Take a deep breath!
Well, placement season is in full swing, and let me tell you, it is a whole new world. Instead of just reading and learning about how to assess and treat clients on paper, speechies everywhere are learning how to work with real live clients. The more time I spend with my clinical educators and new clients, the more I am learning that while our academic background has given us a good foundation, every client brings with them something new to think about and figure out.
One of my placements involves working with dyspaghia clients on an acute care unit, and while much of what we have learned in class has come up in my patient interactions, I am finding that I am learning more and more about an area that we might not consider a typical knowledge area for SLPs: Respiration!
Every chart review of clients being seen for swallowing issues begins with a review of several aspects of their respiratory condition:
- Respiratory rate: this is important to consider because you need the client to be able to maintain an appropriate amount of O2 in their blood while still being able to swallow and talk.
- Upper air way secretions or congestion: a client who cannot manage their secretions, has a wet sounding voice, or who does not sense when they have a build up of saliva might be at increased risk for aspiration, which changes how the client is managed!
- Oxygen needs: Often times, especially in acute care, clients require extra oxygen, which can be delivered via nasal prongs or by an oxygen mask. Needing ventilation can indicate that a client’s airway and respiratory system is currently compromised, which is another big risk factor for aspiration.
Chelsea Sheldon, SLP in the acute care speech pathology department at the Foothills Medical Center in Calgary sees many acute clients throughout the day, and frequently has to assess clients who have a variety of respiratory complications such as trach tubes, pneumonias, and ventilation issues. I asked her to describe a little more about why an SLP would need to have a solid knowledge base about respiratory issues:
“Most often in our dysphasia practise we are most concerned with aspiration and aspiration related pulmonary complications, thus, detailed consideration of a patient’s overall respiratory status is imperative when considering tolerance for aspiration.Change in any of the respiratory factors is one of the best predictors of silent aspiration so it is really important to consider.”
While respiration is touched on in school, I had no idea how important this area of knowledge is to have when working with this population. If you’re planning on working with the dysphagia population, be sure to make friends with the respiratory therapist, they’ll have a gold mine of information to share!