PW is an 85-year-old male transported to the ED via private ambulance from an area nursing home because of sudden onset shortness of breath and fever. He has a long history of COPD and dementia of the Alzheimer type. Physical examination reveals an elderly male who appears thin and cachectic. Respiratory rate 32 and slightly labored, temperature 101.2o F, SpO2 (on room air) 85%. He has a frequent loose nonproductive cough. Skin is dry to the touch with decreased turgor.