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Discussion

Documentation on Bruises

I had a 93 year old pt who had several bruises on all her extremities. It was to many to document each and every size. Should I have documented all them? I think my teachers would have had a cow, because they told us our narrative notes should not been any longer than 3 to 4 pages. How would I include this information in my narrative notes? Could this be related to her anemia and age?

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    Also, I can not for the life of me remember or find what to call these parts of the upper limb. She had an iv site on the back of her palm, So i am assuming I would put - previous bruising on IV site of pronated Left dorsal of the palm? Her new iv site is on her Right - not forearm but underneath. I've been searching for 20 minutes now and I really don't know what to search for or how to describe it.

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    For pt's who have a lot of bruising I usually put something like patient has several/ the exact number if there isn't too many bruises ranging from 2-6 cm on armsor legs... wherever they are. I'll repeat it for each area. If I don't know how they got there I won't put it. At the last hospital I was at there was an elderly man with brusing all over his body. They thought it was elder abuse until they transfered the patient and the next day he had bruises in the shape of the nurses hands on his arms. I left clinicals before I found out what caused it.

    As for the IV site I'm confused anything between the antecubital area and the wrist is the forearm. I can't picture it in my head so I can't help you there.

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    we were taught in NS that you dont call it a bruise, it is an ecchymotic area......try looking up pupura of the elderly...good luck

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    • Experts

    There are two parts to the hand: the palm and the back of the hand.

    With regard to the forearms. . .put your hands palms down on a table top. Now, look at the position of your forearms. The inner forearm is the tender part that is resting against the table top. It is the part that extends backward from the palm of your hand. The outer forearm is the part that you see as you look down at your forearms. The outer forearm is the part the extends backward from the back of your hand.

    fizzgigger said:
    I had a 93 year old pt who had several bruises on all her extremities. It was to many to document each and every size. Should I have documented all them?. . .How would I include this information in my narrative notes?. . .Could this be related to her anemia and age?. . .Also, I can not for the life of me remember or find what to call these parts of the upper limb.

    I would chart "multiple bruises on back of hand, inner and outer forearm and upper arm in various stages of healing." Bruising is due to contusion which is an injury, a blow, where the top surface of the skin has not been broken, but the blood vessels below it have. The discoloration is the result of ruptured blood vessels that have spilled blood out into the surrounding tissues (hematoma). At first the bruise will appear a dark purple colored. As the days go by it lightens up as the blood in the tissues is absorbed, carried away and the discoloration turned brownish to yellow. Aging results in the skin being thinner and easier for the blood vessels to rupture.

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    So i am assuming I would put - previous bruising on IV site of pronated Left dorsal of the palm? She had an iv site on the back of her palm, Her new iv site is on her Right - not forearm but underneath. I've been searching for 20 minutes now and I really don't know what to search for or how to describe it.

    The dorsal palm is simply the "back of the hand". Chart something like "2-inch diameter bruise (or use ecchymosis, if you prefer) noted at old IV site on left hand". We all know that an IV is never put into any veins in the palm of the hand--I was an IV therapist. If you really want to get anal about it, "2-inch diameter flat hematoma noted at old IV site at 2nd metacarpal on left hand."

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    • Author
    morte said:
    we were taught in NS that you dont call it a bruise, it is an ecchymotic area......try looking up pupura of the elderly...good luck

    Last time I put that in my notes because I learned that in med terms but I stood corrected, there was a huge line in it. I even tried pupura once and that was also marked out. My teacher said to use bruise. So i really don't know what the proper way is to use, I guess I'll keep using bruise in the school but when I get out I'll use ecchymotic area. Grr.

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    • Author

    Daytonite, thanks so much. I couldn't for the life of me figure it out. You exercise helped me. Thanks again. And for the most part, I hope I'm able to help to help other out when I get out of school.

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    We use the term bruise. In my LTC facility, they want us to measure and chart each and every bruise. This can make for a fun time when trying to do an admit or readmit assessment. NOT. What I normally would do is try to group them together..."yellow bruising to forarm from wrist to anticubital 20cm x 3cm" purple brusing to anti cubital 3x3 cm due to old IV site"

    Yes...It does get tedious esp on the elderly pts.

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