A client with a history of major depressive disorder with psychotic features was rescued before jumping off a dam. The client is pacing, picking at the arms, and repeatedly mumbling, "I have to die. You cannot stop me." When the health care provider recommends electroconvulsive therapy (ECT) as the initial treatment, the client's spouse says to the nurse, "I can't allow such a cruel treatment. Why can't they just give my spouse medication?" Which is the best response by the nurse?

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Quizplus · Accepted Answer

Due to the severity of this client's clinical presentation, ECT would be the appropriate initial treatment. The client's depression has psychotic features and the suicide attempt used a highly lethal method. The client continues to be highly suicidal as evidenced by behavior and thought content. ECT can be highly effective in helping severe depression, when clients pose a severe threat to themselves and it is not safe to wait until medications take effect. ECT is also used in clients who have not responded to medication or cannot tolerate side effects. During ECT, the client is treated with pulses of electrical energy through electrodes applied to the scalp; the electrical stimulus is sufficient to cause a brief convulsion. General anesthesia and a skeletal muscle relaxant are administered to minimize the motor seizure and prevent musculoskeletal injury. The client feels nothing from the procedure, but confusion and memory loss are common side effects. The usual course of acute therapy is 6-12 ECT treatments performed 2-3 times a week. Response to ECT can be dramatic and life-saving. Maintenance therapy (treatment at 1- to 8-week intervals) can continue on a long-term basis to help prevent relapses. Medication therapy is often given in combination with ECT and is associated with improved outcomes. The best response to a client or family member who expresses doubts about ECT is to ask about their concerns. Responses such as, "Tell me about your concerns," or "What do you understand about ECT?" allow the nurse to assess their knowledge and implement educational interventions to address any misinformation or knowledge gaps. (Option A) This response does not address the spouse's concerns. (Option B) Although this statement may be true, it does not address the spouse's concerns. It is not the best response. (Option C) This is a non-therapeutic statement; it does not address the spouse's concerns and suggests a threatening tone. Educational objective: ECT is an effective treatment for major depression with psychotic features or for a client who is highly suicidal. ECT is used when it is unsafe to wait for medication treatment to become effective. It is also used in clients who do not respond to or cannot tolerate psychotropic medications.

A Client with a History of Major Depressive Disorder with Psychotic