In the psychiatry ward, an ECT procedure is scheduled for a patient with major depressive disorder. Which of the following is the priority nursing pre-operative intervention?

1. A

   Administer the pre-medications

2. B

   Apply ECG Electrodes

3. C

   Ensure NPO status of the patient

4. D

   Remove all jewellery of the patient

Appeared in: NORCET 8 Prelims-2025

Explanation

Listen in Hindi

• Ensuring the patient is NPO (nothing by mouth) for at least 6 hours before ECT is the top priority.
• ECT requires general anesthesia and muscle relaxants, which suppress the gag reflex and increase the risk of aspiration.
• Aspiration of stomach contents can lead to aspiration pneumonia, a severe and potentially fatal complication.
• This intervention directly addresses airway safety, which is the primary concern in the ABCs of prioritization.

Why Other Options Were Wrong

• Option A: Administering pre-medications (like atropine to reduce secretions) is an important step, but it occurs after the fundamental safety check of NPO status is confirmed. It is not the first priority.
• Option B: Applying ECG electrodes is essential for monitoring the patient's cardiac status during the procedure. However, this is typically done in the treatment room just before the ECT is administered, not as the priority pre-operative task on the ward.
• Option D: Removing all jewelry, dentures, and metallic objects is a necessary safety precaution to prevent burns and injury during the electrical stimulus. While important, it is a lower priority than preventing a life-threatening airway complication like aspiration.

Related Visual

• Visual 1: Flowchart: Pre-ECT Nursing Checklist. This visual would outline the sequence of nursing tasks, starting with confirming informed consent and NPO status, followed by removing prosthetics, administering pre-medications, and having the patient void, clearly showing NPO status as a primary step.
• Visual 2: Infographic: ABCs of Prioritization. An infographic illustrating the Airway, Breathing, Circulation framework and how it applies to common clinical scenarios, including pre-operative care.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Prioritization of pre-operative nursing care for Electroconvulsive Therapy (ECT) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Prioritization is a fundamental nursing skill. In any procedure involving anesthesia, always prioritize airway management (preventing aspiration) over other important but less immediately life-threatening tasks.
• Nurses are the last line of defense in patient safety. Verifying NPO status is a critical checkpoint that prevents a major complication and is a core nursing responsibility.
• What if the patient is a diabetic on insulin? The nurse must collaborate with the physician and anesthesiologist to manage the patient's blood sugar and insulin regimen during the NPO period, often involving IV dextrose to prevent hypoglycemia.

How to Approach the Question

• First, identify the question type. This is a 'priority' question, asking for the most important intervention.
• Recall the ABCs of nursing: Airway, Breathing, and Circulation. Interventions related to maintaining a patent airway are almost always the highest priority.
• Analyze the procedure: ECT involves general anesthesia, which carries a significant risk of aspiration if the stomach is not empty.
• Evaluate each option against the ABC framework. 'Ensure NPO status' directly relates to protecting the airway from aspiration.
• Compare the risk of aspiration (a life-threatening airway issue) to the risks associated with the other options (medication timing, monitoring placement, burn prevention). The airway risk is the most immediate and severe, making NPO status the priority.

Concept Tested & Keywords

• Concept Tested: Prioritization of pre-operative nursing care for Electroconvulsive Therapy (ECT).
• Stem keywords: psychiatry ward, ECT procedure, major depressive disorder, pre-operative intervention
• Lead-in keywords: priority
• Clinical cues: The term 'priority' indicates the need to rank interventions based on patient safety, often using the Airway, Breathing, Circulation (ABC) framework.

Question ID

QLPuKYOlvB6rGkLXnqzNPo

Copy ID