Behavioral health restraint: the experience and beliefs of seasoned psychiatric nurses.

Psychiatric nurses are faced with the challenge of using behavioral health restraints to ensure client safety while following changing policies and procedures regarding restraint use. This phenomenological study examined how eight seasoned psychiatric nurses experienced the therapeutic use of physical behavioral health restraint in their current practice settings. Data collected by audiotaped interviews were analyzed using qualitative methodology. Eight themes emerged from the analysis of the nurses' experiences that described the beliefs that use of behavioral health restraints should be resorted to only after less restrictive measures, safely implemented, failed to control potentially harmful behavior, avoided through early recognition and the subsequent implementation of less restrictive interventions. Furthermore, the participants believed that behavioral health restraint should never be employed in a punitive manner and being involved in a therapeutic restraint incident is a painful experience for clients and staff.

Localized versus systemic vasculitis: diagnosis and management.

Localized vasculitis restricted to a specific anatomic site or organ is often histologically indistinguishable from more severe, systemic forms of vasculitis. By definition, localized vasculitis involves blood vessels within a confined vascular distribution or single organ without clinical evidence of generalized inflammation. Important factors that determine treatment and prognosis, in what appears initially to be a localized process, include histopathologic type, organ site, and the presence of systemic inflammatory markers and symptoms. The major issue is whether single organ vasculitis is actually an isolated form of the disease in which case surgical excision is curative, or whether the single organ involvement is simply a precursor of more threatening systemic vasculitis. The Birmingham Vasculitis Activity Score is a valuable tool to identify those patients with concurrent systemic involvement. The physician's recognition of a localized versus systemic vasculitic process is important in terms of making the correct diagnosis, prescribing treatment, and arranging appropriate clinical follow-up.

Splenic rupture as the presenting manifestation of vasculitis.

BACKGROUND: Although underreported, histologic splenic involvement in Wegener's granulomatosis (WG) is not unusual. Splenic rupture in association with WG, however, is rare. Only 2 cases of nontraumatic splenic rupture have been reported as the initial feature of WG. Isolated cases of splenic rupture also have been noted in rheumatoid arthritis, systemic lupus erythematosus, and polyarteritis nodosa. OBJECTIVE: To report the third case of splenic rupture as the presenting feature of WG and review the literature concerning splenic rupture in other rheumatologic diseases to better delineate a mechanism for this rare occurrence. METHODS: Descriptive case report of 1 patient with WG with antecedent splenic rupture and a review of the relevant literature using a MEDLINE search from 1950 to 2001. RESULTS: Our patient presented with symptoms and signs of WG 2 weeks after nontraumatic splenic rupture. Two similar cases have been reported: one showed splenic vasculitis histologically and the other only a neutrophilic infiltration at the site of the splenic tear and subcapsular zone after surgery. Although splenic capsular and pulp hemorrhage alone without signs of vasculitis were noted in our patient, no other cause (ie, hematologic, infectious, neoplastic, or otherwise) for splenic rupture was found. CONCLUSIONS AND RELEVANCE: As in the 2 reported cases, WG may have been responsible for splenic rupture in our patient. Regardless, early evaluation for connective tissue disease in a patient with spontaneous splenic rupture without apparent cause merits consideration, as it may affect patient follow-up and treatment.