What action should a nurse take first upon feeling crackling under the fingertips in a thoracotomy incision area?

Feeling crackling under the fingertips in a thoracotomy incision area suggests subcutaneous emphysema, which occurs when air becomes trapped under the skin. In this scenario, marking the area with a skin pencil serves an important clinical purpose. It allows for precise identification of the location and extent of the crackling sensation, which is crucial for any further evaluation or intervention by the healthcare team.

Marking the area facilitates monitoring over time. It helps in assessing whether the condition is progressing or resolving, providing important information about the patient's status. This action also serves to communicate effectively with other members of the healthcare team, ensuring they understand the area of concern during assessments and discussions.

While preparing an aspiration tray, lowering the head of the bed, or notifying the physician are significant actions to consider afterward, the immediate step should focus on clearly marking the affected area to provide a clear reference point for ongoing care.