0750 - The client presents to the ED with reports of dyspnea, productive cough, and 'not feeling good.' Two days ago, the client saw his primary healthcare provider (PHCP) for a productive cough and dyspnea and was diagnosed with pneumonia. The client began an outpatient antibiotic, azithromycin. The client states he started feeling worse overnight. Triage vital signs - Oral temperature 101.1° F (38.4° C), P 104, RR 26, BP 152/86 mm Hg, pulse oximetry 87% on room air. The client's medical history is depression, transient ischemic attack (TIA), and hyperlipidemia. The client's home medications include rivaroxaban, lovastatin, bupropion, and fluoxetine.

0800 - Report received from triage nurse. Upon assessment, the client's breathing is labored, with tachypnea. The lung sounds are diminished bilaterally—skin slightly cool to touch and pale pink in tone, radial pulse +1 and regular. The jugular vein was flattened. S1/S2 heart tones. Capillary refill is 5 seconds. The client is alert and oriented to person, place, and time. Nasal cannula oxygen at 4 L/minute started. Pulse oximetry 88% after nasal cannula oxygen was applied.