The nurse is palpating a client’s anterior chest wall and notices a course, crackling sensation over the skin surface. Which of the following should the nurse suspect from her findings?
A.
Friction rub
B.
Tactile fremitus
C.
Crepitus
D.
Adventitious sounds
The Correct Answer and Explanation is:
The correct answer is C. Crepitus.
Explanation:
Crepitus is a clinical finding that refers to a coarse, crackling sensation that can be palpated or felt over the skin surface. It occurs when air escapes from the lungs or airways and becomes trapped in the subcutaneous tissues, leading to subcutaneous emphysema. This sensation is typically described as similar to the feeling of rubbing strands of hair between the fingers or like Rice Krispies crackling under the skin.
Crepitus can occur in various clinical scenarios, most commonly associated with pneumothorax, chest trauma, or certain surgical procedures where air leaks into the subcutaneous tissues. For example, in the case of a pneumothorax (collapsed lung), air can escape from the lung into the pleural space and subsequently into the subcutaneous tissue. Similarly, crepitus may be observed after chest surgery or in patients with rib fractures that have punctured the lung or bronchus.
The presence of crepitus is a significant finding and should prompt the nurse to assess the patient for other signs of respiratory distress or underlying conditions, such as chest pain, shortness of breath, or changes in respiratory status. Immediate intervention may be required depending on the underlying cause of crepitus, especially if it is associated with a large pneumothorax or other severe respiratory issues.
In contrast:
- Friction rub (Option A) refers to a grating sound heard with a stethoscope during auscultation, typically caused by inflamed pleural surfaces rubbing together, as seen in pleuritis. It is not palpable.
- Tactile fremitus (Option B) is a vibration felt on the chest wall when a person speaks. It is increased in conditions like pneumonia where lung consolidation is present, and decreased in conditions like pleural effusion or pneumothorax. However, it is not associated with the crackling sensation of crepitus.
- Adventitious sounds (Option D) include abnormal lung sounds heard during auscultation, such as wheezes, crackles, or rhonchi. These are auditory findings rather than palpatory sensations.
Therefore, the nurse’s finding of a coarse, crackling sensation over the skin surface aligns most closely with the phenomenon of crepitus, indicating subcutaneous emphysema, and requires further assessment and intervention.