At the end of the class, students will gain in depth knowledge regarding ECT, develop positive attitude and skill in providing care to clients undergoing ECT

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TNNMC ECHO CASE PRESENTATION
PRESENTER NAME - Mrs. Nisha.S

2. Course : B.Sc. Nursing
Subject :Mental Health Nursing
Unit :V-Treatment modalities &Therapies used in
mental disorder
Topic :Electro Convulsive Therapy
Level of students : B.Sc. Nursing III year
No. of students : 50
Venue :III Year Bsc Nursing Classroom
Date and time :
Duration of class : 1 Hour
Methods of teaching : Lecture cum discussion
Audio visual aids : Power point slides, blackboard, Pamphlet,Mannikin, Flow chart
Review of previous knowledge :Students may have acquired some knowledge about mental disorder and
physical therapy through cinemas, TV serials and other modes of
media

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Central Objective
At the end of the class, students will gain in depth knowledge regarding ECT, develop
positive attitude and skill in providing care to clients undergoing ECT
Specific Learning Objectives
At the end of the class, students will be able to
• define ECT (Cognitive - Understanding )
• List the indication of ECT (Cognitive - Remembering)
• enlist the contraindication of ECT (Cognitive - Remembering)
• classify ECT ( Cognitive - Analyzing)
• explain the mechanism of action of ECT( Cognitive - Analyzing)

4. • locate the placement of electrodes (Psychomotor - Mechanism)
• explain the treatment regimen of ECT (Cognitive - Understanding)
• assess the types of seizure produced in ECT(Cognitive - Evaluating )
• explain the action of the medication used in ECT (Cognitive - Applying)
• State the ECT team members (Cognitive - Remembering)
• identify the side effect of ECT ( Cognitive -Analyzing)
• describe the role of the nurse in the administration of ECT (Cognitive - Evaluating )
• formulate the possible nursing diagnosis for client receiving ECT(Cognitive - Creating )

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Introduction
Good Afternoon dear students,
Today, let us discuss an interesting topic. I will tell you a scenario, kindly listen to it and guess the
topic. Among you, most of the students are staying in the hostel. One of the important rules of hostel you need to
follow is”MOBILE PHONE IS STRICTLY PROHIBITED IN THE HOSTEL PREMISES’’ and for students this is difficult to follow
in this technical world .You might be using mobile and you need to charge everyday. There is no electrical supply in
your room except fan and tubelight. Here, your creativity area of brain is activated ,one of you is planned to take
connection from the tubelight plug holder. While trying to attempt she felt some electrical energy is passing on to her
body and suddenly she shouted as ammaaaa and withdrawn her hand. Her friend asked what happened.
Can you Guess What she might have replied..?????
Students: she experienced electric shock.
Teacher: Yes. she had electric shock. Similarly in Psychiatric field there is a treatment procedure used by a psychiatrist
to treat some of the mental disorder. Can you guess the topic…?
Students: Shock treatment.
Teacher: Good. You are appreciated.. Today’s class is Electro Convulsive Therapy.

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With the emergence of biological psychiatry and the growing knowledge basis in
the neurosciences, interest has increased in somatic therapies for psychiatric illness. ECT
was introduced by the Italian Psychiatrist Ugocerletti and Lucio Bini at Rome in 1938 as a
treatment for schizophrenia. Modified ECT is introduced by Von Meduna in 1950. ECT is
formerly known as Electric Shock Therapy Or Shock Treatment .

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
Define ECT 2 DEFINITION
The induction of a grandmal seizure through the
application of electrical current to the brain
-Mary C. Townsend
ECT is a treatment in which a grandmal seizure is
artificially induced in an anesthetized patient by
passing an electrical current through electrodes
applied to the patients head
-Gail W. Stuart
Explains with
the help of
blackboard
Listening
and taking
notes
What is ECT
List the
indication of
ECT
2 INDICATION
• Major Depression
• Mania
• Schizophrenia
• Other condition
Neurotic disorder
Personality disorder
Explains with
the help of
blackboard
Listening
and taking
notes
What are
the
common
indication of
ECT

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
enlist the
contraindicati
on of ECT
2 CONTRA INDICATION
 Absolute Contra indication
Increased ICP
 Relative Contra indication
H/o MI,CVA Preceeding in 3 months
Brain Tumour,Cerebral Aneurysm
Pneumonia
Retinal detachment
Explains
with the help
of Roller
board
Listening
and taking
notes
What are the
relative
contra
indication
classify ECT 2 TYPES OF ECT
• DIRECT ECT
ECT is given in the absence of anesthesia
and muscular relaxation
• MODIFIED ECT
ECT is given in the presence of anesthesia
and muscular relaxation.
Explains
with the help
of roller
board
Listening
and taking
notes
What is
modified
ECT

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
explain the
mechanism
of action of
ECT
5 MECHANISM OF ACTION Explains
with the help
of Flow
chart
Listening
and taking
notes
How mood
is enhanced
in Anti
convulsant
Theory
• Exact cause is unknown but some
theories suggest the following action
1. Neurotransmitter Theory
2. Neurotrophic factor theory
3. Anti convulsant theory

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
MECHANISM OF ACTION
1.Neurotransmitter Theory
ELECTRO CONVULSIVE THERAPY
Enhance deficient neuro transmission in
monoaminergic system
Increases in DA, 5HT and epinephrine
reduction in symptom and enhances the mood

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
2. Neurotrophic factor theory
ELECTRO CONVULSIVE THERAPY
Upregulation of cyclic Amp(Adenosine
mono Phosphatase)
Increase in brain derived neurotrophic
factor
Regulation of neuronal cell growth
Increase in 5HT, Norepinephrine
Reduction in symptom and enhance the mood

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
3. Anti convulsant theory
ELECTRO CONVULSIVE THERAPY
Induced seizure
Teach the brain to resist seizure
This effort to inhibit seizure dampens
abnormally active brain circuit
Establishing Mood

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
locate the
placement of
electrodes
2 PLACEMENT OF ELECTRODES
1. Bilateral- Electric current is passed across the
whole brain
2. Unilateral- Electric current is passed across
one hemisphere of the brain . Both the
electrodes is placed on the same side of the
head
3. BIFRONTAL-Electrodes is placed between the
bilateral & unilateral
Demonstrate
with the help
of mannikin
Observes and
redemonstrate
s
What is
unilateral
placement
of ECT
explain the
treatment
regimen of
ECT
2 TREATMENT REGIMEN:
PARAMERES OF ELECTRICAL CURRENT APPLIED
According to APA (American Psychiatric
association)
 Voltage-70 to 120 volts
 Duration- 0.7 to 1.5 Seconds
FREQUENCY AND TOTAL NUMBER OF ECT
 Frequency- 2to 3 times per week
 Number- 6 to 12 treatment ( Maximum 20)
Explains with
the help of
PPT
Listening and
taking notes
What is the
time
duration of
ECT

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
assess the
types of
seizure
produced in
ECT
1 TYPES OF SEIZURE PRODUCED
• Grand mal Seizure
Tonic phase lasting upto 10- 15 seconds
Clonic phase lasting for 30 - 60 seconds
Explains
with the
help of
PPT
Listening
and
taking
notes
What are the
phases of
grandmal
seizure
explain the
action of the
medication
used in ECT
2 MEDICATION USED IN ECT
1. Anticholinergic Agent (to decrease secretion)
Example: Atropine, Glycopyrulate
2. Anesthetic Agent: (decreases neuronal activity)
Example: Theopental sodium
2. Muscle Relaxant: (to decrease motor response)
Example: Succinyl Choline
Explains
with the
help of
PPT
Listening
and
taking
notes
What is the
action of
anticholinergi
c agent
State the
ECT team
members
2 ECT TEAM
 Psychiatrist
 Anesthesiologist
 Trained Nurses &
 Aides
Explains
with the
help of
PPT
Listening
and
taking
notes
List the team
members of
ECT

15. 15
SLOs Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
identify the
side effect of
ECT
5 SIDE EFFECT
 Temporary memory loss
 Confusion
 Drowsiness
 Restlessness
 Headache
 Fatique
 Dryness of mouth
 Nausea & vomiting
 Palpitation
 Tongue bite
Explains
with the help
of PPT
Listening
and taking
notes
List any 4
side effect
of ECT
describe the
role of the
nurse in the
administration
of ECT
15 NURSING MANAGEMENT
PRE ECT NURSING CARE
1.Emotional Support & Education
• Allow opportunity to express feelings
including myth, concern or fantasies
involving ECT
• Provide individual or family education
Explains
with the help
of Pamphlet
Listening
and taking
notes
How many
hours
should
patient
remain
NPO status
prior to
ECT

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
2. Patient Assessment
• Review recommended consultation
• Note lab test
3.Check the informed consent
4. Check that the equipment and supplies are
adequate and functional
5. Patient Preparation
• NPO for 6 to 8 hours before treatment
• Loose fitting comfortable clothing
• Remove all Prosthesis: Dentures, contact
lens, Hearing Aids
• Keep patient hair clean and dry
• Instruct the patient to empty the bladder
immediately before receiving ECT

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
INTRA ECT CARE
• Accompany the client to the ECT room and
remain with t6he patient through out the
procedure
• Introduce the treatment team
• Position the client comfortably in a supine
position without a pillow
• Insert a peripheral IV line
• Place leads for various monitors:EEG,
pulseoxymeter, Peripheral nerve stimulation
• Place the BP cuff on an ankle
• Clean the area of electrodes contact with
mild soap and dry

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
• Administer an anticholinergic Agent
• Administer an anesthetic agent
• Inflate BP cuff
• Insert a bite block between upper and lower
teeth
• Administer muscle relaxant
• Support the chin during the delivery of brief
electrical stimiuli
• Assess the motor manifestation of seizure in
the cuffed foot
• A motor seizure 15- 20 second is considered
adequate. Seizure lasting longer than 2
minutes should be terminated by using
benzodiazepines or additional anesthetic
given at the half of the induction dose

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SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
• Observe for progressive muscle relaxation by
cessation of muscle twitching
• Administer oxygen by mask through positive
pressure ventilation
POST ECT CARE
• Position the client
• Shift the client to the recovery room with
pulse oximetry in place
• Monitor vital signs and SaO2 as indicated
• Maintain patient safety to prevent from falls
• Provide Frequent reassurance and
orientation
• Shift the client to the ward if the vital signs
and mental status have returned to an
acceptance level and SaO2 is > 94%

20. 20
SLO Time Content Teacher’s
Activity
Learner’s
Activity
Evaluation
• Hand over the client to unit staff
• Assess for the return of gag reflex and offer
medication and meals
• Clarify that memory disturbances will regain
within 6 months.
formulate
the possible
nursing
diagnosis for
client
receiving
ECT
POTENTIAL NURSING DIAGNOSIS
1.Anxiety (moderate to severe )related to
impending therapy
2. Deficit Knowledge related to necessity for
and side effects of ECT
3.Risk for aspiration related to altered level of
consciousness immediately following treatment
Explains
with the help
of PPT
Listening
and taking
notes
What is the
nursing
diagnosis for
inadequate
knowledge
regarding
ECT
4. Decreased cardiac output related to vagal
stimulation occurring during the ECT
5.Impaired memory /acute confusion related to
side effect of ECT
6. Risk for activity intolerance related to post
ECT confusion and memory loss

21. ECT Machine with
Electrodes
21
Audio Visual Aids used
Supporting chin
during delivery of
electric currents
Placement of
Electrodes

22. Assignment:
Prepare a nursing care plan for a client receiving
ECT.
Date and time of submission:12/05/21 at
10:00am
Place of submission: Department of Mental
Health Nursing
Evaluation(Assessment of Knowledge)
Short answer (5X2=10)
1. Define ECT
2. List any 3 indication and contraindication of ECT
3. Medication used in ECT
4. List any 4 side effects of ECT
5. State any 3 possible nursing diagnosis of client
receiving ECT
22

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Summary
ECT
Introduction
ECT introduced by
Cerletti & Bini(1938)
Modified ECT- Von
Meduna(1950)
Placement of
Electrodes
• Bilateral
• Unilateral
• Bifrontal
Types of Seizure
produced
Grandmal-tonic
& clonic Phase
Medication Used
• Anticholinergic
• Anesthetic
• Muscle relaxant
ECT
Team
Indication
• Depression
• Mania
• Schizophrenia
• others
Contra Indication
• Absolute
• Relative
Types
• Direct
• Modified
Treatment Regimen
• Voltage
• Duration
• Frequency
• Number of ECT
Mechanism of action
• Unknown
• Neurotransmitter theory
• Neurotrophic factor
theory
• Anticonvulsant theory
Definition
Induction of a
grandmal seizure
through the
application of
electrical current
to the brain
Side Effects
• Memory loss
• tongue bite
• Confusion
Nurses Role
• Pre ECT Care
• Intra ECT Care
• Post ECT care
Possible Nursing
Diagnosis

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Conclusion
ECT is a safe treatment for patients who are resistant to other forms of therapy. The
continued success of ECT patients outcomes are dependent on the ECT team
especially the nurses who cares for the patients and are knowledgeable in their
assessment and care during pre, intra and post procedure.

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References
• Sreevani’s (2010) A guide to mental health and psychiatric nursing, 3 rd Edition
Jaypee brothers Medical Publication PVT LTD
• Gail W. Stuart (2013) Principles and practice of Psychiatric Nursing, 10th Edition
Elsevier Publication PVT LTD
• Mary C. Townsend (2014) Essentials of psychiatric Mental Health Nursing, 6th
Edition, Davis Publication PVT LTD.

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Concerns and Issues in Lesson Planning
No issues