Pathophysiology Interrelatedness Case Study: Delusion

Pathophysiology Interrelatedness Case Study: Delusion and Medication of Cardiac Conditions

The scenario described in the case study is centered on the frequently problematic intercession between psychological illness and the need for treatment of regular bodily health concerns. In the case of the subject here, the presence of delusional thinking has confounded regular treatment of high blood pressure and placed the subject in direct danger of ailment or fatality due to myocardial infarction. From a nursing perspective, the primary goal in the scenario is to return the patient to a state of compliance with respect to medication of the hypertension as this is the only conceivable outcome which would reduce the health threat currently facing the patient.

One distinctly complicating factor of the particular scenario is the fact that delusional thinking demands a careful interpretation. The processes which enter into delusional thinking are not always immediately clear. So is this reinforced by the definition drawn from the source by Franklin (1997), which reports that "the DSM-IV defines delusions as "erroneous beliefs that usually involve a misinterpretation of perceptions or experiences." Delusions may be bizarre, that is, 'clearly implausible, not understandable, and not derived from ordinary life experiences' or nonbizarre, that is, involving 'situations that can conceivably occur in real life.' One problem with the DSM-IV definition is that it is not always possible to empirically determine whether the content of a belief is false. Thus, delusions can be placed on a continuum reflecting the availability of evidence that would confirm or disconfirm them." (Franklin, 1)

In the case of the subject of our discussion, this is especially problematic because the patient has selectively determine that it was appropriate to cease taking her blood pressure medication. The decision to suddenly stop t aking one's medication can have damaging and potentially even fatal results. However, it is also directly within one's rights to make the decision that medicating a condition is either an undesirable or ineffective approach. This means that where the patient is concerned, one could make the argument absent the condition of dementia that there are notable positive and negative effects which may be associated with the use of antihypertensives, and that a patient could make the independent decision to withdraw from regular usage.

Indeed, according to some evidence, the long-term usage of diuretic antihypertensives to reduce the presence of excess salts in the body can lead to liver or kidney damage in some cases. (Wikipedia, 1) It has also been connected to kyperkalemia in some instances, which can impact cardiac function as well. (Wikipedia, 1) However, given that the subject of this discussion also suffers from an elevated risk of myocardial infarction, the danger of cardiac arrest or general heart failure is of greater concern than the presence of side effects from the medication. While there is no direct indication of exactly what information or perception caused the patient to make the decision to withdraw from medication, it is clear that the patient's delusional state has prevented her from properly weighing the implications of information, which would instead demonstrate to her the immediacy of the danger of infarction because of sudden withdrawal from a medication regimen.

According to the source provided by Klatt, the risk of myocardial infarction is increased by the implications of hypertension, indicating that withdraw from one's medication as in the case of the patient in our case study can lead to the pairing of "increased intraventricular pressure and myocardial contraction." (Klatt, 1) These, in turn, can lead to the type of constricted bloodflow that is likely to invoke heart failure. Therefore, in the case study at hand, the patient is categorically at a high risk for fatality relative to her condition when on regular blood pressure medication. Also, based on Franklin's connection of delusion to heightened anxiety, and on the connection drawn in the discussion on antihypertensive drugs between anxiety and high blood pressure, it seems clear that the erratic and emotionally unstable nature of the delusional state will provoke an added strain on the cardiovascular system.