Caring for Patients With Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) is a form of intracranial hypotension that often lacks uniformity in its presentation on physical assessment and radiological imaging studies among patients. SIH can be mistaken for a number of other unrelated conditions, and because it is also quite rare, many health care providers and patients are not familiar with this condition. These factors make SIH difficult to recognize and diagnose. This article seeks to bring greater awareness to health care professionals about SIH to direct patients affected by SIH to more appropriate and timely care. This work also offers suggestions for management of patients receiving an epidural blood patch, a common treatment for SIH.     

Caring for the Transgender Patient

The perceived lack of interaction with transgender individuals fosters societal stigma and discrimination against this minority group. The lack of practitioners' ability to provide culturally competent care and knowledge of transgender health issues exacerbates severe health care disparities. Radiology and imaging nurses will routinely encounter transgender patients requiring radiological studies. This short communication provides an answer to a technical question posed about the estimate glomerular filtration rate for a transgender patient. Furthermore, the article provides nurses with several practical communication techniques that can have an immediate impact in improving transgender care by demonstrating dignity and respect toward this patient population.     

Trigeminal Neuralgia in a Patient With Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension and trigeminal neuralgia are examples of pain syndromes arising from shifting anatomical relationships in the posterior fossa. We report both conditions occurring in the same patient and resolving following surgical closure of a cervical nerve root sleeve dural defect. This case further elucidates the pathophysiologic basis of both forms of head pain.     

Caring for the Takotsubo Cardiomyopathy Patient

Takotsubo cardiomyopathy is characterized by an atypical pattern of wall motion abnormalities seen during coronary angiography or echocardiogram as excessive abnormal movement of basal with midventricular and apical hypokinesis. These findings occur in the absence of obstructive coronary artery disease. The disorder was named due to its distinctive resemblance to traditional Japanese octopus fishing pots called tako-tsubo. The heart presents with a wide base and a long thin neck when viewed in an echocardiogram. Takotsubo cardiomyopathy was first identified in Japan in 1990 and, since then, has been gaining increased attention and being diagnosed worldwide.     

An Unusually Rapid Spontaneous Recovery in a Patient With Spinal Epidural Hematoma

Background: Spontaneous epidural hematoma is a rare condition, which usually requires urgent surgical treatment. Objectives: To report two cases of spontaneous epidural hematoma, one of which was treated conservatively, and the other surgically, and discuss the possibility of unusual spontaneous recovery and treatment decision-making. Case Report: We encountered 2 patients with spontaneous spinal epidural hematoma, both of whom were taking an anti-platelet agent, producing severe paraplegia. One patient with a hematoma at C2–T3 experienced a rapid neurological recovery while a magnetic resonance imaging scan was being performed. A complete resolution of the hematoma and complete neurological recovery ensued without surgical intervention. A second patient with a hematoma at T10–12 showed no neurological recovery up to the time emergency surgery started and was treated surgically by T10–12 laminectomy and excision of the hematoma. Neurological function returned to normal in both patients. Conclusion: The occurrence of spontaneous recovery in some patients makes the decision for surgery difficult. Emergency physicians need to be aware of the possibility of spontaneous rapid neurological recovery in patients with spinal epidural hematoma. To avoid unnecessary surgery in patients who will spontaneously have neurological recovery, neurological evaluations need to be repeatedly performed up to the time the emergency surgery begins. However, unfortunately, there is no diagnostic tool at present to identify the patients who recover spontaneously, and the interval between onset and surgery is correlated with clinical results, therefore, conservative treatment should be prescribed only for those patients who exhibit improving neurological signs early in the clinical course.     

Caring for the Dangerous Patient: Legal and Ethical Considerations

When assessing and treating patients who report that they are thinking about hurting themselves or others, nurse practitioners (NPs) must consider not just their codes of ethics but federal laws, state laws, cases in the different courts, and the guidelines set forth by credentialing boards and professional organizations, all of which impact the application of basic confidentiality. The purpose of this article is to help NPs deal with unusual situations that might require a breach of patient confidentiality and to address legal concerns and possible actions by state boards of nursing for breach of patient confidentiality. A list of 10 considerations for NPs facing such a challenge is included.