ECT (electroconvulsive therapy) involves inducing a seizure through electric currents applied to the brain via electrodes on the temples. It is used to treat severe depression, mania, schizophrenia, and other conditions when other treatments are ineffective. Nursing care involves preparing the patient physically and emotionally, monitoring them during treatment, and observing them after to ensure safety and comfort as side effects like confusion and memory loss may occur. The exact mechanism is unknown but it increases neurotransmitter levels in the brain.

1. by
Mohamed Mustafa

2. Definition
• E .C .T is a type of somatic treatment in
which electric current is applied to the
brain through electrode placed on the
temporal regions ,the current is sufficient
to induce a grandmal seizure, from which
the desired therapeutic effect is achieved.

3. Dose ;100 -150 microvolt
• Duration ;0.1 -0.5 seconds
• Course ; the number of shocks of spacing
depend up on the diagnosis and the response of
patient.
• Treatment usually administrated three time per
week.
• Acute psychosis may need the treatment daily.
• Most patient require an average of 6-10
treatment .

4. Indication
• 1-Major depression with danger of suicide.
Its given later on, to depression not responding to
drug therapy.
2-Mania; not responding to other form of
treatment.
3-schizophrenia ; acute schizophrenia and acute
stupor schizophrenia.
4-Epileptic patient before fit.
5- obsessive compulsive disorder.
6-Personality disorders.
7-Anorexia nervosa.

5. Contraindication
• 1- increase intracranial pressure (cardiovascular
accident ,brain tumor)
• 2-Organic brain damage .and recent myocardial
infraction.
• 3-Hypertension or hypotension.
• 4-Pregnancy in 1st &3rd trimester.
• 5-Acute T.B infection diseases &Typhoid
disease with fever,
• 6-Asthmatic pt.(apnea) 7-Fracture
• 8-kidney and liver failure
• 9-Epileptic pt during fit.

6. Side effects & Complication
• 1-Amnesia ( temporary memory loss or disturbance of
memory for few hours)
• 2-Confusion ;it increase with increase number of
treatment.
• 3-Pain in back, chest ,shoulders, arm, legs &headache.
•
4-Dislocation of hipbone shoulders& Fracture may occur.
• 5-Injury of tongue , Teeth, or lips.
• 6-Increase B.P leads to cerebral hemorrhage.
• 7-Suffocation.
• 8-Death ;it rare .01% - .04%

7. Mechanism of action
• The exact mechanism of E.C.T is
unknown
• It produce biochemical changes in the
brain.
• It increase levels of norepinephrin and
serotonin.

8. Nursing intervention
It divided into (3) phases;
1-Preparation of patient.& preparation of
equipments { before E .C .T }
2-Nursing care during E .C .T.
3-Nursing care after E .C .T.

9. 1-preparation of the patient
• A- Emotionally;
• -The patient and family informed about the
procedure.
• -Consent obtained from patient or
relatives.
• -Explain the procedure.
• -Reassuring the patient by telling him
about the procedure will be harmless
&painless.

10. &
• Patient must be oriented to E .C .T.room
&staff working in it.
• Take the patient to another patient who
has done it and good.
• Let the patient to express his feeling.

11. B- physically
• -The pt. fasts 5-6 hrs. before E.C.T.
• -check vital signs before E.C.T especially
B.P.
• Observe the skin for any abnormalities if
the pt. has fever don’t give E.C.T.it will
leads to increase temperature.
• If the pt. takes major tranquilizer stop it
before E.C.T.
• Empty bladder and bowel before E.C.T.

12. &
• Remove pins ,clips ,artificial teeth, glass,
make up to observe signs of cyanosis.
• Give atropine I . M Half an hour before
E.C.T.
• Muscle relaxant first then administer
anesthesia.

13. Preparation of Equipment
• Firm bed - pillows & mattress covered
with mackintosh.
• Working Electrotherapy machine
(unilateral or bilateral).
• Working oxygen cylinder.
• Working suction apparatus.
• Electrode jell or bowl or saline solution.
• Tongue blade rolled with cotton.

14. &
• End tracheal tube. & laryngoscope
• Syringes ,tourniquet, patient chart.
• Emergency medication ( coramine
,Adrenaline ,Decadron).
• Pre E .C .T.medication as (Atropine
,Anesthesia ,muscle relaxant )

15. Nursing care during E.C.T.
• Put PT. in supine position.
• The anesthesiologist I .V.a short acting
anesthesia ( pentothal or Brevital )
• Put tongue blade & ask the pt. to bite on and
support lower jow by a rubber mouth gag.
• Support shoulders and pelvis to prevent fracture.
• Shoked electrodes with saline and putting them
on the temples.
• Administration of oxygen and close supervision
during unconscious stage.

16. Nursing care after E.C.T
• Put pt in semi prone position & turn his
head to one side to prevent aspiration.
• Clear his airway by suctioning of vomiting
or excessive mucus. close attention to
patent airway.
• Check vital signs every 15 m. for first hour.
•
Protect pt .from any injury &give oxygen if
necessary.

17. &
• Sudden standing is avoided and allow the
pt. to sleep.
• Orient pt. to time & place. assist the pt.to
rearranging clothes& combing hair to
promote comfort.
• Serve breakfast and assist if need.
• Listen to the pt. and allow him to express
his feeling and record the procedure.