Case Challenge Do you listen to nurse or resident?

You the ICU doctor on call and the nurse says she's worried but your junior resident says the patient's fine. This patient's a sixty-one year old female who presents to the ER with three days of progressive shortness of breath. She has a history of hypertension, diabetes, hyperlipidemia, and some autoimmune condition which she's currently being worked up as an outpatient. Notably she did have a recent company acquired pneumonia which she was treated with about two to three weeks ago with cyprofloxacin about two to three weeks ago. Daughter tells you that her mother's been getting weak all week long and she keeps choking on her food and has been unable to finish her dinner. And she also notes that her voice now is starting to sound different in the past twenty-four hours. When you go see her she's not in acute distress. She looks actually fine. She's able to speak a few sentences. Her heart rate's a hundred and eighteen. Blood pressure's a bit high, 150s over 88. Respiratory rate says in the twenties, sats are 97% on two liters nasal. On exam her lungs are clear. There's no wheezing or crackles. There's no perfedema. She doesn't have any other chest pain. On head and neck exam she does have a soft voice and she is able to lift her head off the bed. When you ask her to count out loud in one breath she's able to count to twelve. You're doing the exam the daughter mentions oh she usually gets worse by the end of the day and sometimes at the end of the night she has double vision. Blood work shows a WBC of thirteen, sodium 136, potassium 3.8, creatinine 1.1. VBG: pH 7.31 / CO2 58. CXR: low lung volumes, no clear infiltrate. Blood work shows a WBC of thirteen, sodium 136, potassium's normal, creatinine's a bit up at 1.1. VBG shows a pH of 7.38 and a CO2 of 58. And chest X-ray shows basically low lung volumes, no acute infiltrates. In the ER she got some antibiotics after acme some nebulizers and a liter IV fluids. Two hours later when you go and reassess the patient, she's still sitting around 95, 98% but she looks a little bit more fatigued and her voice is barely audible. RT tells you that her NIF is minus twenty-four and her FVC is about 1.1 liters, but she also mentions that the patient gave inconsistent effort. The nurse says I'm really worried about this patient because she tried to drink again and she was choking. The junior resident saw the patient and said vitally everything looks fine. She's sitting fine. There's no need for intervention or to bring to the ICU. So what's the diagnosis and the treatment for this patient and what's the right intervention? Do we listen to the nurse or do we listen to the resident?