Brain Stimulation Therapies

D. Temporary memory loss and confusion

The most common side effects of Electroconvulsive Therapy (ECT) are: A. Permanent memory less and brain damage B. Fractured and dislocated bones C. Myocardial infarction and cardiac arrest D. Temporary memory loss and confusion

monitor vitals and ECG regularly

· Cardiovascular changes can occur with Electroconvulsive Therapy (ECT), so the nurse should:

Seizures

· Client is alert during Transcranial Magnetic Stimulation (TMS). They may feel tapping sensation in the head, scalp skin contraction, and jaw tightening ----Monitor for headaches · _______ are rare, but potential side effect of Transcranial Magnetic Stimulation (TMS) Transcranial Magnetic Stimulation (TMS) is contraindicated in patients with cochlear implants, brain stimulators, or medication pumps

-Provide Safety -Reorient the client frequently -Assist the patient with personal hygiene as needed -Inform the patient prior to treatment that there is a possibility of memory loss.

· Memory Loss, confusion, and disorientation almost always occurs with Electroconvulsive Therapy (ECT) treatment, but most patients return to their cognitive baseline in 6 months of treatment Nursing Interventions:

· Provide Continuous monitoring during procedure and in recovery phase Intervene as Needed

· Reaction to Anesthesia can occur with Electroconvulsive Therapy (ECT), so the nurse should:

memory loss and confusion.

· Side effects of Electroconvulsive Therapy (ECT): ____ and _____

D. I will schedule the client for TMS treatments 3 to 5 times for the first several weeks

A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the new nurse indicates an understanding of teaching? A. TMS is indicated for clients who have schizophrenia spectrum disorders B. I will provide post anesthesia care following TMS C. TMS treatments usually last 5-10min D. I will schedule the client for TMS treatments 3 to 5 times for the first several weeks

C. Memory loss E. Confusion

A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (SATA) A. Hypotension B. Paralytic ileus C. Memory loss D. Polyuria E. Confusion

C. Bipolar disorder with rapid cycling

A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysphoric disorder

A. Voice changes D. Cough E. Neck pain

A nurse is planning care for a client following surgical implantation for a VNS device. The nurse should plan to monitor for which of the following adverse effects? (SATA) A. Voice changes B. Seizure activity C. Disorientation D. Cough E. Neck pain

D. I will receive a muscle relaxant to protect my from injury during ECT

A nurse is providing teaching for a client who is scheduled to received ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. It is common to treat depression with ECT before trying medications B. I can have my depression cured if I receive a series of ECT treatments C. I should received ECT once a week for 6 weeks D. I will receive a muscle relaxant to protect my from injury during ECT

B. The exact mechanism is unknown, but there are several ways that Electroconvulsive Therapy (ECT) may have antidepressant effects

A patient has been ordered Electroconvulsive Therapy (ECT) and asks the nurse, "Exactly how does ECT work?" Which of the following is the most accurate response by the nurse? A. I'm not allowed to tell you that because that would be informed consent B. The exact mechanism is unknown, but there are several ways that Electroconvulsive Therapy (ECT) may have antidepressant effects C. The administration of a show to the brain induced memory less, which will make you forget that you are depressed D. The neuroplasticity affected by seizure activity prevents further brain damage

B. To decrease secretions

Atropine sulfate is administered to a client receiving Electroconvulsive Therapy (ECT) for what purpose? A. To alleviate anxiety B. To decrease secretions C. To relax muscles D. As a short-acting anesthetic

SUICIDAL OR PERSONALITY DISORDERS

ECT IS NOT USEFUL FOR ______ OR ____

Acute Mania

Electroconvulsive Therapy (ECT) can be used for ____ but is rarely used for this purpose because lithium is very effective § Rapid Cycling § Electroconvulsive Therapy (ECT) is effective in patients with acute manic symptoms who are unresponsive to medications, like lithium; OR when their life is threatened by dangerous behavior/exhaustion. · It should NOT be used while a patient is receiving lithium because lithium lowers the seizure threshold. § Electroconvulsive Therapy (ECT) may be beneficial for bipolar disorders with mixed states (concurrent depression or mania)

pregnant women and elderly

Electroconvulsive Therapy (ECT) can be useful in episodic psychosis, atypical psychosis, obsessive-compulsive disorder, delirium, neuroleptic malignant syndrome, hypopituitarism, intractable seizure disorders, and Parkinson's disease. For ____ and ____ individuals who can't take medications, Electroconvulsive Therapy (ECT)can be a safe alternative

Schizophrenia Spectrum disorder

Electroconvulsive Therapy (ECT) can induce a remission in clients with a ____, such as those with marked positive, catatonic, or schizoaffective symptomology. § Schizoaffective § Catatonia § Pregnant and risk of medication

C. Major depression

Electroconvulsive Therapy (ECT) is most commonly prescribed for which of the following? A. Bipolar disorder, manic B. Paranoid schizophrenia C. Major depression D. Obsessive compulsive disorder

Major Depressive Disorder

Electroconvulsive Therapy (ECT) may be used to treat ______, particularly those that experience psychotic symptoms, catatonia, psychomotor retardation, and neurovegetative changes (problems in sleep, appetite, & energy) § Electroconvulsive Therapy (ECT) is only considered with depression if the patient has little to no response to antidepressant medication § Electroconvulsive Therapy (ECT) may be used in emergency situations such as those who are suicidal, homicidal, or with a need for rapid intervention § Psychotic manifestations

· treat with Analgesics (Tylenol) -> Continued Assessment (persistent headache is not good)

Headache is a side effect/complication of Electroconvulsive Therapy (ECT), so the nurse should:

osteoporosis

High risk conditions for Electroconvulsive Therapy (ECT): § Other risk factors: ______, pulmonary disorders, complicated pregnancy

Cerebrovascular

High risk conditions for Electroconvulsive Therapy (ECT): § _____ patients · CVA; Brain tumor; subdural hematoma; · Risk for brain herniation and edema; increased intracranial pressure

Cardiac

High risk conditions for Electroconvulsive Therapy (ECT): § _____ patients · MI; arrythmia; CHF; HTN · The initial vagal response is sinus bradycardia and drop in BP; then tachycardia and hypertensive response (can be life threatening)

§ Client is positioned supine and a short acting anesthetic is administered § Muscle relaxant (succinylcholine chloride; IV) administered to reduce muscle movements during seizure (prevent fractures/injuries) § VS and mental status monitored before and after § IV access is maintained § Bite block is applied § Electrodes applied to the scalp for EEG monitoring § Receives 100% oxygen during and after § Ongoing ECG § Should be alert within 15 minutes § Nursing interventions: ensure airway, observe EEG, vitals, cardiac function, provide support for arms and legs, note amount/movement induced by the seizure

Intraprocedure Electroconvulsive Therapy (ECT):

§ Monitor pulse, respirations, BP every 15 minutes for 1 hour § Position client on their side to reduce aspiration § Orient to time and place and describe what happened § Provide reassurance and allow client to verbalize fears § Remain with client until fully awake, oriented, able to do ADLs § Provide a highly structured schedule to minimize confusion

Postprocedure Electroconvulsive Therapy (ECT):

§ Explain to the patient that treatment is 2 to 3 times per week for six to twelve treatments § Perform assessment of cardiovascular and pulmonary status; blood and urine studies, and skeletal x-ray · Mood, suicidal ideation, level of anxiety/fears of treatment, communication patterns, baseline memory, client/family knowledge, use of medications, baseline vitals, ability to perform ADLs § Informed Consent/May be Involuntary § The client is NPO for 6-8 hours prior to ECT § 1 hour before treatment, vitals as assessed, patient voids, jewelry/dentures removed, apply hospital gown, assist client to remain in bed § Thirty minutes prior atropine or another medication is administered to minimize secretions and counteract vagal stimulation during treatment

Preprocedure Electroconvulsive Therapy (ECT):

A. Anxiety related to deficient knowledge about Electroconvulsive Therapy (ECT)

Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Sam's physician has hospitalized him for a course of Electroconvulsive Therapy (ECT). Sam says to the nurse on admission, "I don't want to end up like McMurphy on One Flew Over the Cuckoo's Nest! I'm scared!" What is Sam's priority nursing diagnosis at this time? A. Anxiety related to deficient knowledge about Electroconvulsive Therapy (ECT) B. Risk for injury related to risks associated with Electroconvulsive Therapy (ECT) C. Deficient knowledge related to negative media representation of Electroconvulsive Therapy (ECT) D. Acute confusion related to side effects of Electroconvulsive Therapy (ECT)

C. I know you are scared, Sam, and we're going to talk about what you can expect from the therapy

Sam, who has been hospitalized for Electroconvulsive Therapy (ECT), says to the nurse on admission, "I don't want to end up like McMurphy on One Flew Over the Cuckoo's Nest! I'm scared!" Which of the following statements would be most appropriate by the nurse in response to Sam's concern? A. I guarantee you won't end up like Murphy, Sam B. The doctor knows what he is doing. There's nothing to worry about C. I know you are scared, Sam, and we're going to talk about what you can expect from the therapy D. I'm going to stay with you as long as you are scared

C. To relax muscles

Succinylcholine is administered to a client receiving Electroconvulsive Therapy (ECT) for what purpose? A. To alleviate anxiety B. To decrease secretions C. To relax muscles D. As a short-acting anesthetic

D. Ensure that consent forms have been signed

What is the priority nursing intervention before starting Electroconvulsive Therapy (ECT)? A. Take vital signs and record B. Have the patient void C. Administer succinylcholine D. Ensure that consent forms have been signed

A. Increased intracranial pressure B. Recent myocardial infarction C. Severe underlying hypertension D. Congestive heart failure

What of the following conditions increases the risk of adverse effects associated with Electroconvulsive Therapy (ECT)? (SATA) A. Increased intracranial pressure B. Recent myocardial infarction C. Severe underlying hypertension D. Congestive heart failure E. Breast cancer

C. One treatment three times per week for 6-12 months

Which of the following best described the average number of Electroconvulsive Therapy (ECT) treatments given and the timing of administration? A. One treatment per month for 6-12 months B. One treatment every other day, 3 times a week for a total of 6-12 treatments C. One treatment three times per week for 6-12 months D. One treatment everyday for a total of 10-20 treatments

Electroconvulsive Therapy (ECT)

_______ is the induction of a grand mal (generalized) seizure though the application of electrical current through the brain -Exact MOA (mechanism of action) of _____ is unknown -Believed that the seizure that is induced enhances the effects of certain neurotransmitters (serotonin, NE, dopamine)

seizure threshold

· The dose of electrical stimulation must be strong enough to reach the patient's _____ (highly variable among individuals). A patient's seizure threshold may increase 25-200% during the course of Electroconvulsive Therapy (ECT) treatment; thus it can act as an anticonvulsant because the seizure threshold increases. · Movements of seizure activity are minimal (due to muscle relaxant treatment). The tonic phase of the seizure may last 10-15 seconds and be evidenced by a rigid plantar extension of the feet. · The clonic phase follows and is characterized by rhythmic movements of the muscles that decrease in frequency until they disappear. (may by only moving toes due to muscle relaxant) · Monitoring EEG activity during treatment provides evidence of seizure activity

Relapse of Depression

· ____ is a side effect/complication of Electroconvulsive Therapy (ECT) educate the client that ECT is not a permanent fix. Weekly/monthly treatment can decrease relapse

Transcranial Magnetic Stimulation (TMS)

· _____ is a noninvasive therapy that uses magnetic pulses to stimulate the cerebral cortex · ____ is FDA approved for major depressive disorder clients unresponsive to medication · _____ is commonly prescribed daily for 4 to 6 weeks · ____ can be done in an outpatient procedure · ____ takes 30 to 40 min

Vagus Nerve Stimulation (VNS)

· _____ is an invasive procedure that provides electrical stimulation through the vagus nerve to the brain by a device inserted into client's chest ---Believed to increase level of neurotransmitters and enhances action of antidepressant medications · ___ is FDA approved for depression · ___ is an outpatient surgical procedure · ___ device provides around the clock pulsations q 5 min x 30 seconds · Client can turn off ___ device with magnet. Dyspnea with exertion is possible. This the client may want to turn off the device during exercise or with periods of prolonged speaking · Must have informed consent · Clients may experience vocal changes/Dyspnea/throat and neck pain from ____ due to proximity of device to the larynx/pharynx

Muscle Soreness

· _____ often occurs as a side effect/complication of Electroconvulsive Therapy (ECT) due to spastic movements during the procedure.