Bruise or ecchymosis?

[SneakySnake]

I said- "resident has bruising on arm and hip because they have been scratching"

Other nurse said- "It looks ecchymotic to me, not bruised....just my opinion"

I thought ecchymosis was bruising:o? Can anyone offer some clarification on this?

[rnccf2007, BSN, RN]

I said- "resident has bruising on arm and hip because they have been scratching"

Other nurse said- "It looks ecchymotic to me, not bruised....just my opinion"

I thought ecchymosis was bruising:o? Can anyone offer some clarification on this?

Sounds like you have a co-worker from hell that we all have (had) to deal with. Where I come from, eccchymosis simply means bruising. Early in my nursing career (hasn't been too long) I worked with an LPN who sounds like your co-worker. She reviewed and critisized all of my nursing assessments. I am can be silly at times, so I started writing big words for my assessments. No generalized edema for me... "anasarca" , no reddened spots that were not a stage I but "blanchable erythema," etc. She stopped her critisim shortly after. Kind of backfired on me, because now I always document this way. LOL. Thankfully, I don't talk to my patients or co-workers that way. So If you ever get a chance, tell you co-worker..."looks like blanchable erythema to me not a reddened area, etc." Hope you get my point.

[lorilvnb]

They are most definately the same thing. I even looked it up to be doubly sure.

[mookyjoe, BSN, MSN, APRN, NP]

From my learning experience I was told a contusion refers to a bone that is suspected of being broken, whereas ecchymosis is more of a bruising where petichiae are pinpoint types of bruising say from a rub, hicky, fat embolism type thing. Something that looks like the bed ran into someone's poor shin would be more ecchymotic. In short, the only thing that matters is documenting size, color, dating when the lesion occured and reporting it as a possible fall if that is what you believe as a nurse. And maybe smarty pants was only stating eccymosis like that because if you had to stand in a court room....God forbid, you would not want council saying so you're a nurse and do not know your temrinology? That would be awkward, but then again, I get the brashness eccyhimosis sloughed off instead of bruising. You're here to vent and vent away! We're all listening and understand. :redpinkhe

[amay256]

Well actually in my studies I've learnt that bruising is commonly but mistakenly called ecchymosis - brusies are caused by trauma (such as an elderly person scratching too hard, or someone knocking themselves or hitting an area and bursting blood vessels. e.g trauma caused by something outside the body). However ecchymosis is a form of purpura, and is caused by something internal to the body, such as vascular, platelet or coagulation disorders. So just to clarify, bruises are caused by trauma to an area where as ecchymosis is the rupturing of blood vessels due to an issue internally.

[amay256]

And I think I read somewhere that ecchymosis and purpura can be caused by medications as well? Not 100% on that though so don't quote me on it. But maybe that's what your co-worker meant when she was saying it was of ecchymotic origin and not simply a bruise from scratching? :)

[systoly]

i really would like to know the other nurse's explanation

did you ask?

[withasmilelpn]

Sometimes it's best to stick to "discoloration" when you are not sure - we have had instances of documentation of 'bruising' when it was actually 'staining' from venous insufficiency. :-)

[withasmilelpn]

Contusion: Another name for a bruise. What is a bruise ? A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury.

Ecchymosis: The skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels. Ecchymoses can similarly occur in mucous membranes as, for example, in the mouth.

A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.

They do look different - ecchymosis appear to be under the outer layer of the skin while bruises or contusions affect the outer layer as well.

[dream'n, BSN, RN]

Bruising and ecchymosis are the same, but petechia and bruising are not. Petechia is seen often in my chemotherapy patients due to low platelets, it appears kind of rashy most of the time. They look very different.

[withasmilelpn]

From http://www.medscape.org/viewarticle/578859_2

Of note, Sheridan reminds us that nurses sometimes use the word "ecchymosis" erroneously in place of "bruising." Ecchymosis is not a synonym for bruise or contusion. Ecchymosis is extravasation of blood under the skin that can be caused spontaneously by medical conditions, such as thrombocytopenia. Elderly patients frequently have areas of ecchymosis that are not trauma-related. However, the word ecchymosis does have a limited use in the assault-related forensic vernacular. Extravasated blood from a vessel broken by trauma can track through fascial planes, resulting in a discoloration forming at a site remote from the original injury, a gravitational process known as ecchymotic spread. This is how a blow to the scalp can result in a black eye. If, however, the patient was actually struck in the eye, the discoloration in that area is a bruise. The blood from this bruise to the eye area can subsequently gravitate further downward.

[amoLucia]

I think the issue between 'bruise' and 'ecchymosis' boils down to an assumption of injury being associated with a 'bruise'. And to facility administration, that is to be avoided as too many 'bumps and bruises of unknown origin' will need to be investigated and will be most likely counted in safety statistics like falls. Too many bumps and bruises statistics send up a 'red flag' to State surveyors. Just like too many falls, new infections, skin breakdowns, etc. And in today's society, families are all too lawsuit-happy if they think there's something improper with care provided.

Most likely, the bruise will be found just randomly during some simple care activity. Facilities will require documented statements from all assigned caregivers for several previous shifts. Usually an incident report is required and the full incident protocol is implemented along with any explanations for possible causes. All the required documentation, phone calls to families and MDs with orders, care planning, in-house safety committee review, etc occurs.

That's my take on the difference between the two definitions. Even as I regard the 2 as interchangeable, I proceed as an injury and do the full protocol just to CYA. And better for you (or me) to first report a bruise as the burden of cause shifts to others ahead.

A lot of work ... but I can understand why the original OP's co-worker may have questioned OP's assessment.

[vicki518]

same thing but I was told not to chart bruise but "ecchymosis"