Ch 10 Brain Stimulation Therapies Flashcards
What are indications of ECT
Major depressive disorder
Schizophrenia spectrum disorders
Acute manic episodes ( bipolar with rapid cycling; 4 or more episodes in 1 yr.)
What are contraindications of ECT therapy
Recent myocardial infarction Hx of cerebrovascular accident Cerebrovascular malformation Intracranial mass lesion Increased intracranial pressure
What are mental health conditions in which ECT has not been found useful in
Substance use disorder
Personality disorders
Dysthymic disorder
What is the typical course of ECT treatment
3x a week for a total of 6-12 treatments
What are nursing actions for ECT regarding any medications prescribed
Any meds that increase the pts seizure threshold must be decreased or discontinued several days before the procedure
MAOI and lithium should be discontinued 2 weeks before procedure
Any cardiac conditions should be treated before the procedure
30 min prior a IM INJECTION of atropine or robinul is given to decrease secretions and counteract any vagaries stimulation
A IV line is maintained until full recovery.
What time of the day is ECT performed
Early in the AM after the client has fasted
How much is the clients HR expected to increase during a ECT procedure and early recovery
By 25%
What may side effects may the patient report after a ECT procedure
Headache
Muscle soreness
Nausea
What is transcranial magnetic stimulation
TMS is s noninvasive therapy that uses magnetic pulsations to stimulate specific areas of the brain
What are indications for TMS transcranial magnetic stimulation
MDD
clients who are not responsive to pharmacological tx
What is education about TMS transcranial magnetic stimulation
It is prescribed daily for 4-6 weeks Can be performed on a outpatient basis Procedure lasts 30-40 min A noninvasive electromagnet is placed on the scalp, allowing magnetic pulsations to pass through. Client is alert during the procedure
What are complications of TMS
Common adverse effects are: mild discomfort or tingling sensation at site of electromagnet
Lightheadness
Seizures are rare but possible
Not associated with neurological deficits
What is Vagus nerve stimulation VNS
It provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the clients chest.
It is believed to result in an increased level of neurotransmitters
What’re indications of vagus nerve stimulation VNS
Depression that is resistant to pharmacological tx or ECT therapy
What is pt education regarding VNS
It is commonly performed on a outpatient surgical basis
Delivers around the clock programmed pulsations
Client can turn off the VNS device at any time by placing s external magnet over the site of the implant
Obtain informed consent
What ate complications of VNS
Changes in VOICE
Hoarseness, throat or neck pain, dysphagia
Dyspnea, the client may want to turn off the VNS During exercise
HOW is ECT performed
ECT uses electrical current to induce brief seizure activity while the client is anesthesized
What is administered to reduce the risk of injury during induced seizures such as ECT therapy
A muscle relaxant, such as succinylcholine ( annectine) is administered to reduce the risk for injury during induced seizure activity
ECT is recommended for which type of diagnosis of bipolar
Bipolar disorder with rapid cycling
What is a common adverse effect of VNS
Voice changes are a common adverse effect of VNS due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx
Dysphagia and neck pain are side effects that usually subsides
