# A nurse is caring for a client who underwent a total laryngectomy 48 hours ago. Which assessment finding requires the nurse's immediate attention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541334  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a client who underwent a total laryngectomy 48 hours ago. Which assessment finding requires the nurse's immediate attention?

## 보기

1. Small amount of blood-tinged mucus from the tracheostomy site
2. Client communicating needs by writing on a notepad
3. Oxygen saturation reading of 94% on room air
4. Sudden onset of severe subcutaneous emphysema around the neck and chest **✔ 정답**

**정답: 4**

## 해설

Sudden severe subcutaneous emphysema indicates tracheal rupture, a life-threatening emergency requiring immediate intervention. Slight bloody drainage, communication board use, and SpO2 94% are expected or manageable findings.

## 심화 해설

Understanding the Priority Finding After Total Laryngectomy

Following a total laryngectomy, the surgical creation of a permanent tracheostomy fundamentally alters the patient's airway anatomy. The immediate postoperative period requires vigilant monitoring for life-threatening complications. While some findings represent expected postoperative changes, others signal an evolving emergency that demands immediate intervention.

Analysis of the Assessment Findings

Subcutaneous emphysema is the presence of air within the tissue layers beneath the skin. When it develops suddenly and severely around the neck and chest 48 hours post-laryngectomy, it is a critical finding. This presentation suggests that air from the airway is being forced under pressure into the soft tissues of the neck and thorax, dissecting along fascial planes. The mechanism is often a disruption in the anatomical barrier between the pharyngeal suture line and the tracheostoma. As described in the literature on surgical technique modifications, maintaining an intact anatomical barrier between the laryngectomy field and the tracheostomy site is crucial to prevent this complication [1]. A sudden onset indicates a possible acute dehiscence of the internal closure or a tracheal injury, which can rapidly progress to airway compromise from external compression, pneumomediastinum, or tension pneumothorax. This constitutes a physiological emergency that the nurse must recognize and report immediately.

The other options represent expected or non-critical findings:

- A small amount of blood-tinged mucus from the tracheostomy site is an anticipated finding in the early postoperative period and does not indicate active hemorrhage.

- A client communicating needs by writing is an appropriate and effective non-verbal method, demonstrating successful adaptation to the altered airway.

- An oxygen saturation of 94% on room air is within an acceptable range for a patient in the immediate postoperative phase and does not signal acute respiratory failure. While monitoring is required, it is not the priority over a finding that suggests impending airway loss.

Clinical Implications and Risk Factors

Postoperative complications following laryngectomy are a significant clinical concern. A retrospective analysis of over 400 patients identified various early complications within 30 days of surgery, with risk factors including specific surgical and patient characteristics . While pharyngocutaneous fistula and wound infection are common complications tracked in such studies, the development of severe subcutaneous emphysema is a distinct and immediately dangerous event. The sudden nature of the onset differentiates it from minor, localized air trapping that can sometimes occur. The nurse's priority is to assess the airway, breathing, and circulation, prepare for immediate notification of the surgical team, and anticipate interventions such as wound exploration, drain placement, or return to the operating room. The focus on techniques to prevent this complication underscores its recognized severity in laryngeal surgery [1].References (research sources)

- [1]The modified apron (Akil) incision: a technical modification to prevent subcutaneous emphysema in partial vertical and supracricoid laryngectomy.Research articleAkıl F, Çelik A. (2026) · DOI: 10.1007/s00405-026-10186-z

## 임상 시나리오

Post-Laryngectomy: Subcutaneous EmphysemaRecognizing a life-threatening airway emergency
Sudden, severe subcutaneous emphysema around the neck and chest is a critical emergency after total laryngectomy. It indicates air is escaping from the airway into soft tissues, often due to pharyngeal suture line disruption or tracheal injury.

This air dissects along fascial planes and can rapidly cause airway compression, pneumomediastinum, or tension pneumothorax. Immediate recognition and reporting to the surgical team is vital.

CautionDo not confuse this with expected findings. A small amount of localized air or blood-tinged mucus is common. The key differentiator is sudden onset and severe, spreading distribution.

## 핵심 개념

- **Subcutaneous Emphysema** — The presence of air or gas in the subcutaneous tissue layers, often felt as a crackling sensation (crepitus) on palpation.
- **Total Laryngectomy** — A surgical procedure to remove the entire larynx, creating a permanent tracheostomy which separates the airway from the digestive tract.
- **Tracheostomy** — A surgically created opening (stoma) in the neck into the trachea to provide an airway.
- **Dehiscence** — The separation or bursting open of a surgical wound along the suture line.
- **Pneumomediastinum** — The presence of air in the mediastinum, the central compartment of the thoracic cavity.

## 같은 주제 문제

- [A 65-year-old male client with a 30-pack-year smoking history presents to the emergency de…](https://mymerci.kr/pages/nclex_q.php?qn_id=541328)
- [A nurse is assessing a 45-year-old client with suspected lung cancer. Which assessment fin…](https://mymerci.kr/pages/nclex_q.php?qn_id=541329)
- [A 68-year-old client with a history of asbestos exposure is admitted with suspected lung c…](https://mymerci.kr/pages/nclex_q.php?qn_id=541330)
- [A nurse is caring for a client who underwent a total laryngectomy 48 hours ago. The client…](https://mymerci.kr/pages/nclex_q.php?qn_id=541331)
- [A nurse is caring for a 58-year-old male client who underwent a total laryngectomy for lar…](https://mymerci.kr/pages/nclex_q.php?qn_id=541332)
- [A nurse is caring for a client with advanced lung cancer who has developed superior vena c…](https://mymerci.kr/pages/nclex_q.php?qn_id=541333)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._