distinguishing between bruise vs. cellulitis

[Ms.RN]

i have a patient who had stroke few weeks ago and his right side of the arm is all bruised from shoulder to his hand. the color is dark purple. we did x-ray and doppler and they are negative for fracture and dvt. and now i"m thinking maybe its cellulitis. how do you know if its bruise or the cellulitis?

[leslie :-D]

cellulitis is normally very painful and an angry red, accompanied with a temp.

i've seen what you speak of.

personally, i think this dark color is reflective of the insult the pt has sustained, where the circulation is sluggish and impaired.

it is the right side where your pt is paralyzed?

leslie

[Ms.RN]

cellulitis is normally very painful and an angry red, accompanied with a temp.

i've seen what you speak of.

personally, i think this dark color is reflective of the insult the pt has sustained, where the circulation is sluggish and impaired.

it is the right side where your pt is paralyzed?

leslie

yes, he is paralyzed on the right side due to his stroke.

[leslie :-D]

yes, he is paralyzed on the right side due to his stroke.

one way you know it's the circulation, is if you touch the affected arm, it will be cooler than the other one.

with cellulitis, the affected area(s) would be very warm to touch...

leslie

[sharlynn]

Infection = Induration Fever Erythema Edema or IFEE to make it easy to remember.

[nghtfltguy, BSN, RN]

DAMN leslie!!!

yeah.. listen to what leslie said... she is exactly right.... pfft. as usual...

leslie...

you cease to amaze me!!!!!

very impressed!!!

i think i like you after all.....

[Daytonite, BSN, RN]

A cellulitis is a acute infection of the skin and subcutaneous tissue that results in inflammation of the cells. It may be a result of damage to the skin as a result of a bruise or a wound or some sort. The underlying cause of cellulitis is almost always a break in the skin integrity so that some bacteria has entered the tissue and invaded the surrounding area. Cellulitis normally occurs in the lower extremities and is not, as a norm, seen in the arms. There is usually fever, warmth and tenderness of the involved skin. There would also be enlargement and tenderness of the regional lymph node (in this case, the axillary lymph nodes). There would also be visible streaking of the skin proximal to (above) the area of cellulitis. I often noted that people with cellulitis had pretty good edema of these inflammed tissues so we were often doing daily measurements of them. There was often weeping of the tissues as well due to some of the massive swelling (one of the cardinal signs of inflammation) they would have. The only time I've seen cellulitis in places other than the lower legs have been for things like insect bites or IV phlebitis in the arms of post-mastectomy patients in particular where most of the lymph nodes had also been removed.