LESSON PLAN

TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
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 INTRODUTION:-
1. To give 1 min ECT is one of the most potent and sometimes life-saving
treatments in Psychiatry. It is a painless form of electric
introduction therapy, primarily used for patients with depression and
about self & the schizophrenic disorders .It was first described by Cerletti
topic. and Bini in 1938 as a treatment for the schizophrenia.
DEFINITIONS:-
2 min - ECT is an electric shock delivered to the brain through
electrodes that are applied to both temples to produce Real
At the end of Objects
seizures.
class the
- ECT is a physical /somatic therapy in which with the help
students will be of two electrodes, current is passed through the temporal
to : region in between the two hemisphere of the brain, to Real Demonstration What is
2. -define 2 min Electroconvulsive
produce a grand mal - type of seizures. Objects
ECT(Electroconv - ECT is a treatment in which a grand mal seizure is artificially therapy?
ulsive therapy) induced in an anesthetized patient by passing an electrical
current through electrodes applied to the patient’s head.
- ‘Artificial induction of a grand mal seizure
(tonic phase: 10-15 sec; clonic phase: 30-60 sec)
through the application of electrical current to the brain,
the stimulus is applied through electrodes which are
placed either bilaterally in the fronto-temporal region or
unilaterally on the non-dominant side’.

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 -LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
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3. -enlist the 3 min INDICATIONS:-
Depression-
indications of Real Demonstration What are the
Suicidal tendency
ECT Objects indications for
Stuporous condition
Endogenous Depression
ECT?
Psychotic Depression
Reactive Depression which is not responding
to other therapies like psychotherapy, casework,
drugs.
Atypical Depression
Melancholia
Severe psychosis-
Severe attack of mania
Destructive ,assaultive behaviour
Delirium
Schizophrenia
Organic psychosis
Senile and pre-senile dementia
Other responsive groups to ECT treatment are-
Premorbid personality
Anorexia
Weight loss
Early morning insomnia
Lack of concentration
Ideas of guilt and worthlessness
CONTRAINDICATIONS:-
4. -enlist the 3 min
contraindications 1. Increased intracranial pressure Real Demonstration What are the
of ECT 2. Brain tumours Objects contraindications
3. Hematomas for ECT?

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S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
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Contd… 4. Subarachnoid haemorrhage
5. Myocardial infarction (ECT will lead to increased decompensation of
Contd..
heart)
6. Hypertension (ECT will lead to increase in blood pressure and heart
rate temporarily)
7. Retinal detachment
8. Severe systematic diseases involving lungs, kidney, heart
9. First trimester of pregnancy
10. Osteomalacia
11. Fractures

5. -list down the 3 min SIDE-EFFECTS/COMPLICATIONS:-

Real Demonstration What are the side-
side-effects of 1. Memory impairment Objects effects/complicatio
ECT 2. Restlessness ns of ECT?
3. Anxiety
4. Confusion
5. Drowsiness
6. Poor concentration
7. Aches-body aches, headache, painful masticatory
movements
8. Tongue bite, abrasions on the lips
9. Dyspnoea, apnoea(due to anaesthesia and
muscle-relaxant)
10. Cardiac arrest
11. Joint dislocation
12. Unsteady gait
13. Dryness of mouth
14. Palpitations
15. Nausea, vomiting
16. Missed seizures i.e.; seizures fails to occur despite higher
stimulation and the anaesthetic affect wears off
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 17. Inadequate seizures-when seizures last fewer than 20
seconds
Contd… Contd..
18. Prolonged seizures-seizures lasting more than 180
seconds(3 min) lead to excessive post-ictal confusion
19. Tardive seizures.
DELAYED EFFECTS:-

1. Amnesia for recent events

2. Confusional psychosis

6. FREQUENCY OF ECT:-
-mention the 2 min Real Demonstration How frequently
frequency of No fixed regimen objects ECT is
giving ECT Based on clients condition frequency of treatment varies, administered to the
e.g;in severe excitement cases ECT is given 2-3 times /day; patient?
followed by alternate days; weekly twice or once a
week till the completion of remission of symptoms and
upto total improvement
In schizophrenia clients: 12-15 ECTs may be required
MDP cases 6-8 ECTs may be needed.

7. PLACEMENT OF ELECTRODES:-
-describe the 2 min Real Demonstration Mention about the
 The location of electrodes depends upon the unilateral and
position of ECT objects location of ECT
bilateral ECT.
electrodes electrodes?
 Bilaterally, ECT involves the placement of electrodes in the
bitemopral region. An imaginary line is drawn from the
outer canthus of the eye to the targus of the ear. The
midpoint of this imaginary line is located and the electrode
is placed one inch above the midpoint.

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S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
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 Unilaterally -To minimise post-convulsive confusion and
amnesia, unilateral ECT has been devised in which the
electrodes are placed so as to avoid the dominant
temporal lobe. One electrode is placed for bilateral ECT
(in a right handed person in the left side and left handed
person on the right side in the temporal area. The
second electrode is placed on the non-
[Link] scalp, just lateral to the midline
vertex.

TYPES OF ECT-
8. -enlist the types 1 min DIRECT ECT-Absence of anaesthesia, Absence of muscle
Real Demonstration Explain about the
of ECT relaxation drugs objects types of ECT?
MODIFIED ECT- Drug induced muscle relaxation and
General anaesthesia may or may not be used
ECT TEAM-Psychiatrist, Anaesthetist ,Nurses, Nursing aids

9. -list the members 1 min Real Demonstration Who are the main
of ECT team objects members of ECT
team?

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 SPECIFIC CONTENTS A.V. METHOD OF EVALUATION
S.N. OBJECTIVES TIM AIDS TEACHING
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10. TREATMENT FACILITIES: Which articles are
-Pre ECT Room- required in
Comfortable waiting room with adequate preparing the tray
Sitting facilities both for patient and attender. for ECT?
-ECT Room-
[Link] ECT Bed:-
-table with mattress
-small pillow
-linen
-extra sheet/gown
[Link] for giving injectables:-
-A tray containing: I/V set, Normal Saline,
syringes(2 ml, 5ml, 10ml), Intracath of different
sizes(21G, 22G, 23G, 24G,26G), spirit swabs,
tourniquet, adhesive tape, scissors, Drugs-
[Link](1ml), [Link](500mg) Real Demonstration
-to explain the 5 min [Link](500mg) objects
articles by tray -tray
preparation setting
3. Articles for resuscitation:-
Resuscitation trolley containing-
Oxygen cylinder with adjustable valve
AMBU Bag
Curved tongue depressor
Mouth-gag-well padded with gauge & cotton
Oral airway adult size(2 to 5 no.)
Endotracheal tubes(4.5mm,5,5.5,6,6.5,7,7.5,8,
8.5,9mm)
Laryngoscope
Suction catheter(16 to 18 french)
BP apparatus
Tray containing emergency drugs--Lignocaine,
Sodium bicarbonate, Adrenaline, Dexona,
Hydrocortisone, Ketanov,Diclofenac,Calciumgluconate,
Atropine,Heparin,Deriphylline,Dopamine,diazepam,
Lasix, Nitro-glycerine, Avil,potassium chloride

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 4. Others:-ECT Machine
Cardiac monitor
Anaesthetic appliance
Suction apparatus
Defibrillator

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 TEACHING
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S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
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ECT Injections:-
11. -demonstrate for 3 min 1. [Link] (Pyrolate)
Action-Anticholenergic, 1ml=0.2mg,Route-I/V
the preparation of Real Demonstration Which injections are
2. [Link] (Thiosol)-500mg
ECT injections objects being used in giving
Action-Anaesthetic agent, Recommended dose-3 to 5 mg/kg
of body weight, Route-I/V
the ECT?
Preparation - a. Dilute the drug in 10 [Link] sterile water
(10 ml. =500mg)
b. Take 5 ml.(250 mg) from vial & add 5ml of sterile water,
it will become- 10 ml=250mg, 1 ml=25 mg
3. [Link] (sucol, succa)
Action-Muscle-relaxant, Route-I/V,10ml=500mg,1ml=50mg
R Recommended dose-0.5 to 1mg/kg of body weight

AMOUNT OF CURRENT:-
70-120 VOLTS of 50 cycles of alternating current passed for
0.3-1.5 seconds through electrodes.

OBSERVATION ON PRODUCTION OF SEIZURES:-

1. The production of grand mal seizures is necessary for

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 direct and modified [Link] direct ECT, the TONIC PHASE
that is muscle contractions last for 10 seconds approximately.
2. The CLONIC PHASE that is movement or convulsion lasts
for 25-30 seconds approximately.
3. Then the patient goes into the relaxation phase.
12. 4. The physician can see changes in EEG (Electroencephalograph) also.
-mention the 2 min 5. There is a slow planter flexion during the tonic phase and Real Demonstration How much current is
amount of current there are fine movements of the toes during the clonic phase. objects administered to
for giving the PROCEDURE:- induce the seizures?
ECT ROLE OF NURSE IN ECT TREATMENT:-
In a hospital setting where the electroconvulsive therapy is given,
the nurse should see to the set-up which includes:-
[Link] room or resting room
[Link] room or ECT room
3. [Link] room or after-care room
13.
-observation on 2 min Real Demonstration What to observe on
1. WAITING ROOM OR RESTING ROOM-
production of objects the production of
-In this room patients are asked to wait or take rest before ECT.
seizures -The room should be calm with dim lights, light colour of the
seizures?
Walls.


 Put some flowers to give pleasant feelings to the patient.

 There should be some magazines to read, so that patient
can divert his mind and reduce anxiety.
 Lavatory (toilet) should be attached, because the patient
may feel need to empty his bladder and bowels before
getting ECT.
 The nurse should always be available in this room so that
the patient and relatives can clarify their doubts.
 Pre-anaesthetic drugs should be kept ready.
2. TREATMENT ROOM/ECT ROOM-
14. a. ARTICLES FOR COMFORT OF THE PATIENT:-
-explain the steps 2 min Real Demonstration Explain the steps of
of ECT procedure  The room should be near the waiting room.
objects ECT procedure?
 For privacy a bedside screen, well-padded low level beds with the
railings should be placed to prevent injury due to fall.
b. b. ARTICLES FOR THE PREPARATION OF THE PATIENT:-
 Small pillow to put under patient’s waist to prevent injury.

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  Mouth gag to prevent injury to the tongue during convul-
sions and to keep the airway patent.
 Tongue spatula, Endotracheal tube and sterile catheter for
suction of the respiratory tract.
 Oxygen cylinder and an AMBU bag to give oxygen imme-
15. diately after the therapy and to give artificial respirations,
Real Demonstration Explain the role of
-describe the role 2 min if required.
objects nurse in ECT
of nurse in ECT ARTICLES FOR THE PROCEDURE- treatment?
treatment  A trolley with an ECT machine in working order ,check all
the electric plug points.
 Jelly or saline for putting on electrodes as it helps in good
conduction of electric current.
 Emergency drugs and a resuscitation tray ,mouth wipes,
BP apparatus , sterile syringes and spirit swabs.
 Doctors and nurses should be present in the ECT room.
3 3. RECOVERY ROOM OR AFTER-CARE ROOM-
contd….
 Once the patient responds to a painful stimulus he is
transferred to the recovery room.
 A stretcher should be kept ready to transfer the patient
to the ward.
 Observations of vital signs.
 Mouth wipes are kept to wipe excessive secretions from
the mouth.
 An extra set of clothes in case the patient has spoiled them
with urine or faeces during convulsions.
 Toilet facilities should be available near by the recovery
room.

16. NURSING CARE BEFORE, DURING AND AFTER ECT-

-enlist the articles 2 min Real Demonstration Describe the articles
needed for the BEFORE ECT- objects used for the patient’s
comfort of patient comfort?
NURSING IMPLEMENTATION

[Link] for written ,informed consent from the patient /relative

17. Describe the articles

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 -explain the 2 min [Link] that a thorough physical used for the patient’s
examination(including blood Hb,serum
articles needed preparation?
electrolytes, urea/creatinine,RBS,Routine
for the Urinalysis, ECG etc is done and that results are available
preparation of
patient
[Link] detailed explanation to the patient and relatives

[Link] patient should be kept nil orally for atleast 8 hrs. Prior to
ECT (3-4 hrs in case of Emergency)

[Link] metallic articles(watch, bangles, ring, hair clips, etc.)

[Link] artificial dentures or check for loose Teeth

[Link] lipstick, nail polish or any other make-up

18. 8. Loosen tight clothes. Preferably, the patient should be
Real Demonstration Enlist the articles for
-enlist the articles 2 min dressed in loose hospital clothes objects the procedure?
used in the
procedure
[Link] that the patient empties bowel and Bladder before
the therapy

[Link] should be oil-free

[Link] escorting nurse should be a registered nurse who knows

the patient and is aware of his/her Legal status, consent
and any possible medical complications

19. Real Demonstration Explain the role of

[Link] premedication to the patient as ordered
-explain the role 2 min objects nurse in recovery
of nurse in [Link] the patient on a trolley in the waiting room room?
preparation of [Link] the patient’s bladder is empty by palpation over the
recovery room perineum area.

DURING ECT-

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 NURSING IMPLEMENTATION

1. Transfer the patient on to a well-padded bed and place in a

comfortable dorsal or supine position. A small pillow or a sheet
may be place under the lumbar curve.

2. Reassure the patient with proper explanation.

[Link] intravenous fluid like normal saline with muscle

relaxant like [Link] sodium .

4. Monitor vital signs as blood pressure, pulse, respiration.

5. Administer Anti-cholinergic –inj. Glycopyrolate 1ml..I.V. ,

a short-acting anaesthetic agent-Thiopentone according to
20. Real Demonstration What are the nursing
body weight, Verify dosage for each patient.
-describe the objects responsibilities before
nursing [Link], inflate the BP cuff upto 30mmhg and administer giving ECT?
responsibilities 3 min [Link] and monitor vital signs
before, during
[Link] a well-padded mouth gag or tongue depressor between
and after the ECT
the teeth.

8. Support the shoulder and arms lightly, restrain the thighs

with hands.

9. Hyper extend the head with support to the Chin.

10. Give a few breaths of oxygen.

[Link] the electrodes with the help of jelly on Forehead

(one between the both brows, one on Left brow above 1.5 cm.
And vice-versa.), (one electrode tip behind the left ear and
vice-versa)

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 12. Pass the current to induce seizures by setting the volt
on monitor.

[Link] the occurrence of grand mal seizures

14. Do suction immediately. Give oxygen by mask continuously,

If required.

AFTER ECT-
NURSING IMPLEMENTATION-
1. Observe and record the patient’s pulse, respiration and blood
pressure.

[Link] up the railings and place the patient on a side lying

position, wipe the secretions

[Link] the vital signs, blood pressure and LOC every 15

minutes, once stable every 30 min till complete recovery
[Link] the patient to sleep for 30 min to 1 hour if he/she wants
to sleep
[Link] the patient

[Link]-orient to the ward ,toilet, nurse’s station, etc.

[Link] and inform the treating team if there are any

injuries/complaints of pain by the patient(body ache, headache)
[Link] the patient to wash his/her face or bathe if
necessary.
[Link] the patient to take clear tea followed by lunch if he/she
does not vomit
[Link] the patient to carry on with the activities of daily living

21. Real Demonstration Explain the role of

-discuss the role 3 min [Link], record and report any changes in the patient objects nurse during the
of nurse during ECT?
the ECT

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 22. Real Demonstration What are the nursing
-explain the role 3 min objects responsibilities after
of nurse after the giving the ECT/
ECT

Real Demonstration
objects

23. Real
-discuss about the 3 min objects
myths related to
ECT

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 TEACHING
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SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME A.V. METHOD OF EVALUATION
CONTENT AIDS TEACHING

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 24. -give further REFERENCES
references for 4 min Biblio- Discussion method
detailed study 1. Shives L. R. Basic concepts of psychiatric mental health graphy
nursing. (7th edn) Lippincott Williams and Wilkins.

2. [Link]

3. Benjamin J. Sadock, Virginia A. Sadock, Menas S.

Gregory; comprehensive textbook of psychiatry, 8th edition.

4. Merry C. Townsend, psychiatry mental health nursing, 5th

edition, Jaypee publications.

5. Stuart [Link]; Laraia T Michele, principles of psychiatry

nursing, 8th edition, Mosby publications.

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TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
TEACHING

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 TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
TEACHING
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 TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
TEACHING

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 TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
TEACHING

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 TEACHING
-LEARNING
SPECIFIC ACTIVITY
S.N. OBJECTIVES TIME CONTENT A.V. METHOD EVALUATION
AIDS OF
TEACHING

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