Sally Nelson was admitted to hospice one week ago. She was diagnosed with acute renal failure 10 days ago secondary to chemotherapy. She has decided to discontinue chemotherapy and refused dialysis after a few treatments based on information that her pancreatic cancer was spreading despite aggressive treatment. She is receiving oral Morphine Sulfate, Lorazepam (Ativan) and oxygen. Her oral intake has been minimal and she sleeps much of the time. Prescribed medications have been effective in controlling her symptoms. Urine output over the last 24 hours has been less than 150 mL. She has become very dyspneic over the last three to four hours and has audible respirations.