Ecchymosis

Definition

Ecchymosis is bluish, purplish, or yellowish-green discoloration of the skin caused by extravasation of blood into subcutaneous tissue. It is larger than petechiae (>1 cm) and results from trauma or bleeding disorders.

Evolution (Color Changes)

Red → blue/purple (days 1 to 3) → green (days 5 to 7) → yellow/brown (days 7 to 14). Resolution takes 2 to 3 weeks.

Common Causes

• Trauma/injury
• Anticoagulant therapy (warfarin, heparin)
• Thrombocytopenia
• Clotting factor deficiency
• Liver disease
• Elderly (increased skin fragility)
• Abuse (consider in children and elderly, especially patterned bruises)

Nursing Considerations

Assess distribution, size, and age of bruises, such as document color, location, and measurements. Evaluate for underlying bleeding disorder or abuse. Teach bleeding precautions for anticoagulated patients. Monitor Hgb/Hct and coagulation studies.

NCLEX Relevance

Sign of bleeding or injury, such as distinguish from petechiae (smaller, non-raised, pinpoint).