53
The nurse is aware that the side effect of electroconvulsive therapy that a client may experience:
A. Loss of appetite
B. Postural hypotension
C. Confusion for a time after treatment
D. Complete loss of memory for a time
Correct Answer: C. Confusion for a time after treatment
The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment. Cerebral blood flow and intracranial pressure both increase with ECT therapy. Clinically, patients may exhibit confusion, delirium, disorientation, and memory loss. ECT is classified as a low-risk procedure by the AHA-ACC guidelines because it is well-tolerated, and demonstrates only transient hemodynamic lability and low mortality rate.
Option A: Bilateral or bitemporal ECT causes more cognitive impairment than unilateral ECT, although this effect is transient. A meta-analysis of 1415 depressed patients treated with ECT revealed that global cognition, verbal memory, and autobiographical memory were worse with bilateral treatment three days after treatment.
Option B: 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 D: 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.