Bruises develop when small blood vessels under the skin tear or rupture, most often from a bump or fall. Blood leaks into tissues under the skin and causes the black-and-blue color. As bruises (contusions) heal, usually within 2 to 4 weeks, they often turn colors, including purplish black, reddish blue or yellowish green. Sometimes the area of the bruise spreads down the body in the direction of gravity. A bruise on a leg usually will take longer to heal than a bruise on the face or arms.

Blood Spots

Blood spots under the skin may be either purpura or petechiae. Purpura might look like bruises, but they are not caused by an injury as most regular bruises are. Petechiae don't look like bruises. They are tiny, flat, red or purple spots in the skin, but they are different than the tiny, flat, red spots or birthmarks (hemangiomas) that are present all the time.

Sudden unexplained bruising or blood spots under the skin or a sudden increase in the frequency of bruising may be caused by medications such as aspirin or blood thinners, infection, clotting disorders such as hemophilia, cirrhosis, cancers of the blood or lymph system, vitamin deficiencies.

BRUISES as a sign of abuse:

Bruises that do not appear to be caused by an accidental injury may be caused by abuse. It is important to consider this possibility, especially if the bruises cannot be explained or if the explanations change or do not match the injury. Report this type of bruising and seek help to prevent further abuse.

As nurses working independently in our clients' homes, we find that oftentimes what we do, say and see can be our word against another's. Therein lies the all important motive for comprehensive, complete and detailed documentation and communication with your nursing supervisors.

Do not forget to document any type of skin lesion, bruise or scratch during your head to toe assessment of your client. This could form a defense on your behalf if allegations of child abuse would occur. I know that this is a scary thought but one that cannot be dismissed by any prudent professional. Report your findings during your report off to the next caregiver and note it in the communication book. Continue to perform follow-up assessments of the bruised area to ensure there is no other injury to the area. If abuse is suspected, report this to the office and to the DCFS Hotline.

Documentation:

Child Abuse Trends. What to look for:

• Majority of Injuries are Contusions
• Primary Sites are Face and Buttocks
• Hand is Most Common Instrument
• Over 90% Involve Injuries to Skin
• "Inflicted" bruises: Occur at unusual locations, may be patterned, are multiple and of different ages, and do not fit history or developmental stage of child
• "Accidental" bruises: Usually occur at the protuberant areas, such as the chin, cheek bone and forehead
• Head Trauma - Consider Abuse if A "Trivial" Injury Results In:
  • Irritability
  • Vomiting
  • Decreasing Levels of Consciousness
  • Irregular Breathing or Apnea

When to See a Doctor

• A bruise doesn't go away after 2 weeks.
• You bruise often and you haven't been bumping into things.
• Bruises seem to develop for no known reasons.
• A bruise is getting more painful.
• Your bruise is swelling.
• You can't move a joint.
• The bruise is near your eye.