VIII. Electroconvulsive Therapy (ECT) indicated when other antidepressants are not effective, acutely suicidal, psychotic features, vegetative signs contraindicated in increased ICP, CVA, brain mass/lesion action increases level of circulating neurotransmitters, especially norepinephrine improvement in 6-12 treatments requires informed consent pre-procedural preparation o D/C meds that decrease seizure threshold Interferes with seizure potential required for the treatment o Wash hair, void, NPO, VS, IV access, cardio respiratory monitoring o Airway management Simple oxygenation via nasal cannula Suction Give medication (atropine; robinul) Manage oral secretions Bite guard o Short acting anesthetic, muscle relaxant Brevital, Anectine electrical stimulus 1.5 – 2.0 seconds – o grand mal generalized tonic/clonic seizure activity (at least 15-25 seconds) response evaluated by EEG activity/use of tourniquet post-procedural care
o reassurance, monitor VS, airway management, seizure potential, ensure physical safety and security, orient side effects o muscle soreness (D/T seizure activity) o nausea o headache o memory impairment retrograde/anterograde IX. Psychotherapeutic Management Nursing Interventions Nurse-patient relationship recognize signs of the disorder the patient is exhibiting o assess acuity of patient’s pathology o promote appropriate care develop a trusting relationship o brief contact, consistency, offer self utilize communication skills that foster dialogue o simple, concrete, silence, open approaches, observations administer antidepressant medications o bio-manipulation of neurotransmitters protect from self-harm o suicide prevention Suicide Prevention/ Psychotherapeutic Management intentional taking of one’s own life o 2 nd leading cause in U.S. military o 10 th leading cause of death in 2013 occurs on a continuum o thoughts, threats, gestures, attempts intent may not always be for death o response to external event o act of escape, release o gain control over others o gestures o manipulating others o embarrassment o poor impulse control o ineffective coping affects 10-15% of all patients with depression o treat all with potential for self-harm self- awareness assume all depressed patients are at risk o SAD scale
Men have higher risk Elderly have higher risk inquire into suicidal expressions/ideas o listen for verbal cues o promote further dialogue determine intent seriousness o prior attempt, plan, method, rescue o Columbia suicide severity rating scale ask questions! closely observe behavior o as condition improves more likely to commit suicide, more concert thinking so they can plan better o at random times o one-to-one staff observation in acute situations environmental measures o remove potential hazards contract o verbal or written ambivalence o discuss benefits of life and effects of death on significant others offer hope; explore alternatives o therapeutic nurse-patient relationship and communication
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- Fall '19
- Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant, Tricyclic antidepressant