[Expert Solution]: Consider the Patient Situation Regina Marias…

Consider the Patient Situation Regina Marias 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 labor and financial instability. Over the years, Regina 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 Maria had become more forgetful, occasionally struggling to recall recent events or conversations. Collect cues Regina 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, experiencing difficulty concentrating. Regina 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 back ache • 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: 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 Maria, 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.1. Consider Regina's history, and all assessment data. In your answer, i) describe the likely causes of her liver dysfunction. ii) describe the effect of excessive alcohol consumption on liver architecture. In your answer, indicate in brackets ( ) the data from the case scenario that support your arguments. 2. Provide the rationale for the Spironolactone therapy by describing: the mechanism of action, the aim of therapy for Regina, one associated risk of the medication, and identifying guidelines for this therapy.