The tell tell sign to me is engine misfire on cylinder # 3 (Passengers side, next to the last cylinder). I had the same issue... it was the classic 5.4L timing chain tensioner gasket blow out, which caused low oil pressure on the passengers side cylinder head... and therefore damage to the valve train. Removing the valve cover on the passengers side will confirm the rocker is either worn or completely misplaced, mine was worn, not flat and not misplaced. My camshaft lobe however, was definitely worn down. My Navigator needed the repair at 140k
I wound up replacing the passengers side cam all my lifters and rockers, timing assembly, water pump, oil pump, phasers and injectors.
I had to make up heater hoses from ends I acquired from the local parts store, Y pipe and heater hose.
Its a big job for sure, involving several weekends if you do it in-frame.
I concluded after doing the timing job the first time, that if I ever had to do it again, I would pull the engine to do the job, because you would have much better access. The job in-frame involves some contortion, reaching down from the top and up from the bottom and attempting to squeeze your hands into the limited rear cylinders, especially when installing the rockers.