0700 handoff. Mr. K, 78, has stage IV non-small-cell lung cancer and advanced COPD and has been on the inpatient hospice unit for five days for refractory dyspnea. His plan is comfort focused, and a DNR/DNI order is on file. His son has asked to be called if signs suggest that death may be near. Throughout this stay he has had pursed-lip breathing, clubbed fingernails, and respirations of 28/min, and his saturations have ranged from 84 to 88 percent. This morning his breathing is labored with a new Cheyne-Stokes pattern, and SpO2 is 86 percent on his usual 4 L/min. His BP is 96/58, compared with 112/70 yesterday, and his knees are mottled. He is arousable only to firm voice; he has received no lorazepam for two days. With a small sip of water he coughs and pockets fluid in his cheek. He intermittently grimaces and reaches into the air. New pooled upper-airway secretions are audible. Temperature is 37.2 C, ankle edema is unchanged at 1+, and his last bowel movement was two days ago; his abdomen is soft and nondistended, and a bladder scan shows 90 mL.
0700の申し送り。K氏（78歳）はステージIV非小細胞肺癌と進行性COPDを患っており、難治性呼吸困難のため入院ホスピス病棟に五日間入院しています。彼の計画は安楽に焦点を当てており、DNR/DNI指示が記録されています。息子は、死期が近いことを示唆する兆候があれば連絡するよう求めています。入院中ずっと、彼は口すぼめ呼吸、ばち指、呼吸数28回/分があり、酸素飽和度は84〜88%の範囲でした。今朝、彼の呼吸は新たなチェーン・ストークス呼吸パターンを伴い努力性で、通常の4L/分酸素投与下でSpO2は86%です。彼のBPは96/58で、昨日の112/70と比較して低下しており、膝はモットリングを呈しています。彼は強い声かけにのみ覚醒します。二日間ロラゼパムは投与されていません。少量の水を飲むと咳き込み、頬に水分をため込みます。彼は間欠的にしかめ面をして空中に手を伸ばします。新たな上気道分泌物の貯留が聴取されます。体温は37.2℃、足首の浮腫は1+で変化なし、最後の排便は二日前です。腹部は柔らかく膨隆しておらず、膀胱スキャンでは90mLを示しています。