Substance Abuse and Abuse Q 16
A hospitalized client is being considered for ECT. The client appears calm, but the family is anxious. The client’s mother begins to cry and states “My son’s brain will be destroyed. How can the doctor do this to him?” The nurse’s best response is:
A. “It sounds as though you need to speak with the psychiatrist”
B. “Your son has decided to have this treatment. You should be supportive of him.”
C. “Perhaps you’d like to see the ECT room and speak to the staff.”
D. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.”
Correct Answer: D. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.”
The nurse encourages the client and the family to verbalize fears and concerns. Today ECT is now frequently used to treat a variety of mental health disorders besides depression. The procedure is relatively safe and does work. However, the delivery of ECT requires an interprofessional team that includes a nurse, anesthesiologist, psychiatrist, and neurologist. The benefits of ECT are seen after several sessions and the results are durable. The key is to educate the patient and family about ECT because the procedure has been associated with many false and illogical beliefs.
Option A: 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.
Option B: In a patient under intravenous sedation or general anesthesia, electroconvulsive therapy (ECT) uses an electric current to create a generalized cerebral seizure. Although it is primarily utilized to treat patients with severe depression, patients with schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, and bipolar disorder may also benefit. However, the practice has a stigma attached to it due to misinformation regarding procedural methodology.
Option C: The other options avoid dealing with concerns and are blocked to communication. 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.