Mrs. Liz Walker – 78 y/o caucasian widow - admitted to your acute care hospital with a diagnosis of right lower lobe pneumonia. Prior to admission she was living alone and has had osteoarthritis for 20 years - limiting her mobility. She is dependent on her neighbour for assistance and she does her own personal activities of daily living (bathing, dressing, etc.). She has been taking non-steroidal anti-inflammatory agents for pain associated with her osteoarthritis. The following information was documented in her health record six hours after admission:

Elevated temperature, breathing rapid and shallow, 43 kg, 160cm. She responds to verbal questioning but is lethargic and does not communicate her needs.  Over the past four days she has been increasingly fatigued, spending most of her time in bed. She is very weak and unable to change her position independently. Her intake has been limited to half a bowl of cereal twice a day and a piece of toast for lunch for the past four days. She has crackles over right lower lobe, coughing periodically, productive of yellow mucous. Continuous oxygen is administered via nasal cannula, continuous pulse oximetry monitoring. Skin is warm, moist and translucent with reduced skin turgor noted. Sacrum and hips are dark pink. Episodes of urinary incontinence for the past four days. Now is voiding concentrated urine and wets herself occasionally.