Question: 82 Year Old Female, DNR, Admitted Two Days Ago In The ER Department With Endocarditis, Currently Awaiting An Inpatient Bed. She Is On Day 2 Of Antibiotics, O2 Saturations >92% On 2L NP, Up Walking In The Hall On The Day Shift. At The Beginning Of Your Night Shift You Notice She Is Weak, Using Accessory Muscles To Breathe, O2 Sats Are 88% On 2L, And …

82 year old female, DNR, admitted two days ago in the ERdepartment with Endocarditis, currently awaiting an inpatientbed.   She is on day 2 of antibiotics, O2 saturations>92% on 2L NP, up walking in the hall on the dayshift.    At the beginning of your night shift younotice she is weak, using accessory muscles to breathe, O2 sats are88% on 2L, and having muscle pain.

Past Medical History:

1. NIDDM
2. Hyperlipidemia
3. Peptic ulcer disease
4. CHF with EF of 40%
5. Asthma/COPD
6. HTN

Social History:

Lives with husband, dwelling is asmall bungalow, fully functionally with ADL’s, active within hercommunity, volunteer for the food bank.

Medications:

• Metformin 500mg PO BID
• Ramipril 5mg PO daily
• Lipitor 40mg PO daily
• Pantoloc 40mg BID
• Norvasc 10mg PO daily
• Ventolin 2 puffs PRN (with asthma/COPD symptoms)
• Coumadin 1mg PO daily

Initial Parameters:

Patient:No response except to painful stimuli,current GCS 9

Vitals: BP 178/92, HR 74, RR 31, O2 sat 88% on2L Temp 36.8 C

Eyes: Closed, pupils reactive

Lungs: Inspiratory/Expiratory crackles/wheezes (audible withouta stethoscope)

Heart Sounds: Normal S1, S2, systolic murmur

Heart Rhythm: Paced Rhythm at 74

Abdomen: Flat, soft, non-tender

Labs: Bloodwork   (WBC 16.2, Fasting Glucose- 7.7, INR1.6)

CXR: Fluid overload (Pulmonary Edema)

ECG: Ventricular Paced Rhythm (70’s) with an ICD

which are the four questions which i can ask to patient rightnow