Mrs. J is a 63-year-old woman admitted to the ICU for acute decompensated heart failure and exacerbated COPD. She has a history of hypertension, heart failure, and COPD despite smoking two packs a day for 40 years. She presents with fever, productive cough, nausea, malaise and inability to perform daily activities or walk without assistance. Her vital signs show tachycardia, tachypnea, low blood pressure and oxygen saturation. She is started on IV diuretics, ACE inhibitor, beta blocker, opioids, bronchodilators, steroids and oxygen to control her symptoms.