Question

A client develops subcutaneous emphysema after the surgical creation of a tracheostomy. what assessment by the nurse most readily detects this complication?

Answer 1

There are choices for this question namely:

Palpating the neck or face
Evaluating the blood gases
Auscultating the lung fields
Reviewing the chest x-ray film

A patient with subcutaneous emphysema commonly presents with crepitations. Crepitations are described as "popping a bubble wrap" upon palpation of the neck and face. This corresponds to the escape of air from the airways (in this case, from the tracheostomy) to the subcutaneous tissue. 

Answer 2

The right answer is Palpating the neck or face.

The collection of air in the inner layers of the chest or under the skin of the tracheostomy can result in pneumomediastinum or subcutaneous emphysema respectively.

The subcutaneous emphysema is recognized by the characteristic sensation of cracking when palpating the skin, swelling. In this case, you need to remove some of the sutures from the wound and loosen the bandage.