N201 ACTUAL EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Describe pneumonia
Pneumonia is an acute infection of the LOWER RESPIRATORY TRACT (LRTI),
Caused by bacteria/viruses from infected people where the lungs(s) fill with pus and
fluid.
What are the types of pneumonia?
- Community acquired (CAP) - Most common cause of hospital admissions in adults in
NZ, Incidence highest in winter, Streptococcus pneumoniae most common, Atypical
organisms (Mycoplasma; Legionella; Chlamydia), viral - spread through
respiratory droplets.
- Ventilator acquired (VAP) - occurs > 48hrs via ETT ventilation
- Hospital acquired (HAP) - occurs > 48hrs post admission
Name some risk factors for pneumonia
- Ageing - very young or older people
- Altered conscious level (those in a coma, anesthetised)
- Altered flora secondary to antibiotic therapy
- Bed rest / prolonged immobility
- Chronic diseases (diabetes, asthma, emphysema)
- Immunosuppression
- Malnutrition
- Smoking (damages cilia)
- Tracheal intubation
- URTI (upper respiratory tract infection)
- Air pollution
- NG feeds (aspirate NG tube)
What is aspiration pneumonia?
,A pneumonia that occurs from abnormal entry of secretions or substances into the lower
airway. It usually follows aspiration of material from the mouth or stomach into the
trachea and subsequently the lungs.
Describe the four stages of pneumonia if antibiotics are NOT used
1. Congestion: First 24 hours the lung is becoming boggy, Vascular engorgement, Fluid
inside alveoli, Neutrophil inside alveoli and numerous bacteria. Signs: shortness of
breath, exertion, extreme fatigue, tachycardia
2. Red hepatisation: 2-3 days, Consistency of lung is like liver, red because of RBC,
Exudation Neutrophil debris bacteria and blood consistency pus forming and lung
harder than normal
3. Gray hepatisation: 2-3 day days after red hepatisation, consistency of liver but grey
because of exudate in lung, Disintegration of RBC and becomes greyish colour
4. Resolution: time depends on the person. Debris ingested and complete restoration of
lung, Gas exchange terms to normal
Name some signs and symptoms of pneumonia
Systemic: high fever, chills
Lungs: cough with sputum or phlegm, shortness of breath, pleuritic chest pain,
haemoptysis
Skin: clamminess, cyanotic
Muscular: fatigue, aches
Central: headaches, loss of appetite, mood swings, confusion
Vascular: low BPHeart: high HR
Gastric: nausea, vomitingJoints: pain
Name two ways to prevent pneumonia
Pneumococcal vaccine
Haemophilus influenzae (Hib) vaccine
How is pneumonia diagnosed and treated?
,History and physical examination
- Auscultate for adventitious/abnormal breath sounds-bubbling, wheezing, crackles
- Percuss for a dull sound
- Chest X-ray
- Sputum microscopy (Gram stain), culture & sensitivity
- FBC (fluid balance chart)
- Blood cultures
- Possibly bronchoscopy +/- washings/brushings
Treatment:
- Broad spectrum antibiotic cover - Penicillin + Cephalosporin
- Nutritional Therapy (3 L intake/day; 6300 kJ/day)
- Symptom Management
- Health Promotion
Name the three most common causes of airway compromise
Airway obstrcution
Hypoxaemia
Hypoventilation
Describe airway obstruction
Blockage of airway by patient's tongue - Supine position/ Extremely sleepy patient.
Complete airway obstruction = hypoxia and cardiac arrest
Partial obstruction = subtle and insidious in onset
- Laryngospasm
- Retained secretions
- Laryngeal oedema
Describe hypoxaemia
Hypoxemia - Low oxygen in the blood, commonly caused by Atelectasis (partial or
complete collapse of lung).
- PaO2 (ABG) <60mmHg severe hypoxaemia. (Normal 80-100mmHg)
- SpO2 (O2 Sats) < 95% hypoxaemia. (Normal - 95-100%)
, Ranges from agitation to somnolence, hypertension to hypotension, and tachycardia to
bradycardia
Why is pneumonia and atelectasis common post thoracic/abdominal surgery
Postoperative development of mucous plugs and decreased surfactant are related to
hypoventilation, recumbent position, ineffective coughing, and smoking. Also, immobile
patients
Describe pulmonary oedema - symptoms and treatment
An accumulation of fluid within the alveoli from an imbalance of hydrostatic and oncotic
fluid
- Can result from fluid overload, left ventricular failure, or prolonged airway obstruction,
sepsis, or aspiration
Signs: crackles, dyspnoea, haemoptysis
Treatment: O2, fluid restrict, diuretics
Describe symptoms and treatment of aspirating gastric contents
Aspiration of gastric contents potentially serious airway emergency
Symptoms: Bronchospasm, Atelectasis, Crackles, Alveolar haemorrhage, Respiratory
distress, O2 saturations
Can cause laryngospasm, infection, and pulmonary oedema
Management: Because of serious consequences PREVENTION is best treatment
- Patients at risk; obese, pregnant, hx hiatus hernia, GORD, trauma may be pre-
medicated with histamine-H2 receptor antagonist before induction of anaesthesia (e.g.
ranitidine) or an antacid (e.g. sodium citrate)
- If aspiration occurs requires O2 therapy, cardiac support, antibiotics
Describe bronchospasm - symptoms and treatment
Results from increase in bronchial smooth muscle tone with resultant closure of small
airways. Airway oedema develops, causing secretions to build up
Causes: A serious potential complication of ET intubation during GA. Suctioning,
allergic response. The patient can become apnoeic. More frequent in asthma COPD
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Describe pneumonia
Pneumonia is an acute infection of the LOWER RESPIRATORY TRACT (LRTI),
Caused by bacteria/viruses from infected people where the lungs(s) fill with pus and
fluid.
What are the types of pneumonia?
- Community acquired (CAP) - Most common cause of hospital admissions in adults in
NZ, Incidence highest in winter, Streptococcus pneumoniae most common, Atypical
organisms (Mycoplasma; Legionella; Chlamydia), viral - spread through
respiratory droplets.
- Ventilator acquired (VAP) - occurs > 48hrs via ETT ventilation
- Hospital acquired (HAP) - occurs > 48hrs post admission
Name some risk factors for pneumonia
- Ageing - very young or older people
- Altered conscious level (those in a coma, anesthetised)
- Altered flora secondary to antibiotic therapy
- Bed rest / prolonged immobility
- Chronic diseases (diabetes, asthma, emphysema)
- Immunosuppression
- Malnutrition
- Smoking (damages cilia)
- Tracheal intubation
- URTI (upper respiratory tract infection)
- Air pollution
- NG feeds (aspirate NG tube)
What is aspiration pneumonia?
,A pneumonia that occurs from abnormal entry of secretions or substances into the lower
airway. It usually follows aspiration of material from the mouth or stomach into the
trachea and subsequently the lungs.
Describe the four stages of pneumonia if antibiotics are NOT used
1. Congestion: First 24 hours the lung is becoming boggy, Vascular engorgement, Fluid
inside alveoli, Neutrophil inside alveoli and numerous bacteria. Signs: shortness of
breath, exertion, extreme fatigue, tachycardia
2. Red hepatisation: 2-3 days, Consistency of lung is like liver, red because of RBC,
Exudation Neutrophil debris bacteria and blood consistency pus forming and lung
harder than normal
3. Gray hepatisation: 2-3 day days after red hepatisation, consistency of liver but grey
because of exudate in lung, Disintegration of RBC and becomes greyish colour
4. Resolution: time depends on the person. Debris ingested and complete restoration of
lung, Gas exchange terms to normal
Name some signs and symptoms of pneumonia
Systemic: high fever, chills
Lungs: cough with sputum or phlegm, shortness of breath, pleuritic chest pain,
haemoptysis
Skin: clamminess, cyanotic
Muscular: fatigue, aches
Central: headaches, loss of appetite, mood swings, confusion
Vascular: low BPHeart: high HR
Gastric: nausea, vomitingJoints: pain
Name two ways to prevent pneumonia
Pneumococcal vaccine
Haemophilus influenzae (Hib) vaccine
How is pneumonia diagnosed and treated?
,History and physical examination
- Auscultate for adventitious/abnormal breath sounds-bubbling, wheezing, crackles
- Percuss for a dull sound
- Chest X-ray
- Sputum microscopy (Gram stain), culture & sensitivity
- FBC (fluid balance chart)
- Blood cultures
- Possibly bronchoscopy +/- washings/brushings
Treatment:
- Broad spectrum antibiotic cover - Penicillin + Cephalosporin
- Nutritional Therapy (3 L intake/day; 6300 kJ/day)
- Symptom Management
- Health Promotion
Name the three most common causes of airway compromise
Airway obstrcution
Hypoxaemia
Hypoventilation
Describe airway obstruction
Blockage of airway by patient's tongue - Supine position/ Extremely sleepy patient.
Complete airway obstruction = hypoxia and cardiac arrest
Partial obstruction = subtle and insidious in onset
- Laryngospasm
- Retained secretions
- Laryngeal oedema
Describe hypoxaemia
Hypoxemia - Low oxygen in the blood, commonly caused by Atelectasis (partial or
complete collapse of lung).
- PaO2 (ABG) <60mmHg severe hypoxaemia. (Normal 80-100mmHg)
- SpO2 (O2 Sats) < 95% hypoxaemia. (Normal - 95-100%)
, Ranges from agitation to somnolence, hypertension to hypotension, and tachycardia to
bradycardia
Why is pneumonia and atelectasis common post thoracic/abdominal surgery
Postoperative development of mucous plugs and decreased surfactant are related to
hypoventilation, recumbent position, ineffective coughing, and smoking. Also, immobile
patients
Describe pulmonary oedema - symptoms and treatment
An accumulation of fluid within the alveoli from an imbalance of hydrostatic and oncotic
fluid
- Can result from fluid overload, left ventricular failure, or prolonged airway obstruction,
sepsis, or aspiration
Signs: crackles, dyspnoea, haemoptysis
Treatment: O2, fluid restrict, diuretics
Describe symptoms and treatment of aspirating gastric contents
Aspiration of gastric contents potentially serious airway emergency
Symptoms: Bronchospasm, Atelectasis, Crackles, Alveolar haemorrhage, Respiratory
distress, O2 saturations
Can cause laryngospasm, infection, and pulmonary oedema
Management: Because of serious consequences PREVENTION is best treatment
- Patients at risk; obese, pregnant, hx hiatus hernia, GORD, trauma may be pre-
medicated with histamine-H2 receptor antagonist before induction of anaesthesia (e.g.
ranitidine) or an antacid (e.g. sodium citrate)
- If aspiration occurs requires O2 therapy, cardiac support, antibiotics
Describe bronchospasm - symptoms and treatment
Results from increase in bronchial smooth muscle tone with resultant closure of small
airways. Airway oedema develops, causing secretions to build up
Causes: A serious potential complication of ET intubation during GA. Suctioning,
allergic response. The patient can become apnoeic. More frequent in asthma COPD
