NVS Staff Nurse - 2019
Mental Health Nursing
Medium
Following electroconvulsive therapy, the patient should be carefully observed for?
Appeared in: NVS Staff Nurse - 2019
Explanation
- Following ECT, the patient is recovering from general anesthesia and a muscle relaxant (succinylcholine).
- These medications suppress the central respiratory drive and paralyze respiratory muscles, making respiratory difficulties the most immediate life-threatening risk.
- Nursing care prioritizes the ABCs (Airway, Breathing, Circulation), placing respiratory assessment first.
- The patient is positioned on their side to prevent aspiration of secretions, and oxygenation is monitored closely until the gag reflex returns and breathing is stable.
Why Other Options Were Wrong
- Option A: A seizure is the intended therapeutic outcome of ECT. Post-procedure seizures are a rare complication, whereas respiratory depression is an expected potential side effect of the anesthesia used.
- Option B: Dizziness is a common, non-life-threatening side effect of ECT and anesthesia. It does not take priority over airway and breathing.
- Option D: Nausea and vomiting are potential side effects of anesthesia, but the primary danger they pose is aspiration, which is a respiratory complication. Therefore, managing the airway to prevent this is the higher priority.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Post-ECT nursing care and immediate complications to guide bedside assessment, documentation, and the next nursing action.
- The nurse's primary role in the immediate post-ECT recovery phase is vigilant monitoring of respiratory status. This includes checking oxygen saturation, respiratory rate and effort, and ensuring a patent airway.
- Positioning the patient in a lateral (side-lying) position is a critical intervention to prevent the tongue from obstructing the airway and to allow secretions to drain, preventing aspiration.
- The gag reflex must be confirmed to have returned before offering any oral fluids or food to prevent aspiration.
How to Approach the Question
- First, identify the core of the question: it asks for the priority observation after ECT.
- Recall the key components of the ECT procedure: it involves inducing a seizure under general anesthesia with a muscle relaxant.
- Apply the universal prioritization framework in nursing: Airway, Breathing, Circulation (ABCs).
- Evaluate each option based on the ABC framework. Anesthesia and muscle relaxants directly impact Airway and Breathing.
- Respiratory difficulties are a direct threat to 'A' and 'B', making this the highest priority over other common but less immediately life-threatening side effects like dizziness or nausea.
- Conclude that monitoring for respiratory difficulties is the most critical initial observation.
Concept Tested & Keywords
- Concept Tested: Post-ECT nursing care and immediate complications
- Stem keywords: electroconvulsive therapy, ECT, observed for
- Lead-in keywords: carefully observed for
- Negative lead-in flag: false
Question ID
QutK3kGRwi1bE1M6V_VJq
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 11194-11196, 11205-11207
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 142-144
Practise the full NVS Staff Nurse - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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