A director of nursing in a rehabilitation facility is planning to measure the quality of care provided. Which of the following audits should the director plan to use after clients are discharged to gather information about quality of care?

A. Speech-language pathologist: Speech-language pathologists (SLPs) specialize in evaluating and treating swallowing disorders (dysphagia). They can assess the client’s swallowing ability, recommend appropriate diet modifications, and provide strategies to reduce choking risk.

B. Social worker: Social workers provide support for psychosocial needs, discharge planning, and community resources, but they do not assess or manage swallowing difficulties. Referral to a social worker may be appropriate for broader care needs but not for dysphagia.

C. Respiratory therapist: Respiratory therapists focus on airway management, ventilation, and pulmonary function. While they can assist if aspiration leads to respiratory complications, they do not primarily assess swallowing function.

D. Occupational therapist: Occupational therapists help clients with activities of daily living and adaptive equipment. Although they may assist with feeding techniques or positioning, they are not specialized in assessing or treating swallowing disorders.

Rationale for Correct Choices:

• Macrosomia: Post-term infants (≥ 42 weeks) are at higher risk of excessive birth weight due to prolonged nutrient exposure in utero. Larger infants are prone to birth trauma, shoulder dystocia, and hypoglycemia after delivery.

• Meconium aspiration syndrome: Thick green amniotic fluid indicates meconium passage in utero, likely due to fetal stress from prolonged labor and late decelerations. Inhalation of meconium-stained fluid at birth can cause airway obstruction, chemical pneumonitis, and respiratory distress.

Rationale for Incorrect Choices:

• Bronchopulmonary dysplasia: This chronic lung disease is typically a complication in premature infants requiring prolonged mechanical ventilation and high oxygen concentrations, not in post-term newborns.

• Intraventricular haemorrhage: This complication is primarily seen in premature infants with fragile germinal matrix vessels; it is uncommon in term or post-term neonates unless there is severe birth trauma or asphyxia.