Mrs. j. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. she has been smoking two packs of cigarettes a day for 40 years and has refused to quit. three days ago, she had an onset of flu with fever, pharyngitis, and malaise. she has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. today, she has been admitted to the hospital icu with acute decompensated heart failure.