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Aids
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SELF INTRODUCTION
1 Establish 1 min I am Kawaljit Kaur, student of M.Sc. nursing I year of MHR DAV Institute of Introducing
rapport with Nursing, Jalandhar self to the
the group group.

2 State the ½ min ANNOUNCEMENT OF TOPIC Announcing

topic the topic
Today we are going to discuss about “ Electro Convulsive Therapy”

INTRODUCTION TO THE TOPIC

3 Introduce the 2 min DEFINITION :- Name the PowerPoint
topic persons who Presentation
developed
Electroconvulsive therapy is the treatment in which the grandma seizure is
ECT ?
artificially induced by passing an electric current of 70-130 volts for 0.1-
0.5 seconds through the electrodes applied to temples.

ECT was introduced by two Italian psychiatrists, Ugo cerletti and Lucio
Bini in 1938.
4 Enlist the
indications of 5 min INDICATIONS:- What are the Brochure
ECT indications of
The three clear indications of ECT are:- ECT ?
1) Major depressive disorder:- The most common indication is
major depressive disorder ECT should be considered as a treatment
for patients who've failed medication trial, have not tolerated
medications, have serve psychiatric symptoms of agitation and
stupor. It's effective in depression of old age.
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2) Manic episode:- ECT is least equal to & perhaps superior to
lithium in the treatment of manic episodes. As the pharmacological
treatment is effective in the short term & for prophylaxis, the use of
ECT is limited.
3) Schizophrenia:- It's effective treatment for the symptoms of acute
schizophrenia and not for symptoms of chronic schizophrenia.
Patients with marked positive symptoms and catatonia are thought
to be most likely to respond.
What the Brochure
5 Enlist the 2 min CONTRAINDICATIONS contra
contra- indications of
Indications 1) Brain tumors:- The sudden increase of intracerebral pressure ECT ?
Of ECT during a convulsion represents a great danger to patients with brain
tumors.
2) Others:- There is no absolute other contraindications. The
situations which arises the risk of ECT are acute myocardial
infarction, hematoma, subarachnoid hemorrhage, and hypertension.
6 Enlist the 2 min What are the PowerPoint
COMPLICATIONS
complications complications Presentation
of ECT. of ECT ?
Complications of ECT are reduced due to modified ECT some of the risks
are as follows:-
1) Mild impairment of memory of memory which may lead to severe
confusion temporarily.
Memory returns fully within a few weeks to a month.
2) Dislocation or fractures are caused due to muscle contraction.
3) Dislocation of jaw is not a frequent complication.
4) Fracture of humorous or femur occurs in young muscular people.
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5) Compression fractures of dorsal vertebrae between third and fourth
and fifth vertebrae is common.
Dislocation and fractures can be prevented with the proper support
while the patients in in tonic & colonic phase during ECT.
6) Headache, backache, painful mastication to mouth and tongue and
the other complaints patient may express.
What are the PowerPoint
7 Explain the 5 min TYPES OF ECT types of ECT ? Presentation
types of ECT
- Direct ECT: - is given directly without any muscle relaxant and
anesthesia after giving sedation.
- Modified ECT:- Muscle relaxant like succinyl choline followed by
a short acting barbiturate like thiopentone is given under anesthesia.
8 Explain the 5 MIN MECHANISM OF ACTION
mechanism What is the
of Action of mechanism of PowerPoint
The specific way in which ECT works has been the subject of much
ECT ECT ? Presentation
research, but the precise mechanism of action is still not known.

The following theories have been proposed (Kellner, Etal,

1997).
- Neurotransmitter theory suggests that ECT acts like tricyclic
antidepressants by enhancing deficient neurotransmission in
manoaminergic systems. Specifically it is thought to improve
dspaminergic, seiotonergic and adrenergic neurotransmission.
- Neuroendocrine theory suggests that ECT releases hypothalamic or
pituitary hormones or both, which results in its antidepressants
effects. ECT release prolactin, thyroid stimulating hormone,
Sr. No. Specific Time Subject Matter Teaching A.V. Aids
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Adrenocorticotropic hormone and endorphins, but the specific
hormones responsible for the therapeutic effect are not known.
- Anticonvulsant theory suggests that ECT treatment exerts a
profound anticonvulsant effect on the brain that results in an
antidepressant effect. Some support for this theory is based on the
fact that a person's seizure threshold rises and the seizure duration
decreases over the course of ECT and that some patients with
epilepsy have fewer seizure after receiving ECT.
9 Explain the
placement of 5 min PLACEMENT OF ELECTRODES
Electrodes What you PowerPoint
It can be understand by Presentation
- Unilateral Unilateral
- Bilateral Placement?
In bilateral ECT, the electrodes are placed on both the sides of
temporal region.
In unilateral ECT to reduce the post convulsive confusion and
amnesia one electrode is placed on the temporal region in the right
handed person. The other electrode is placed on centroparietal area,
lateral to midline vertex. For placing electrode on temporal region
an imaginary line is drawn from the outer canthus of eye to the
tragus of ear. 1 inch above the midline of this imaginary line is the
point for placement of electrode.
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Explain the 10 min NURSING CARE OF PATIENT FOR ECT AND PREPARATION What are PowerPoint
10 nursing care steps included Presentation
Of patient for I. Preparation of Physical setup i.e. waiting room, ECT room, recovery In waiting
ECT and room. area for
Preparation Preparation includes seeing the:- preparation of
- Waiting room patient ?
- ECT room
- Recovery room

Waiting room:-
Patient from the ward is received is waiting room. This is required
if the ECT block is totally independent waiting room should be
calm and quiet with dim light. Leave some magazines so that
patients and relatives can spend time with less anxiety. Toilet
should be attached so that patient can empty bladder and bowel
'before' treatment. Preanasthetic drugs should be kept ready.

ECT room:-
ECT room should have law level beds with side railings to prevent
fall. Railways should well padded with gauze on both sides.

Articles required for ECT are:-

- ECT machine in working condition check all the plug points for
connection.
- Electrodes well padded with gauze on both the sides.
- Normal saline to clean the temporal region also to dip electrode in
the saline as it is good conductor of electrode in the saline as it is
good conductor of electricity.
- End tracheal tubes
- Sterile suction and O2 catheters
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- Mouth wipes and cotton balls.
- Covered tray containing all emergency drugs
- Sterile spirit swabs for giving injection
- AMBU bag in the lower shelf
- Sterile syringes of 2cc, 5cc, 10cc should be kept ready.
- B.P. apparatus
- mouth gag well padded (to avoid injury in the mouth)
- Tongue depressor
- Small pillow to be kept under patient's back
- Kidney tray and paper bag to throw swabs

Recovery Room:-

After the patient is brought to the recovery room, a floor bed or low
level bed should be kept ready. All the emergency drugs, mouth wipes
to clean salivation or excessive secretion should be handy.
Toilet facilities should be available in the recovery room.
11 Explain the 15 min
NURSING CARE OF THE PATIENT
nursing care
of the
I) Before ECT
patient In which PowerPoint
trimester of Presentation
- Ensure the patient had through physical examination including pregnancy
ECG, HB, and urine for sugar, X-ray skull and chest. This is ECT is
important to rule out any problem which may lead to complication prohibited ?
during/after ECT.
- Take written consent from the patient's close relative to avoid any
legal complications
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Explain the 15 min - Explain to the relatives the whole procedure and to patient that Why artificial PowerPoint
11 nursing care he/she will be getting injection, avoid the word ECT as patient gets dentures are Presentation
of the apprehension that he/she will be getting electric current. removed
patient - Explain the patient and relatives not to give anything orally, not Before ECT ?
even tea 4-6 hours before the treatment. Because during
convulsions patients may vomit and regurgitate leading to
respiratory distress.
- Remove all the metal articles like bangles, watch, any rings as
metal is good conductor of electricity and current may be passed to
the areas.
- Encourage patients to remove tight clothes like tight blouse or
undergarments in women, necktie in men. So the patient can be
helped in respiration.
- Remove artificial dentures or even one tooth or loose tooth should
be taken care of because it may fall in the respiratory tract.
- In women, do not allow them to apply nail polish, lipstick or blush
because it will be difficult to check for cyanosis.
- Give pre medication as prescribed and record in atropine and
Larpose.
To reduce secretions and anxiety
- Encourage patient to remove oil from hair because oil is bad
conductor of electricity.
- Ensure that patient has passed stool & urine if he/she wants to, just
prior to ECT. Patient feels embarrassed when wakes up in soiled
bed.
- Accompany the patient preferably on wheel till the ECT room and
hand over to the ECT room nurse.
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Explain the 15 minII) During ECT:- What are the PowerPoint
11 nursing care articles Presentation
of the - In the ECT room patient is put on well padded bed and placed in required for
patient supine/dorsal position with a small pillow under the lumber region. ECT ?
- For modified ECT short acting anesthetic agent thiopental 0.25gms
to 0.5 gms I/v & 30-50 mg scoline is given as prescribed by
psychiatrist.
- Padded mouth gag or tongue depressor is placed in between the
teeth to prevent biting of tongue or lips.
- Patient should be placed in lying position
- Support head and jaw, shoulders and arms, hips and knees, feet.
Hyperextension prevents tongue feeling back, and support at all the
joints will prevent dislocation or fracture.
- Ensure that O2 cylinder is ready
- Dip electrodes in saline.
- Observe for grand mal convulsions/ seizures, tonic stage which
lasts for 10-15 seconds, convulsion lasting for 25-30 seconds
followed by phase of muscular relaxation with traitorous respiration
- Restore respiration by immediate suctioning and O2 by mask if
required.

III) After ECT:-

- Check patients pulse, respiration and blood pressure immediately
and record
- Put the railings up to prevent patient from fall.
- Transfer the patient to recovery room once the patient responds
simple questions such as Mahesh "show your tongue".
Sr. No. Specific Time Subject Matter Teaching A.V. Aids
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11 Explain the 15MIN - Allow the patient to sleep for 1/2 hour to 1 hour, if patient wants to What type of PowerPoint
nursing care sleep records are Presentation
of the - Wipe off the excessive secretions maintained In
patient - Record pulse, respiration and B.P. every 15 min. ECT
Procedure ?
- Once the vital signs stabilize record after every 30 minutes till the
patient is fully oriented
- Reassure the patient as he/she is highly suggestible during post
treatment phase.
- Patient should be given reorientation to the ward, toilet etc. as
he/she may be confused.
- Make note of any injuries or complaints such as headache or body
ache.
- Encourage patient to go for both if patient wants to go change
his/her clothes.
- Give clear fluid, if patient do not vomit, give breakfast.
- Encourage the patient to do his daily activity and make observation
of any change in the behavior.
- Record the treatment and observation made of patient's behavior.

SUMMARIZATION Briefly the

12 Conclude the 2 min
topic
Today we have discussed about topic to the
Definition of ECT group ?
Indications of ECT
Contraindications of ECT
Complications of ECT
Procedure of ECT
Role Of Nurse
13 Appraise the 2 min RECAPTULIZATION Asking
knowledge questions
gained by What are the characteristic of alcohol? from the
group. What are the side effects of alcohol ? group ?

ASSIGNMENT:-
14 Encourage 1 min Write short note on Self help groups?
group for
Date of
further Submission
exploration
of topic
REFERENCES:- Bibliography
15 Encourage 1 min Ross and Wilson; “Anatomy and Physiology in Health and Reading card
the group for Illness”9th edition; Churchill Livingstone Publishers. bibliography
further study Gerard j. tortora ; Bryan derrickson, principles of anatomy and and then
displaying
physiology, 11th edition, john Wiley & sons, inc publication.
bibliography
Benjamin J. Sadock, Virginia A. Sadock, Menas S. Gregory; card on board
comprehensive textbook of psychiatry, 8th edition.
Roy A; Sadock BJ Sadock VA, editors. Comprehensive textbook of
Psychiatry 7th ed. Lippincott Williams & Wilkins publishers.
www.googles.co.in
Merry C. Townsend, psychiatry mental health nursing, 5th edition,
jaypee publications.
Tasman, Allan, Kay Jerald, MD, Jeffrey A. Lieberman, MD, eds.
Psychiatry. 1st ed. Philadelphia: W. B. Saunders Company
 Lesson plan
Subject Mental Health Nursing
Unit X
Topic Electroconvulsive therapy
Group of students B.Sc. Nursing III year
No. Of students 60
Name of student teacher Ms. Kawaljit kaur
Name of supervisor Mrs. Baljinder Kaur
Date & time of teaching
Teaching method Lecture cum discussion
Audio-visual aids L.C.D. Projector, Pamphlet, Flash Cards
Venue of teaching B.Sc. Nursing III year classroom.
Duration of teaching 60 min

General objectives: -

The students will be able to Understand the Electroconvulsive therapy.

SPECIFIC OBJECTIVES:

At the end of the discussion, group will be able

-define the ECT
- enlist the Indications of ECT
- enlist the Contraindications of ECT
- explain the Complications of ECT
- explain procedure of ECT
- Explain the role of Nurse.