Niа Pаtel, аge 34, has systemic lupus erythematоsus and a dоcumented latex allergy. Befоre beginning treatment that may suppress immune function, she receives a tuberculin skin test. At 48 hours, the test site has palpable induration. Several months later, Nia is admitted with fever, productive cough, dyspnea, and bilateral pulmonary infiltrates consistent with bacterial pneumonia. Her condition worsens despite initial treatment. Assessment findings include: Heart rate: 122/min Respiratory rate: 32/min Blood pressure: 82/48 mm Hg Oxygen saturation: 84% despite supplemental oxygen Crackles in both lungs Increasing confusion Urine output: 15 mL/hr Laboratory findings include: Sodium: 128 mEq/L Potassium: 5.6 mEq/L Lactate: elevated pH: 7.29 PaCO₂: 31 mm Hg HCO₃⁻: 15 mEq/L Nia is diagnosed with septic shock and acute respiratory distress syndrome.