[Expert Solution]: your explanation on how decreased albumin…

your explanation on how decreased albumin levels impact filtration pressures, ultimately causing ascites and peripheral oedema. Tracy Brown is in her late 50s. She has worked hard her entire life, immigrating to Australia in her early 20s to seek a better future. Despite her efforts, life has been challenging, marked by long hours of physical labour and financial instability. Over the years, Tracy developed a habit of coping with her stress through heavy drinking, a habit she’s found hard to break. She has no history of illicit drugs use but has been a heavy smoker for over 30 years. Her access to healthcare has been limited due to her financial situation and lack of insurance. Recently, after persistent urging from her daughter, especially after her daughter observed vomit with blood stains, she visited a local community health centre that offers free medical services. Her daughter also observed that Tracy had become more forgetful, occasionally struggling to recall recent events or conversations. Collect Cues. Tracy reports to the healthcare provider that she has been experiencing a persistent, dull pain in her abdomen and has noticed her skin and eyes turning yellow. She mentions that her appetite has decreased significantly, and she has lost weight without trying. She also reports swelling in her legs that seems to get worse as the day goes on. She reported feeling unusually confused and disoriented, particularly in the late afternoon and evening, having trouble concentrating. Tracy has several tattoos, which she got at various points in her life. She reported that she had received blood transfusions following a major surgery in her uterus two decades ago in her home country. Vital signs: • Respiration rate: 24 breaths per minute • SpO2: 96% (on room air) • Blood pressure: 100/70 mmHg (MAP 80 mmHg) • HR: 105 bpm • Temp: 36.9oC General Assessment: • Jaundice noticeable in sclera. • Petechiae and bruising evident on arms and legs. • Oedema is noted in both legs, worse in the ankles. Pain Assessment: • P persistent, nothing really makes it worse, or better • Q dull, aching • R abdomen, occasionally experiences a backache • S 5 – 6 /10 • T consistent, cannot identify how long she has been feeling the pain Abdominal Assessment: • Abdominal distension • Abdomen protuberant and tight, Caput medusae evident • Non-palpable liver margin and an enlarged spleen • A positive fluid wave test Respiratory Assessment: Breathing – some minor accessory muscle use noted , but no crackles or wheezes are heard upon auscultation. Bloods: Results Maria Reference range RBC 3 x 10/L 3.8-5.8 x 10/L WBC 2.8 x 10/L 3.5 -11 x 10/L Platelets 75 x 10/L 150-450 x 10/L Hb 95g/L 115-165g/L Haematocrit 35% 37-47% Total Protein 48g/L 60-80g/L Serum Albumin 23g/L 33-48g/L Total Bilirubin 38umol/L 0-20 umol/L Serum Sodium 122mEq/L 135-145mEq/L Serum Potassium 4.5mmol/L 3.5-5.0 mmol/L Blood Urea Nitrogen 9.1mmol/L 3-8 mmol/L Creatinine 115umol/L 45-90 umol/L Liver enzymes(ALT,Phosphatase) All elevated Hepatitis +ve for C RNA INR 1.8 Serum ammonia 110um/dL 35-65um/dL Further investigations suggested for definitive diagnosis of Cirrhosis: Abdominal Ultrasound First-line imaging to assess liver texture, size, and presence of ascites or splenomegaly. Doppler studies can evaluate portal hypertension. Liver Biopsy Endoscopic investigation of oesophagus. Interventions: The healthcare team suggests the following care plan for Tracy, which is discussed with her and her family. It is acknowledged that some recommendations may be challenging due to her financial situation and lifestyle habits. • Lifestyle Complete abstinence from alcohol • Diet A low-sodium diet (<2.5 g/day) and a high-protein/high-energy diet • Supplements Vitamin and mineral supplementation, especially vitamins A, B complex, D, E, and zinc, should be initiated. • Medications Spironolactone (25 mg daily), and lactulose (30 ml 3-4 times daily) • Monitoring Regular follow-up appointments at the community health centre are for ongoing evaluation and support.