Gross bruising and scratches at surgical site

[qaqueen]

I am a student nurse, working as a CNA in a transitional care unit. We see a lot of post op knee and hip replacement pts for post op care and physical therapy. 99% of our pts have reasonable looking incision and surgical site bruising. I had a new knee admit yesterday that looked like he had been attacked by a bear! Gross bruising and scratches well beyond the surgical site. As I have NEVER seen anything like this before, I would like to know if this is typical and I have just had very lucky patients or was this or was this atypical.

The pt is 90+, our average knee pt is usually in their 80s.

Please advise.

Thanks

[EricJRN, MSN, RN]

I moved your post to its own thread since it starts a different topic. Good luck to you!

[Marie_LPN, RN, LPN, RN]

We see a lot of post op knee and hip replacement pts for post op care and physical therapy. 99% of our pts have reasonable looking incision and surgical site bruising. I had a new knee admit yesterday that looked like he had been attacked by a bear! Gross bruising and scratches well beyond the surgical site. As I have NEVER seen anything like this before, I would like to know if this is typical and I have just had very lucky patients or was this or was this atypical.

I wouldn't call that typical, but maybe a few reasons why:

1) Mallets, slaphammers, power saws, power and manual files, power drills, nails, and slap impactors are used during joint replacements. Not exactly gentle instruments.

2) Pt. may have received heparin during or before surgery.

3) Pt. may not have had a drain post-op.

4) Pt. may be easy to bruise as it is.

5) What kind of pain meds did the pt. receive/take afterward.

[P_RN, ADN, RN]

I'm thinking what about fracture blisters? The edema stretches the skin and makes subcut blisters. Or perhaps she got her little fingers under the dressing? I'm allergic to betadine and I've done some pretty bad damage scratching myself.