Physiological Integrity Q 5
The client is having electroconvulsive therapy for treatment of severe depression. Which of the following indicates that the client’s ECT has been effective?
A. The client loses consciousness.
B. The client vomits.
C. The client’s ECG indicates tachycardia.
D. The client has a grand mal seizure.
Correct Answer: D. The client has a grand mal seizure.
During ECT, the client will have a grand mal seizure. This indicates completion of electroconvulsive therapy. Seizure threshold is established via trial and error via incrementally higher doses of current during the primary treatment session. Following initial dose calculation, the dose at subsequent ECT sessions for bilateral ECT is 1.5 to 2 times seizure threshold, and for right unilateral is six times the seizure threshold. During the course of ECT treatment, the seizure threshold commonly increases as the patient develops tolerance.
Option A: Once the patient is rendered unconscious, administration of a muscle relaxant follows, along with bag valve mask ventilation with 100 percent oxygen. A nerve stimulator is utilized to determine the adequacy of muscle relaxation along with the clinical assessment of plantar reflexes and fasciculations in the calves and left foot.
Option B: Physiologically, during the tonic phase of the seizure, a 15- to 20-second parasympathetic discharge occurs, which can lead to bradyarrhythmias including premature atrial and ventricular contractions, atrioventricular block, and asystole. Patients with sub convulsive seizures are at higher risk for asystole.
Option C: 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.