Electroconvulsive therapy (ECT) is a physical treatment that induces grand mal (generalized) convulsions by applying electric current to the head. It is also called electric shock therapy (EST).

1. CHARACTERISTICS of electroconvulsive therapy:
1. Usually used in treating: major depression with severe suicide risk, extreme hyperactivity, severe catatonic stupor, or those with bipolar affective disorders not responsive to psychotropic medication.
2. Consists of a series of treatments (6 to 25) over a period of time (e.g., 3 times per week).
3. Person is asleep through the procedure and for 20 to 30 minutes afterward.
4. Convulsion may be seen as a series of minor, jerking motions in extremities (e.g., toes). Spasms are reduced by use of muscle-paralyzing drugs.
5. Confusion is present for 30 minutes after treatment.
6. Induces loss of memory for recent events.
2. VIEWS CONCERNING SUCCESS of electroconvulsive therapy:
1. Posttreatment sleep is the "curative" factor.
2. Shock treatment is seen as punishment, with an accompanying feeling of absolution from guilt.
3. Chemical alteration of thought patterns results in memory loss, with decrease in redundancy and awareness of painful memories.
3. NURSING CARE PLAN/IMPLEMENTATION in electroconvulsive therapy:
1. Always tell the client of the treatment.
2. Inform client about temporary memory loss for recent events after the treatment.
3. Pretreatment care:
1. Take vital signs.
2. See to client's toileting.
3. Remove: client's dentures, eyeglasses or contact lenses, and jewelry.
4. NPO for 8 hours beforehand.
5. Atropine sulfate subcutaneously 30 minutes before treatment to decrease bronchial and tracheal secretions.
6. Anesthetist gives anesthetic and muscle relaxant IV (succinylcholine chloride [Anectine]) and oxygen for 2 to 3 minutes and inserts airway. Often all three are given close together—anesthetic first, followed by another syringe with Anectine and atropine sulfate. Electrodes and treatment must be given within 2 minutes of injections, because Anectine is very short acting (2 minutes).
4. During the convulsion, the nurse must make sure the person is in a safe position to avoid dislocation and compression fractures (although Anectine is given to prevent this).
5. Care during recovery stage:
1. Put up side rails while client is confused; side position.
2. Take blood pressure, pulse (check for bradycardia), and respirations.
3. Stay until person awakens, responds to questions, and can care for self.
4. Orient client to time and place and inform that treatment is over when awakens.
5. Offer support to help client feel more secure and relaxed as the confusion and anxiety decrease.
6. Medication for nausea and headache, prn.
6. Health teaching: teach family members what to expect of client after ECT (confusion, headache, nausea); how to reorient the client.
4. EVALUATION/OUTCOME CRITERIA: feelings of worthlessness, helplessness, and hopelessness seem diminished.