Psychiatric Mental Health - Therapies, part 3: ECT, VNS
by Cathy Parkes August 04, 2021 Updated: January 03, 2022 5 min read
This article covers the non-pharmacological therapies electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS).
You can follow along with this series using our Psychiatric Mental Health Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy or ECT is the use of an electrical current to the brain to create generalized cerebral seizure under general anesthesia. This increases the levels of neurotransmitters such as dopamine, serotonin, and norepinephrine.
ECT is indicated for severe depression that is resistant to antidepressants.
ECT is contraindicated when there is increased intracranial pressure (ICP).
ECT delivers an electrical stimulus through electrodes that are attached to the patient's temple.
Additionally, a number of medications are administered to the patient during this procedure, including:
- Anticholinergics, such as atropine, to help decrease secretions
- Anesthetic agents (e.g., methohexital or propofol) because the patient is under general anesthesia for ECT
- Neuromuscular blocking agent, such as succinylcholine, to help decrease muscle contractions in order to prevent injury to the patient during the procedure
Side effects of ECT
The side effects of ECT can include short-term memory loss and confusion.
ECT nursing care
Electroconvulsive therapy is an invasive procedure, so informed consent must be obtained from the patient prior to the procedure.
The patient should be NPO (fasting) for six to eight hours before ECT.
If the patient is taking anti-seizure medications (anticonvulsants), these should be discontinued before commencing ECT. Remember: ECT is a procedure in which we are trying to generate a seizure in the patient.
It is also important to hyperventilate the patient (to enhance seizures and to increase patient’s safety) before and after the procedure.
Patient teaching for ECT
The patient should be taught that they may experience short-term memory loss and confusion, which is to be expected with this procedure. Patients should also understand that 6 to 12 treatments are usually needed, and that they are usually administered three times a week.
Vagus nerve stimulation (VNS)
The vagus nerve (cranial nerve X) is the longest cranial nerve in the body, containing both motor and sensory functions. The nerve travels widely throughout the body, affecting several organ systems and regions of the body, such as the tongue, pharynx, heart, and gastrointestinal system.
Vagus nerve stimulation, or VNS is a procedure where a device is surgically implanted under the patient’s skin on the left side of the chest. This device delivers electrical pulses to the vagus nerve at five-minute intervals, approximately. This helps to alter the levels of neurotransmitters in the brain.
Like ECT, vagus nerve stimulation is an invasive procedure and is indicated for treatment-resistant depression. It may also be used for epilepsy (recurring seizures).
Side effects of VNS
The side effects of VNS can include hoarseness as well as cough, because the vagus nerve controls the pharynx and larynx muscles.
It is also possible that the patient may experience a tingling sensation over the implantation device.
Patient teaching for VNS
Teach the patient that the VNS device can be deactivated by holding a magnet over the implant in the chest.
Also, the device is intended to be used along with antidepressants, which means it is important to teach the patient that they should not discontinue their antidepressant medications — VNS and the medications are working together.
Hi, I'm Cathy with Level Up RN. In this video, I'm going to talk about electroconvulsive therapy as well as vagus nerve stimulation. And if you stick with me through this whole video, at the end, I will give you guys a little quiz to test your understanding of the information that I'm about to cover.
First, let's talk about electroconvulsive therapy or ECT. This is where we use an electrical current to the brain to create a seizure, which in turn increases the levels of neurotransmitters such as dopamine, serotonin, and norepinephrine. This is done under general anesthesia, and ECT is used for severe depression that is resistant to antidepressants. It can also be used for schizophrenia as well as mania associated with bipolar disorder. A key contraindication of this procedure would be increased intracranial pressure. So if a patient has that, we would not do ECT. ECT delivers that electrical stimuli through electrodes that are attached to the patient's temple. And there's a number of medications that are given to the patient during this procedure. This includes anticholinergics, such as atropine, to help decrease secretions. This also includes anesthetic agents, of course, because they're under general anesthesia, and we would also give them a neuromuscular blocking agent, such as succinylcholine, to help decrease muscle contractions and therefore prevent injury in the patient during the procedure.
Side effects of ECT can include short-term memory loss, as well as confusion. In terms of nursing care, because this is an invasive procedure, we're definitely going to need to get informed consent from the patient prior to this procedure. Also, we want to make sure the patient is NPO for six to eight hours before ECT, and we also want to make sure anticonvulsants are discontinued prior to ECT. Because ECT is trying to generate a seizure in the patient, if the patient is taking anti-seizure medication, so anticonvulsants, then that is not going to help us do that, and that's why we discontinue those medications ahead of time. During the procedure we're going to monitor the patient's vital signs, their EEG, their EKG continuously, and we're going to want to hyperventilate the patient before and after the procedure. In terms of patient teaching, of course, you're going to want to share that short-term memory loss and confusion are expected with this procedure. You're also going to want to let the patient know that 6 to 12 treatments are usually needed, and they are usually administered three times a week.
All right. Next, let's talk about vagus nerve stimulation or VNS. So with VNS, we are surgically implanting a device under the patient's skin on the left side of the chest. And this device delivers electrical pulses about every five minutes to the vagus nerve, and this, in turn, alters levels of neurotransmitters in the brain. This is an invasive procedure, obviously, so we are only going to use this for treatment-resistant depression. It is also used for epilepsy. In terms of side effects, side effects can include hoarseness as well as cough because that vagus nerve, cranial nerve 10, controls the pharynx and larynx muscles, so that's why you get that hoarseness and cough. Also, the patient may experience tingling over the implantation device.
So in terms of patient teaching, we want to teach the patient that the device can be deactivated by holding a magnet over that area. Also, the device is intended to be used along with antidepressants. So it's going to be important to teach our patient that they should not discontinue their antidepressant medications, that we're using these two things together.
Okay. As promised, I have a quiz for you now. I have three questions. The first question is true-false. Short-term memory loss is expected after electroconvulsive therapy, true or false? The answer is true, as well as confusion.
Second question, how do you deactivate the vagus nerve stimulation device? The answer is, you hold a magnet over the device in the chest.
Third question, how many treatments are typically required for electroconvulsive therapy? The answer is 6 to 12 treatments, and they are typically given three times a week.
Hopefully, you got those right. If not, you may want to go back and review this video again or review those concepts on our flashcards. Take care and good luck with studying.
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