Patient Presentation: What do you think about this case?

A five foot, seventy nine pound 92 year old female with a past medical history of osteoporoesis, osteoarthritis, and congestive heart failure, presents in the emergency department with shortness of breath, tachycardia (fast heart rate), tachypnea (fast breathing rate), and vague abdominal pain following a two week stay in a rehab nursing care. The patient says the pain started "a few days ago" but she can not quantitate the pain. She denies chest pain, dizziness, diarrhea, nausea, vomiting, or any other significant symptoms. The patient initially presented two and a half weeks prior with a sprained ankle and was thereafter discharged to the nursing home to recover before returning home. The patient lives alone and has two home attendants that spend the days with her. She does spend the nights alone, which is the reason for sending her to the rehab facility. NOTE: The patient is alert and oriented to time, person and place. She signed a DO NOT RESUSCITATE (DNR) and a DO NOT INTUBATE (DNI) on admission.
Social, Family, and Past History are non contributory. According to the patient's daughters and her private physician, she has been ill for a few days but the nursing facility did not notify the physician until the evening prior to admission.
On physical exam, the patient is an underweight, ambulatory, elderly female, with shortness of breath, tachycardia, hypotension, and generalized discomfort. Heart rate is 118, BP is 96/48, Oxygen saturation is 94%, temperature not taken, Respiratory rate:35. Total bilirubin is 4.9 (high), AST: 101 (high), LDH: 328 (high), WBC:15.8 (high) Bands: 20% (20x normal)....Overall the labs reveal through WBC and Bands that there is a severe infection present. The other values demonstrate that her liver enzymes are elevated and the vitals (BP, HR...) demonstrate the likelihood of sepsis.
Assessment: The patient is suspected to have an ascending cholangitis or possibly an acute abdomen because the lungs are clear bilaterally and urinalysis returned normal. The plan for this patient is to administer labetalol to decrease the heart rate and thus increase diastolic filling time of the heart, give levaquin, flagyl, and vancomycin to cover gram +, gram -, and anaerobes that could be causing the infection. The patient will be followed by her private physician as well as infectious disease.

This is a real patient. What do you think?