Preparation
The patient preparing for ECT will need to be NPO for
What is 6-8 hours
This medication may be given approximately 1 hour before the ECT to dry secretions and offset the bradycardia from anesthesia
What is atropine or Rubinul (glycopyrrolate)
Post ECT, the patient should remain in bed until oriented, while lying in this position to prevent aspiration
What is side lying
There is only a 0.002% chance of this occurring during an ECT treatment, and even then, it is caused from cardiovascular complications
What is mortality
1. A client engages in frequent temper tantrums that usually result in her parents giving in to her demands. A nurse identifies that the client's parents affect her behavior by which of the following?
A. Shaping the behavior.
B. Modeling the behavior.
C. Positively reinforcing the behavior.
D. Aversive stimulus.
c. correct: Positively reinforcing the behavior: the reinforcing stimulus increases the probability that the behavior will recur
a. incorrect-in shaping, reinforcements are given for increasingly closer to the desired response i.e. "make this sound by shaping your lips like mine."
b. incorrect-modeling in imitation
d. incorrect- aversive stimuli decreases the probability that the behavior will occur again
The patient preparing for ECT will need to discontinue these 2 types of medications
What is Barbiturates and Benzodiazepines
This medicine will be used for anesthesia purposes during an ECT procedure
What is Methohexital (Brevital Sodium) or Propofol (dipravan)
Post ECT, the RN will do this type of focused assessment, knowing that anesthesia puts everything to sleep
What is Respiratory assessment
The timeframe that puts a patient at higher risk for complications during ECT, after a CVA
What is 3-6 months
A client who is learning about electroconvulsive therapy (ECT) asks a nurse, “Isn’t this treatment dangerous?” Which is the most appropriate nursing reply?
A. “No, this treatment is side-effect free.”
B. “There can be temporary paralysis, but full functioning returns within 3 hours of treatment.”
C. “There are some risks, but a thorough examination will determine your candidacy for ECT.”
D. “Transient ischemic attacks (TIAs) can occur but are rare.”
c. correct-acknowledge there are risks but assure they will be assessed for risks vs benefits
a. incorrect-there are side effects involved
b. incorrect-don't guarantee what you cannot control because every patient reacts differently
d. incorrect-although this is a risk, there is a more appropriate answer
A patient preparing for ECT will need to sign this
What is a Consent
This medicine will be used for muscle relaxation so the full seizure effect does not occur
What is Anectine (succinylcholine)
Post procedure, the RN might need to stay with the patient until he is fully awake and _______ to time and place
What is oriented
Patients with this may be at risk for edema or brain herniation after ECT
What is intracranial lesions
Parents of a child with ADHD tell the nurse, “We try to teach our child how to behave, but it doesn’t help. We feel as though we are terrible parents.” Select the nurse’s most helpful response.
a. Refer the parents for pastoral counseling.
b. Discuss how traumatic life events precipitate ADHD.
c. Explain the correlation between ADHD and parental conflict.
d. Provide information about the relationship between ADHD and biochemical abnormalities.
d. correct-helps assure the parents that there are internal factors that are unrelated to parenting
a. incorrect-although counseling may be beneficial, you can't assume that religious counseling is what they need
b. incorrect-ADHD is not caused from trauma
c. incorrect-this comes across as blaming and is not therapeutic communication
In preparation of the ECT procedure, the patient will be taken to the bathroom to do these 2 things
What is void and remove all jewelry/articles
Providing a highly structured ___________ of routine activities will minimize confusion while memory is restored
What is a schedule
If a patient is pregnant when they receive ECT, the pregnancy will be considered _____________
What is a high risk pregnancy
A 4-year-old has feelings of self-blame related to the parents’ recent divorce. Which therapy is most likely to be helpful for this child?
a. Cognitive behavioral therapy
b. Therapeutic drawing
c. Behavioral therapy
d. Pharmacotherapy
b. correct-this is at their cognitive development and will allow them to process their feelings
a. incorrect-a child is not ready to make choices to change their own thoughts
c. incorrect-a child is not ready to make choices to change their own behavior
d. incorrect-pharmacotherapy-this not the least restrictive measure, other techniques should be tried first
Along with an overall exam, and the normal lab work like a CBC, the main test that the patient will do before an ECT is
What is an EKG
This item is used so the patient does not bite their tongue during the ECT
What is a bite block
Reassure the patient that memory loss will usually be restored, all memories accept
What is the short term memory around the ECT procedure
The condition that puts a patient at the highest risk during an ECT
A nurse assesses a patient’s thoughts in response to the patient’s family missing visiting hours after they said they’d come. The patient stated, “My immediate response is that they forgot me because I am worthless.” The nurse asks the patient what other responses or thoughts fit this situation. Which of the following best describes the nurse’s response as an intervention? What treatment is the nurse using? What are 3 other examples
a. Generating alternatives to modify automatic thoughts. Cognitive therapy: questioning the evidence, Decatastrophizing, Daily record of dysfunctional thoughts (DRDT)
b. Contingent Contracting to reward changed behavior. Cognitive therapy: questioning the evidence, Decatastrophizing, Daily record of dysfunctional thoughts (DRDT)
c. Distracting technique to help the patient have a new experience. Cognitive therapy: questioning the evidence, Decatastrophizing, Daily record of dysfunctional thoughts (DRDT)
d. Universality, curative factor from realizing others suffer. Cognitive therapy: questioning the evidence, Decatastrophizing, Daily record of dysfunctional thoughts (DRDT)
a. correct-Generating alternatives to modify automatic thoughts. Questioning the evidence, Decatastrophizing ('what's the worst thing that can happen), DRDT (tool to help identify/modify dysfunctional thoughts).
b. incorrect-rewarding for unhealthy thought processes will not change the thought process
c. incorrect-the patient is having real feelings, so distracting the patient will not change the thought process
d. incorrect-joining a group like AA, where everyone is suffering the same problem, is not what this patient is needing to change his thought automatic process