A 76-year-old woman with a history of progressive weight loss and fatigue is admitted to the hospital after colonoscopy showed complete obstruction of the sigmoid colon. Biopsy of the mass confirmed a diagnosis of ovarian adenocarcinoma, and CT scan indicated metastases to the liver. On admission, she appears frail and cachectic but is awake, alert, and oriented. BMI is 19 kg/m2. Her temperature is 37.2°C (99°F), pulse is 68/min and regular, respirations are 16/min, and blood pressure is 125/70 mm Hg. She has marked muscle atrophy and weakness and is unable to ambulate. The patient undergoes surgical resection of the mass followed by a diverting colostomy. On the third postoperative day, she develops a cough and fever. A chest radiograph confirms right upper lobe pneumonia. Intravenous (IV) antibiotics are started.
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