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ATI Mental Health > Ch. 10: Brain Stimulation Therapies > Flashcards

Ch. 10: Brain Stimulation Therapies Flashcards

1
Q

What are brain stimulation therapies?

A

Non pharmacological treatment for mental health disorders

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2
Q

What are the 3 types of brain stimulation therapies?

A

Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation (TMS)
Vagus nerve stimulation (VNS)

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3
Q

What therapy:

Uses electrical current to induce brief seizure activity while the client is anesthetized

A

ECT

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4
Q

What types of clients get ECT therapy?

A

Major depressive disorder
Schizophrenia spectrum
Acute Manic episoders

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5
Q

Why would clients who have MDD go through an ECT therapy?

A
  • Dont respond to pharmacologic treatment
  • Risk of other treatment outweight risk of ECET (pregs)
  • Ones who are actively suicidal or homicidal and need rapid therapeutic response
  • Ones experienceing psychotic manifestations
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6
Q

What type of schizophrenia spectrum disorder may get ECT treatment?

A

Ones that are less responsive to neuroleptic medications–schizoaffective disorder

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7
Q

Acute manic episodes: ECT is used for clients who have bipolar disorder with rapid cycling (4 or more episodes of mania within 1 year) and very destructive behavior. Both of these features tend to respond poorly to _____. These clients receive ___ and then a regimen of ____.

A

Poorly to lithium therapy

Receive ECT, then a regimen of lithium

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8
Q

There are no absolute contraindications for ECT therapy if it is deemed necessary to save a clients life. True or false?

A

True

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9
Q

What conditions place clients at higher risk if ECT is used?

A

Recent MI
History of CVA
Intracranial mass lesion
Increased ICP

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10
Q

What conditions is ECT NOT useful in?

A

Substance use
Personality disorder
Dysthymic disorder

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11
Q

What is the typical course of ECT treatment?

A

3x/week for 6-12 treatments

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12
Q

Like all procedures, the provider obtains informed consent. What if ECT is involuntary, who do we get consent from?

A

Next of kin or court order

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13
Q

ECT: Any medications that affect the clients seizure threshold must be decreased or discontinued ____ before the ECT procedure

A

Several days

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14
Q

____ & ____ should be DISCONTINUED 2 weeks before the ECT procedure?

A

MAOIs and lithium

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15
Q

ECT: What should be controlled and why?

A

HTN bc a short period of HTN occurs immediately after ECT procedure

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16
Q

ECT: Should we monitor cardiac conditions before the procedure?

A

Yes

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17
Q

ECT: What does the nurse monitor before and after an ECT procedure?

A

VS and mental status

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18
Q

ECT: The nurse also asses the client’s and family’s _______

A

Understanding and knowledge of the procedure and provides teaching as necessary

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19
Q

What is given 30 MINUTES prior to the beginning of ECT? Why?

A

An IM injection of atropine sulfate or glycopyttolate to decrease secretions and counteract any vagal stimulation

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20
Q

ECT: Does client have IV line?

A

Yes, and it is maintained until full recovery

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21
Q

When is ECT administer?

A

Early in the morning after client has fasted for prescribed period of time

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22
Q

ECT: What should e used to prevent trauma to the oral cavity?

A

Bite guard

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23
Q

ECT: Where are electrodes applied for EEG monitoring?

A

Scalp, either unilaterally or bilaterally for ECG monitoring

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24
Q

Is the client ventilated during ECT?

A

Yes, and receives 100% O2

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25
Q

ECT: What kind of monitoring is provided?

A

Cardiac (BP, ECG, and O2sat)

26
Q

ECT: Does the client get anesthesia?

A

Yes, short acting

27
Q

ECT: What is administered after the short acting anesthesia?

A

Muscle relaxant (succinylcholine)

28
Q

ECT: A cuff is placed on one leg or arm to ____ the muscle relaxant so that seizure activity can be monitored in the limb distal to the cuff

A

Block

29
Q

ECT: How long is the electrical stimulus applied? Then what?

A

0.2-0.8 seconds, then seizure activity is monitored and the duration of the seizure is documented

30
Q

ECT: How long is the seizure usually?

A

25-60 seconds

31
Q

When do we discontinue the anesthetic?

A

After seizure activity has ceased

32
Q

Postprocedure ECT: What is monitored? What position is the pt and why? When does client transfer back to mental health unit/facility?

A

Monitored: LOC, cardiac status, VS, O2sat; ability to swallow and return of gag reflex
Position: Side to facilitate drainage and prevent aspiration
Transfer: Within 30-60 min after procedure

33
Q

What are some complications of ECT?

A
  • Memory loss and confusion
  • Reactions to anesthesia
  • ECG changes
  • Headache, muscle soreness, nausea
  • Relapse of depression
34
Q

Complications of ECT: Memory loss and confusion

Short term memory loss, confusion, and disorientation may occur immediately following the procedure. Memory loss may persist for ____. Whether or not ECT causes permeant memory loss is ____

A

Several weeks

Controversial

35
Q

Complications of ECT: ECG changes

  1. What is the clients baseline HR expected to increase by during the procedure and early recovery?
  2. What happens to BP during the procedure?
A
  1. HR expected to increase by 25% during procedure and early recovery
  2. BP may initially fall, then rise during procedure. Elevated BP should resolve shortly after procedure.
36
Q

A noninvasive therapy that uses magnetic pulsations to stimulate specific areas of the brain

A

TMS (transcranial magnetic stimulation)

37
Q

Who uses TMS therapy?

A

MDD (clients who aren’t responsive to pharmacologic treatment)

38
Q

TMS is commonly prescribed daily for a period of ____

A

4-6 weeks

39
Q

Is TMS inpatient or outpatient?

A

Outpatient

40
Q

How long does TMS procedure last?

A

30-40 min

41
Q

What is the TMS procedure?

A

A noninvasive elecromagnet is placed on client’s SCALP, allowing the magnetic pulsations to pass through

42
Q

Is the client under anesthesia for the TMS procedure?

A

No, client is alert during it

43
Q

What are common adverse effects of TMS?

A

Mild discomfort or tingling sensation at the site of electromagnet

44
Q

TMS: What do we monitor the client for after procedure?

A

Lightheadedness

45
Q

TMS: What is a rare, but potential complication of TMS?

A

Seizures

46
Q

Is TMS associated with systemic adverse effects or neurologic deficits?

A

No

47
Q

Provides electrical stimulation through the vagus nerve to the brain trough a device that is surgically implanted under the skin on the client’s chest

A

Vagus nerve stimulation (VNS)

48
Q

VNS is believed to result in an increased level of _____

A

Neurotransmitters

49
Q

VNS is indicated for who?

A
  • Depression that is resistant to pharmacological treatment and/or ECT
  • Possibly anxiety disorders (current research still going on to evaluate efffectiveness)
50
Q

Is VNS outpatient or inpatient?

A

Outpatient

51
Q

T/F. The VNS device delivers around the clock programmed pulsations.

A

True

52
Q

How does the client turn off the VNS device?

A

At any time by placing a special external magnet over the site of the implant

53
Q

What is a complication of VNS and why?

A

Voice changes–due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx

54
Q

What are some other adverse effects of VNS?

A
  • Hoarsness
  • Throat/neck pain
  • Dysphagia

(improve with time)

55
Q

Why may the client want to turn off the VNS during exercise?

A

Dyspnea, especially with physical exertion is possible

56
Q

A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of MDD. Which of the following client statements indicates understanding of the teaching?
A. “It is common to treat depression with ECT before trying meds”
B. “I can have my depression cured if I receive a series of ECT treatments”
C. “I will have seizures lasting 1.5-2 min during ECT”
D. “I will receive a muscle relaxant ant to protect me from injury during ECT”

A

D

57
Q

A charge nurse is discussing TMS with a newly liscenced nurse. Which of the following statements by the newly licensed nurse indicated a need for further teaching?
A. “TMS is indicated for clients whose depression is not relieved by medication”
B. “I will provide post anesthesia care following TMS”
C. “TMS is usually performed as an outpatient procedure”
D. “I will schedule the client for daily TMS treatments for the first several weeks”

A

B

58
Q 
A nurse is assessing a client immediately following an ECT procedure. Which of the following are expected findings? (select all that apply)
A. Hypotension
B. Paralytic ileus
C. Memory loss
D. Nausea
E. Tachycardia
A

C, D, E

59
Q

A nurse is leading a peer group discussion about the indications of ECT. Which of the following is appropriate to include in the discussion?
A. Borderline personality disorder
B. Acute withdrawal r/t substance use disorder
C. Bipolar disorder with rapid cycling
D. Dysthymic disorder

A

C

60
Q 
A nurse is planning care for a client following surgical implantation of VNS device. The nurse should plan to monitor for which of the following adverse effects (SATA).
A. Voice changes
B. Seizure activity
C. Disorientation
D. Dysphagia
E. Neck pain
A

A, D, E

ATI Mental Health (8 decks)

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