ANSWER SCRIPT PART B

Student Matric M I D 1 7 0 0 1 4
no
Course Code M I D 3 0 0 8
Course Title MENTAL HEALTH NURSING

NAME: NUR SYAFIQAH WANI BINTI ABU SUPIAN

QUESTION 1

1.1 4 drugs used in ECT

• Muscle relaxant: suxametonium chloride.
• Anesthetic drug: Propofol
• Atropine: To dry the secretion
• Local anesthesia
1.2 Nursing responsibilities before the ECT.
• Obtain written consent from relatives or family members to undergoes the procedure
electroconvulsive therapy and anesthesia.
R: To provide the agreements and acts a prove that the patient’s family member is
agreed with the procedure. It is important to respect the patient and their family
members’ right for making decision.
• Assist the doctor to do physical examination for the patient such as checking from
head to toe.
R: To ensure there is no contraindication with the patient for the procedure.
• Ensure that the investigation result is done for the patient and put the result in the
patient’s case note such as full blood count (FBC), blood urea serum electrolyte
(BUSE), ECG and the chest X-ray if necessary.
R: These all the investigations act as the baseline for the patient.
• Weight the patient before undergoes the procedure.
R: Act as baseline and it is important for adequate amount or dose of medicine for the
patient.
• Fasting the patient at least 6 hours prior to the procedure or treatment.
R: It is to prevent the complication occurs due to anesthethic drug that can cause
aspiration.
• Prepare the electroconvulsive room such as prepare for broncho-sucker, oxygen
therapy, electroconvulsive therapy machine and the anaesthetic trolley.
R: It is to provide the treatment for the patient.
• Prepare for recovery area such as clean the recovery area, prepare the broncho-sucker
and the oxygen set.
R: This recovery area is required for stabilize the patient condition after the procedure
of ECT.
• Ensure that the patient remains fasting till the time of the procedure.
R: The empty stomach is important to prevent the aspiration after procedure due to
side effect of the anesthetic drugs.
• Request the patient to remove all the dentures, jewelleries, glasses and others and
keep it in safe places.
R: It is to prevent the patients belonging from missing.
• Accompany the patient for the procedure.
R: To give moral support and reduce the anxiety.
• Prepare the patient for the procedure such as lie the position in the supine position.
R: It is to provide comfort to the patient.
• Loose the patient’s clothing.
R: To reduce the injury during the presence of the convulsion.
• Clean the patient’s forehead with normal saline.
R: It is to comfort the patient.
• Attach all the relevants wire to the patients such as ECT, EEG, ECG, blood pressure
cuff and the pulse oximeter.
R: It is to monitor the patient’s condition during the procedure.
• Assist the anesthetist for giving or administering the anesthesia and muscle relaxant
such as muscle relaxant like suxametonium chloride, atropine for drying the
secretion, anesthesia such as propofol and the local anesthesia.
R: To induce the control epileptic convulsion and reduce pain during
electroconvulsive therapy.
1.3 Nursing responsibilities during the ECT.
• Hold the patient’s main joints such as shoulder, wrist, hip joint, knees and ankle
joints.
R: To prevent patient from fall and reduce risk of fracture.
• Observe the patients during the convulsion occur such as observe the presence of the
convulsion, colour of the patient, pulse rate and the respiratory rate.
R: To prevent complication and detect any abnormality such as inadequate oxygen,
pallor and other.
• Turn the patient into semi prone position once the convulsion is over as anesthetist
instructions given.
R: To provide comfort for the patient and reduce risk of aspiration.

1.4 Six (6) nursing responsibilities after the ECT.

• Push the patient into recovery area.

R: Stabilize the patient’s condition after the procedure.
• Check for the airways, breathing and circulation of the patient.
R: To prevent block of airways, to provide and ensure the adequate oxygen for the
patient.
• Place the patient into the recumbent position once the patient is conscious.
R: To ensure the patient feels comfortable.
• Check for vital signs such as especially take the blood pressure and pulse rate for the
patient.
R: To detect any abnormality and prevent the complication after the procedure.
• Tidy the patient’s clothes.
R: To comfort the patient.
• Administer the medication and provide breakfast for the patient.
R: It is to reduce the symptoms.
• Report and record the patient’s response to treatment.
R: To ensure effectiveness of the treatment.
 • Always ensure patient’s safety at all time to prevent something bad happen.
R: The patient’s safety is nursing priority.

QUESTION 2
2.1 Nursing interventions to handle sleep difficulties caused by hallucinations.
• Provide the psychotherapeutic environment that can help patient to sleep such as dark
and quiet.
R: To provide comfort and promote patient to sleep.
• Discourage patient from sleep during the daytime.
R: Patient will feel tired and sleepy at the night.
• Encourage patient to do normal things as he does at home that help him to sleep such
as drink milk before sleep.
R: The body responds and adjusts to a routine cycle of rest and activity.
• Ensure patient not disturbed by other persons that can interrupt him to sleep.
R: To improve the productivity of sleep.
• Encourage patient to be active during the day such as doing the exercise.
R: It is can distract patient from sleep during the day.
• Encourage patient to stop all the activities as the sleep time approach such as
watching television, phone and others.
R: To get patient ready to sleep.
• Redirects the patient thought to calmer subject if the patient worrying to his problems
such as family problems, financial problem and others.
R: To distract and divert the patient from thinking about the problems at night.
• Administer the sedation if all nursing measures are failed such as prescribe the
benzodiazepine.
R: It is to help patient to sleep.
• Record the patient’s sleep chart.
R: To monitor the pattern sleep habits.
2.2 Health advice needed for the patient and his family to avoid recurring of disease.
• Reinforce all information given by the doctor about the illness, how the patient and
family members are going to manage with it.
R: To reduce high express emotion among the family.
• Inform the patient and family members about the importance of medication that is
prescribed such as make sure the patient not stop taking medication, not to reduce the
dose of medication and inform the patient of possible side effect and what to do.
R: It is to reduce the risk of relapse.
• Inform the patient about the importance of follow up.
R: It helps the doctor to monitor the progress of the patient.
• Educate the patient regarding the sign of relapse such as unable to sleep, feel guilty
and others.
R: Make sure the prompt action can be taken.
• Encourage the family to discuss with patient realistically about his future plans by
advising the family members to involve patient in all family activities and encourage
patient ventilate if he has problem.
R: To help family to understand patient’s illness.