breif introduction of electric current through the brain to induce seizure attack for 25-150 seconds.
electro convulsive therapy
how many times and session may this therapy required?
2-3 times per week 6-12 session
ECT indications
🔘severe depression🔘treatment resistance depression🔘severe mania🔘catatonia🔘agitation and aggression in people withdementia
ECT contraindication
🔘increase ICP🔘brain tumors
ECT risk
🔘cva🔘retinal detachment(causes blindness) mgt;(patch)🔘pheochromocytoma ( adrenal tumor)
ECT special use:
🔘during pregnancy🔘meds can't be taken because they might harm the developing fetus🔘in adults who can't tolerate drug side effects
ECT side effects:
🔘confusion 🔘memory loss (mgt) orient pt.🔘physical side effects( vomiting,headache,altered vs)
this is generally effective and most widely used electrode placement causes the greatest post-ECT disorientation.
Bitemporal electrode placement
this hasbeen shown as efficacious as bitemporal placement while producing less disorientation
bifrontal placement
nursing considerations BEFORE ECT:
🔸provide family education🔸obtain informed consent🔸advice client to prepare memory aids(lists,notepad,etc)🔸NPO x 8-12 hrs🔸client should wear loose, comfortable and non-restrictive clothing 🔸remove client's denture,contact lense, hearing aids, glasses, prosthesis, jewelries, and metal accessories🔸client's hair should be clean and dry🔸anti-convulsant should not be given after 5 pm before procedure
ECT nursing consideration DURING PROCEDURE
🔸insert bite block and put on a stretcher with side rails up 🔸the client will be given short acting general anesthesia and muscle relaxant 🔸continuous EEG monitoring ;cardiac monitor
ECT nursing consideration AFTER PROCEDURE
🔸ensure client's safety🔸provide support🔸monitor VS🔸administer O2 and prepare suction equipment and supplies
mimics the effect of neurotransmitter
agonist
blocks neurotransmitter in the brain
antagonist
endogenous chemicals that transmit signals from a neuron to a target cell across a synapse
neurotransmitter
the absorption of a neurotransmitter by a neurotransmitter transporter of a presynaptic neuron after it has performed its function of transmitting a neural impulse
reuptake
increased acetylcholine causes
depression
decreased acetylcholine causes
alzheimer's dse.
increased norepinephrine causes
🔸mania🔸anxiety🔸schizophrenia
decreased norepinephrine causes
depression
increased dopamine causes
🔸mania🔸schizophrenia
decreased dopamine causes
parkinson's depression
increased serotonin causes
anxiety
decreased serotonin causes
depression
decreased in GABA amino acid causes
🔸huntington's🔸schizophrenia 🔸anxiety states🔸epilepsy
increased substance (neuropeptide)
depression
decreased substance P (neuropeptide)
🔸huntington's🔸alzheimer's
also known as neuroleptics, use to treat psychosis, schizophrenia, mania, paranoid, organic dementi, etc
antipsychotics
anti-psychotic is CONTRAINDICATED to patient who has ____?
🔸hypersensitivity🔸CNS depression🔸bone marrow depression🔸blood dyscrasias and brain damage
3 classifications
🔸typical🔸atypical🔸novel antipsychotic
this is conventional/traditional"1 st generation(1950-1990) ; cause EPSE's; use for (+) signs only ; older antipsychotic, effective in treatment of acute psychosis and agitation.
TYPICAL
high potency antipsychotic DRUGS
🔸Fluphenazine(prolixin)🔸Haloperidol(haldol)🔸Thiothixine(navane)🔸trifuoperazine(stelazine)
moderat potency DRUGS
🔸Loxapine(loxitane)🔸Molidone(moban)🔸Perphenazine(trilafon)
low potency causes more anticholinergic and antiadrenergic SE
🔸Chlopromazine(thorazine)🔸Thioridazine(mellaril)
2nd generation;fewer EPSE's but causes agranulocytosis and anticholonergics
ATYPICAL
atypical or 2nd generation DRUGS
🔸Clozapine (clozaril)🔸Risperdone(risperdal)🔸Olanzapine(zypreza)🔸Quentiapine(seroquel) 🔸Sertindole(serlect)🔸Zipresalone(zeldox)🔸Ziprasidone(geodon)🔸Paliperidone(inverga)
newest 1 day dosing only
Paliperidone (inverga)
(dopamine system stabilizer) ✖️most common SE are headache, lightheadedness and akathesia
Nobel antipsychotic
cause by blocking of CN's
PNS (anticholinergic effects)
CN III-occulomotor nerve block causes;
🔸Mydriasis🔸Blurring of vission🔸Impaired accomodation
CN III nursing intervention
🔸Advise to report eye pain immediately avoid potentially dangerous task 🔸Normal vision return in 5 weeks, pilocarpine eye drops can be use for short-term basis
CN VII-facial nerve block and CN IX glossopharyngeal causes:
🔸Dry mouth 🔸decrease tearing🔸Dry nasal passage
CN VII and CN IX nursing intervention:
🔸take sips of water frequently 🔸Provide sugar less, hard candies, sugarless gums mouth rinses
CN X vagus nerve block causes:
🔸tachycardia🔸constipation🔸urinary hesitancy
CN X nursing intervention:
🔸Provide privacy, run water into sink,warm water over perineum 🔸Increase fiber in diet 🔸Give laxative as prescribe