Course: Mental Health Nursing

LESSON PLAN- ELECTRO CONVULSIVE THERAPY

Unit : V
Topic: ELECTRO CONVULSIVE THERAPY
Group: [Link] Nursing III year
Venue: [Link] Nursing III year class room
Date: 05.01.2024
Time: 02.00 – 02.20 pm
Teaching method: Lecture Cum Discussion
Teaching aids: PPT, Black Board, Pamphlet, Card & Hand Out.
General Objectives:

Students are able to gain adequate knowledge and develop skills regarding electro convulsive therapy and develop desirable attitude
towards practicing this knowledge in all clinical setting.

Specific Objectives:

Students are able to

 Define ECT
 Enlist the types of seizure
 Describe the mechanism of action
 List out the types of ECT
 Describe about the frequency and application of electrodes
 Discuss the indication
 Enumerate the contra indication
 Enlist the complications and side effects
 List down the role of nurse
Sl. TIME CONTRIBUTORY SUB – TOPIC TEACHING AV AIDS EVALUATION
No OBJECTIVES LEARNING
ACTIVITY
1. 1mins Introduction INTRODUCTION Lecture cum
Electroconvulsive therapy is a type of discussion PPT
somatic treatment first introduced by
Bini and Cerletti in April 1938. From
1980 onwards ECT is being
considered as a unique psychiatric
treatment.
2. 1mins Mention the DEFINITION Lecture cum PPT What is meant by
Definition Electroconvulsive therapy is the discussion ECT?
artificial induction of a grandmal seizure
through theapplication of electrical
current to the brain.

3. Enlist the types of TYPE OF SEIZURE Lecture cum PPT Which type of
1 mins seizure Grandmal seizure – discussion seizure occur
 Tonic phase lasting for 10 - 15 during ECT ?
seconds.
 clonic phase lasting for 30-60
seconds
Parameters of Electrical
CurrentAppliedStandard dose according
to American PsychiatricAssociation,
1978:
• Voltage - 70-120 volts.
• Duration - 0.7-1.5 seconds
4. 2 mins Describe the MECHANISM OF ACTION Lecture cum Card What are the
mechanism of The exact mechanism of action is not discussion theories of action?
action known. There are various theories which
state the action of ECT
 Psychological theory.
 Brain damage theory.
 Anti-convulsant theory.
  Neuro-endocrine theory.
 Neuro-transmitter theory
Neurotransmitter theory - ECT works
like anti-depressant medication,
changing the way brain receptors
receives .
Anti-convulsant theory-ECTinduced
seizures teach the brain to resist
seizures. This effort to inhibit seizures
dampens abnormally active brain
circuits, establishing mood.
Neuroendocrine theory-The seizure
causes the hypothalamus to release
chemicals that cause changes throughout
the body. The seizure may release a
neuropeptide that regulates mood.
Brain damage theory- Shock damages
the brain, causing memory loss and
disorientation that creates an illusion
that problems are gone, and euphoria,
which is a frequently observed result of
brain injury. Both are temporary.
Psychological theory- Depressed
people often feel guilty, and ECT
satisfies their need for punishment.
Alternatively, the dramatic nature of
ECT and the nursing care afterwards
makes patients feel they are being taken
seriously – the placebo effect.

5. 1 mins List out the types of Types of ECT Lecture cum Black What is meant by
ECT Direct ECT: In this, ECTis given in the discussion board modified ECT?
absence ofanaesthesia and muscular
relaxation. This is not a
 Commonly used method now.
Modified ECT: Here ECT is modified
by druginducedmuscular relaxation and
generalanaesthesia.
6. 2 mins Describe about the Frequency and application of Lecture cum Card How will you place
frequency and electrodes: discussion electrodes in
application of Frequency: Three times per week or as bilateral ECT?
electrodes indicated.
Total number: 6to 10; upto 25 may be
preferred asindicated.

Application of Electrodes
Bilateral ECT: Each electrode is placed
2.5-4 cm above the midpoint, on a line
joiningthe tragus of the ear and the
lateral can thus of theeye.
UnilateralECT: Electrodes are placed
only on one side of head, usually non-
dominant side (rightside of head in a
right-handed individual).
Unilateral ECTis safer, with much fewer
sideeffectsparticularly those ofmemory
impairment.

7. 2 mins Discuss the Indications Lecture cum PPT List any two
indication a. Major depression: With suicidal risk; discussion indication?
withstupor; with poor intake of food and
fluids;melancholia with psychotic
features with
unsatisfactory response to drugs or
wheredrugs are contraindicated or have
seriousside-effects .
b. Severe catatonia (functional): With
stupor; withpoor intake of food and
fluids; withunsatisfactory response to
 drug therapy, orwhen drugs are
contraindicated or haveserious side-
effects.
c. Severe psychosis (schizophrenia or
mania): Withrisk of suicide, homicide or
danger of physical
assault; with depressive features; with
unsatisfactory response to drug therapy,
orwhen drugs are contraindicated or
haveserious side-effects.
d. Organic mental disorders:
• organic mood disorders.
• organic psychosis
e. Other indications: ECT is preferred to
antidepressanttherapy in some cases,
such as forclients with cardiac disease;
when tricyclicsare contraindicated
because of the potentialfor
dysarrythmias and congestive
heartfailure; and for pregnant women, in
whom
antidepressants place the fetus at risk
forcongenital defects.

8. 2 mins Enumerate the Contraindications Lecture cum Black What are the
contra indication A Absolute: discussion board relative
• raised ICP (intracranial pressure) contraindication?
B. Relative:
• cerebralaneurysm
• cerebral haemorrhage
• brain tumor
• acute myocardial infarction
• congestive heart failure
• pneumonia or aortic aneurysm
• retinal detachment
9. 2 mins Enlist the Complications of ECT Black Enlist any two side
complications and  Life-threatening complications Lecture cum board effects?
side effects of ECT are rare. discussion
 ECT does not cause any brain
damage.
 Fractures can sometimes occur in
elderlypatients with osteoporosis.
 In patients with ahistory of heart
disease, dysrhythmias
andrespiratory arrest may occur.
Side Effects of ECT
• Memory impairment.
• Drowsiness, confusion and
restlessness.
• Poor concentration, anxiety.
• Headache, weakness/fatigue,
backache,muscle aches.
Dryness of mouth, palpitations,
nausea,vomiting.
• Unsteady gait.
• Tongue bite and incontinence.

10. 6 mins List down the role TreatmentFacilities Lecture cum Pamphlet List the role of
of nurse There should be a suite of three rooms: discussion nurse during the
1. A pleasant, comfortable waiting room procedure?
(PREECTROOM).
2. ECT room, which should be equipped
with ECT machine and accessories ,an
anaesthetic
appliance, suction apparatus, face
masks, oxygen cylinders with adjustable
flow valves,curved tongue depressors,
mouth gags, resuscitation
apparatus ,emergency drugs and
defibrillator.
3. A well-equipped recovery room.
Role of the Nurse
Pre-treatment evaluation
• Detailed medical and psychiatric
history, including history of allergies.
• Assessment of patient's and family's
knowledge of indications, side-effects,
therapeutic effects and risks associated
with ECT.
• An informed consent should be taken.
Allay any unfounded fears and anxieties
regarding the procedure.
• Assess baseline vital signs.
• Patient should be on empty stomach
for 4-6 hours prior to ECT.
• Withhold night doses of drugs, which
increase seizure threshold like diazepam
barbiturates and anticonvulsants,
• Withhold oral medications in the
morning.
• Head shampooing in the morning since
oilcauses impedance of passage of
electricity to brain.
• Any jewellery, prosthesis, dentures,
contactlens, metallic objects and tight
clothing should
be removed from the patient's body.
• Empty bladder and bowel just before
ECT.
• Administration of 0.6 mg atropine IM
or SC 30 minutes before ECT, or IVjust
before ECT.
b. Intra-procedure care
• Place the patient comfortably on the
ECT table in supine position.
• Stay with the patient to allay anxiety
and fear.
• Assist in administering the anesthetic
agent (thiopental sodium 3-5 mg/kg
body weight) and muscle relaxant
(1mg/kg body weight of
succynylcholine).
• Since the muscle relaxant paralyzes
allmuscles including respiratory
muscles, patent
airway should be ensured and ventilator
support should be started.
• Mouth gag should be inserted to
preventpossible tongue bite.
• The place(s) of electrode placement
should be cleaned with normal saline or
25 percent
bicarbonate solution, or a conducting
gelapplied.
• Monitor voltage, intensity and duration
ofelectrical stimulus given.
• Monitor seizure activity using cuff
method.
• 100 percent oxygen should be
provided.
• During seizure monitor vital signs,
ECG, oxygen saturation, EEG, etc.
• Record the findings and medicines
given in the patient's chart.
c. Post-procedure care
• Monitor vital signs.
• Continue oxygenation till spontaneous
respiration starts.
• Assess for post-ictal confusion and
restlessness.
Take safety precautions to prevent injury
(sidelyingposition and suctioning to
prevent aspiration of secretions, use of
side rails to
prevent falls).
If there is severe post-ictal confusion
and restlessness,
IVdiazepam may be administered
• Reorient the patient after recovery and
stay with him until fully oriented.
• Document any findings
SUMMARY:
So for we discuss about the definition, types, mechanism of action, indication, contraindication, complication, side
effect, role of nurse in ECT .

CONCLUSION:
ECT is an effective treatment for treatment resistant disorder and may be more additional than pharmacological
stratergies.
ASSIGNMENT:
Mr. John Anderson, 45 years old, Male, with Diagnosis of Major Depressive Disorder (MDD) with psychotic features. Mr. Anderson
has a history of recurrent depressive episodes and has not responded well to multiple medication trials. His symptoms have
significantly impacted his daily functioning, leading to social withdrawal and suicidal ideation.
Present a case study on Mr. John Anderson, evaluating the success of the Electroconvulsive Therapy. Address aspects of knowledge,
understanding, application, and skill in your analysis, considering the patient's history, the rationale for choosing ECT, the treatment
protocol, and the overall outcome. Discuss the role of nursing professionals in supporting Mr. Anderson throughout the ECT process.
Score : 10 marks
Date of submission: 08.01.2024
Evaluation:
Blue Print for Evaluation:

Content Knowledge Understanding Application Skill Total

Teachers References:

1. K. Lalitha , “Mental Health & Psychiatric Nursing” 1st edition, W.M.G. Book House Publications, 2007, Page No:120-128
2. R. Sreevani, “A Guide to Mental Health & Psychiatric Nursing”, 2 nd edition, Jaypee Publications, New Delhi, 2007, Page
No:182-185.
3. Townsent M.C., “Psychiatric Mental Health Nursing”, 5th edition, Jaypee Publications, New Delhi, 2007, Page No:336-341.
4. Kalpan and Saddocks, “Comprehensive Textbook of Psychiatry”, 7th edition, volume I, Lippincott William, Publishers,
2000,Page No:214-215.
5. [Link] /PMC 314629.

Student References:

1. R. Sreevani, “A Guide to Mental Health & Psychiatric Nursing”, 2 nd edition, Jaypee Publications, New Delhi, 2007, Page
No:182-185.
2. K. Lalitha , “Mental Health & Psychiatric Nursing” 1st edition, W.M.G. Book House Publications, 2007, Page No:120-128

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