Page 2264 - Saunders Comprehensive Review For NCLEX-RN

infarction, stroke (brain attack), or intracranial mass
lesions.
B. Uses (Box 65-8)
1. Clients with severe depressive and bipolar depressive
disorders, especially when psychotic symptoms are
present, such as delusions of guilt, somatic delusions,
and delusions of infidelity
2. Clients who have depression with marked
psychomotor retardation and stupor
3. Manic clients whose conditions are resistant to lithium
and antipsychotic medications and clients who are
rapid cyclers (a client with a bipolar disorder who has
many episodes of mood swings close together)
4. Clients with schizophrenia (especially catatonia),
clients with schizoaffective syndromes, and psychotic
clients
C. Preprocedure
1. Explain the procedure to the client.
2. Encourage the client to discuss feelings, including
myths regarding ECT.
3. Teach the client and family what to expect.
4. Informed consent must be obtained when voluntary
clients are being treated.
5. For involuntary clients, when informed consent cannot
be obtained, permission may be obtained from the
next of kin, although in some states the permission for
ECT must be obtained from the court.
6. Maintain NPO (nothing by mouth) status after
midnight or at least 4 hours before treatment as
prescribed.
7. Baseline vital signs are taken.
8. The client is requested to void.
9. Hairpins, contact lenses, and dentures are removed.
10. Administer preprocedure medication as prescribed.
D. During the procedure
1. As the intravenous line is inserted,
electroencephalographic and electrocardiographic
electrodes are attached.
2. The blood pressure, pulse, and oxygen saturation are
monitored throughout the treatment.
3. A blood pressure cuff is placed around 1 ankle and
inflated to block the medication from entering the
foot. When the procedure begins, seizure activity can
be monitored by watching for movement in that foot.
4. Medications administered may include a short-acting
anesthetic and a muscle relaxant.
5. Oxygen is administered by face mask.
6. An airway or mouth guard is placed to prevent the

2264