Soru

A 74-year-old male farmer is brought to the emergency department by his wife due to a 3-day history of progressively worsening shortness of breath, increased cough frequency, and a change in his sputum from clear to thick yellowish-green. He has a 45-pack-year smoking history and uses an albuterol inhaler as needed. Upon arrival, his temperature is $37.7^\circ\text{C}$ ($99.9^\circ\text{F}$), blood pressure is $145/88\text{ mmHg}$, pulse is $114/\text{min}$, and respiratory rate is $26/\text{min}$. Pulse oximetry shows an oxygen saturation of $85\%$ on room air. Physical examination reveals an anxious, mildly somnolent patient who is easily arousable and follows commands. He is using accessory muscles of respiration. Auscultation demonstrates globally diminished breath sounds with a prolonged expiratory phase and diffuse expiratory wheezing. Jugular venous pressure is normal, and there is no lower extremity edema. An arterial blood gas drawn on room air reveals:

Which of the following are appropriate initial management steps for this patient? (Select all that apply)