📘 Important for Psychiatric Nursing, Mental Health Procedures & Staff Nurse Competitive Exams
🔰 Definition:
Electroconvulsive Therapy (ECT) is a psychiatric treatment in which controlled electric current is passed through the brain to produce a generalized seizure for therapeutic purposes.
✅ Used for severe, treatment-resistant psychiatric conditions under anesthesia and muscle relaxants.
“Inducing seizure therapeutically to reset abnormal brain function.”
🧠 Mechanism of Action:
The exact mechanism is unknown
Believed to cause neurochemical changes, increased serotonin, dopamine, norepinephrine
Alters brain activity associated with depression, psychosis, or mania
🎯 Indications of ECT:
🟥 1. Major Depression (especially with):
Suicidal thoughts
Catatonia
Poor response to antidepressants
🟧 2. Acute Mania (bipolar disorder)
🟨 3. Schizophrenia (especially with):
Catatonic features
Severe delusions and hallucinations
🟩 4. Other Conditions:
Postpartum psychosis
Neuroleptic Malignant Syndrome (NMS)
Parkinsonism with depression (rare)
❌ Contraindications of ECT:
🔺 Absolute:
Raised intracranial pressure (ICP)
⚠️ Relative (used cautiously):
Recent myocardial infarction
Severe hypertension
Cerebral aneurysm
Retinal detachment
Unstable fractures
🧪 Pre-ECT Nursing Care:
✅ 1. Physical and Mental Assessment
Obtain informed consent
Assess vitals, ECG, lab values
Ensure NPO status for 6–8 hours
✅ 2. Preparation for Procedure
Remove dentures, jewelry, hairpins
Empty bladder
Explain procedure and reduce anxiety
Administer pre-medications:
Atropine (reduce secretions, prevent bradycardia)
⚡ During ECT Procedure:
Given short-acting anesthesia (e.g., thiopentone)
Given muscle relaxant (e.g., succinylcholine)
Electrodes applied to scalp (bilateral/unilateral)
Seizure induced for 20–60 seconds
Oxygenation and monitoring throughout
🩺 Post-ECT Nursing Care:
Position patient on side-lying to prevent aspiration
Monitor vitals and airway
Check for confusion, headache, nausea
Reorient patient to time and place
Provide emotional support and reassure
🔁 ECT Schedule:
Usually 2–3 sessions/week
Total of 6–12 sessions per course
⚠️ Side Effects of ECT:
Temporary memory loss (retrograde amnesia)
Headache, muscle soreness
Nausea
Confusion immediately after ECT
👩⚕️ Nurse’s Role in ECT:
🟩 Before ECT:
Obtain written consent
Ensure NPO, pre-op care, patient comfort
🟨 During ECT:
Assist in airway management, positioning
Support anesthesia team
🟧 After ECT:
Monitor vitals and recovery from anesthesia
Provide post-ECT orientation and reassurance
Document seizure duration, patient condition
📚 Golden One-Liners for Revision:
🟨 ECT = induced therapeutic seizure
🟨 Used for severe depression, catatonia, acute psychosis
🟨 Administered with anesthesia and muscle relaxants
🟨 Temporary memory loss is common
🟨 Nurse ensures safety, monitoring, emotional support
✅ Top 5 MCQs for Practice:
Q1. ECT is most commonly used in:
🅰️ Phobia ✅ 🅱️ Major depression with suicidal risk 🅲️ Personality disorder 🅳️ Panic disorder Correct Answer: 🅱️ Major depression with suicidal risk
Q1. Which is the most commonly used and effective form of ECT? (a) Unilateral unmodified (b) Bilateral modified (c) Maintenance ECT (d) Weekly ECT Answer: ✅ (b) Bilateral modified
Q2. Unilateral ECT is preferred when: (a) Rapid action is needed ✅ (b) Memory preservation is important (c) Anesthesia is contraindicated (d) Seizure is not needed Answer: ✅ (b) Memory preservation is important
Q3. Which type of ECT includes anesthesia and relaxants? (a) Unilateral (b) Maintenance ✅ (c) Modified (d) Unmodified Answer: ✅ (c) Modified
Q4. Unmodified ECT is avoided today because: (a) It is costly (b) Less effective ✅ (c) Causes fractures and trauma (d) Requires oxygen Answer: ✅ (c) Causes fractures and trauma
👩⚕️⚡ Nursing Responsibilities in Electroconvulsive Therapy (ECT)
📘 Important for Psychiatric Nursing, Mental Health Procedures & Staff Nurse Exams
🔰 Overview:
Nurses play a crucial role in the safe and effective administration of ECT by ensuring patient preparation, intra-procedure support, and post-procedure care.
“The nurse ensures patient safety, comfort, education, and psychological support during ECT.”
🧾 Phases of Nursing Responsibilities in ECT:
🟥 1. Pre-ECT Responsibilities:
✅ a. Consent and Assessment:
Verify informed written consent
Assess:
Medical history, allergies, psychiatric diagnosis
Vital signs, ECG, blood pressure, blood sugar
Physical & mental status
✅ b. Patient Preparation:
Ensure NPO (nothing by mouth) 6–8 hours before ECT
Remove dentures, contact lenses, jewelry, nail polish
Ask patient to empty bladder before procedure
Provide gown and identity tag
Administer pre-medications as prescribed:
Atropine sulfate (30 minutes before) to reduce secretions and prevent bradycardia
✅ c. Psychological Preparation:
Provide clear explanation of the procedure
Alleviate anxiety and fears
Reassure safety and recovery
🟨 2. During ECT Responsibilities:
✅ a. Assist the Anesthesia and Psychiatric Team:
Position patient supine with head slightly extended
Assist in applying electrodes (unilateral or bilateral)
Ensure availability of emergency equipment (oxygen, suction, Ambu bag)
Monitor:
Oxygen saturation
Airway and respiratory effort
Seizure duration (ideal: 20–60 seconds)
✅ b. Safety Measures:
Use bite guard if required
Prevent injuries during seizure (padded bed, side rails)
Stay calm and observant
🟩 3. Post-ECT Responsibilities:
✅ a. Monitoring and Recovery:
Place patient in side-lying position to prevent aspiration
Monitor:
Vital signs (BP, pulse, respiration)
Airway and oxygenation
Consciousness level
Post-ECT confusion, headache, or agitation
✅ b. Reorientation and Support:
Reorient patient to time, place, and person
Provide comfort and reassurance
Avoid overstimulation (quiet environment)
Allow fluids or light diet once fully awake and oriented
✅ c. Documentation:
Record:
Time of ECT
Seizure duration
Pre- and post-ECT vitals
Medications given
Patient response or adverse effects
📚 Golden One-Liners for Revision:
🟨 Atropine is given pre-ECT to prevent bradycardia & reduce secretions
🟨 Patient should be NPO 6–8 hours before ECT
🟨 Post-ECT, patient is placed in side-lying position
🟨 Nurse monitors for confusion, aspiration, seizure response
🟨 Seizure duration should ideally be 20–60 seconds
✅ Top 3 MCQs for Practice:
Q1. What is the nurse’s priority immediately after ECT?
✅ 🅱️ Monitor airway and consciousness
Q2. Why is atropine given before ECT?
✅ 🅲️ To prevent bradycardia and reduce secretions
Q3. The nurse places the patient in which position post-ECT?
✅ 🅱️ Side-lying position
💉 Insulin Therapy
📘 Important for Medical-Surgical Nursing, Endocrine Disorders & Competitive Exams
🔰 Definition:
Insulin therapy is the administration of insulin to patients with diabetes mellitus, particularly type 1 diabetes, and sometimes in type 2 diabetes, to regulate blood glucose levels.
“Insulin replaces or supplements the body’s own insulin to control hyperglycemia.”
🧪 Types of Insulin:
Type
Onset
Peak
Duration
Rapid-acting
10–30 min
30–90 min
3–5 hrs
Short-acting
30–60 min
2–4 hrs
5–8 hrs
Intermediate-acting
1–2 hrs
4–12 hrs
12–18 hrs
Long-acting
1–4 hrs
Minimal
24+ hrs
Pre-mixed
Varies
Dual peak
Up to 24 hrs
✅ Examples:
Rapid-acting: Lispro, Aspart
Short-acting: Regular insulin
Intermediate-acting: NPH insulin
Long-acting: Glargine, Detemir
Pre-mixed: 70/30 (NPH + Regular)
🎯 Indications for Insulin Therapy:
Type 1 Diabetes Mellitus (always required)
Type 2 Diabetes Mellitus (when oral drugs fail)
Gestational diabetes
Diabetic ketoacidosis (DKA)
Stress, infection, or surgery in diabetic patients
⚠️ Contraindications / Precautions:
Hypoglycemia
Insulin allergy (rare)
Rotate injection sites to prevent lipodystrophy
🩺 Methods of Administration:
Subcutaneous injection (most common)
Intravenous (IV) for emergency use (only Regular insulin)
Insulin pumps (continuous infusion)
💉 Insulin Injection Sites (Subcutaneous):
Abdomen (best absorption)
Upper arms
Thighs
Buttocks
✅ Rotate sites to prevent tissue damage.
👩⚕️ Nursing Responsibilities in Insulin Therapy:
🟩 1. Patient Assessment:
Check blood glucose level before administering
Assess for hypoglycemia signs (sweating, tremor, confusion)
🟨 2. Right Technique & Site:
Use correct syringe (U-40 or U-100)
Maintain sterility
Rotate sites to prevent lipohypertrophy
🟧 3. Timing of Insulin & Meals:
Give rapid/short-acting insulin 15–30 min before meals
Monitor for hypoglycemia post-dose
🟥 4. Storage and Handling:
Store unopened insulin in refrigerator
Opened vials at room temp for 28 days
Do not expose to heat or light
🟦 5. Patient Education:
Teach self-injection technique
Educate on hypo/hyperglycemia symptoms
Teach importance of diet and exercise
📚 Golden One-Liners for Revision:
Insulin is given subcutaneously, except Regular insulin, which can be given IV
Always check blood sugar before insulin
Rotate sites to avoid lipodystrophy
Hypoglycemia is the most dangerous side effect
Long-acting insulin has no peak — mimics basal insulin
✅ Top 5 MCQs for Practice:
Q1. Which type of insulin can be given IV? 🅰️ NPH ✅ 🅱️ Regular insulin 🅲️ Lispro 🅳️ Glargine Answer: ✅ (b) Regular insulin
Q2. Best site for insulin absorption is: 🅰️ Thigh 🅱️ Arm ✅ 🅲️ Abdomen 🅳️ Buttocks Answer: ✅ (c) Abdomen
Q3. Which of the following is long-acting insulin? 🅰️ Aspart 🅱️ Regular 🅲️ NPH ✅ 🅳️ Glargine Answer: ✅ (d) Glargine
Q4. Main complication of insulin therapy is: 🅰️ Hypertension ✅ 🅱️ Hypoglycemia 🅲️ Weight gain 🅳️ Polyuria Answer: ✅ (b) Hypoglycemia