Metabolic syndrome nursing case

For a 42-year-old Internet practitioner with abdominal obesity and metabolic syndrome, we abandoned the "one-size-fits-all" standardized care plan and adjusted the intervention details based on his work and life scenarios. No new anti-diabetic or lipid-lowering drugs were added within 3 months. Only through lifestyle intervention, he achieved a weight loss of 12.1kg and a waist circumference reduction of 9cm. Fasting blood sugar dropped from 6.8mmol/L to 5.3mmol/L, resting blood pressure dropped from 146/93mmHg to 128/82mmHg, and triglycerides dropped from 3.21mmol/L to 1.42mmol/L. The intervention compliance rate was nearly doubled compared with traditional standardized care. 】

When I met Lao Zhang for the first time last winter, he rushed in with a crumpled physical examination report in his hands, with half-dried coffee stains on his collar. The first thing he said when he sat down was, "I don't have time to be hospitalized, and I don't have time to cook and exercise by myself. Can you just prescribe some medicine?" ”

He is the head of operations for a leading Internet company. It is normal for him to work overtime until 11 o'clock every day. He relies on takeout every day to eat. In his free time, he meets friends to drink beer and eat barbecue. He is 175cm tall and weighs 89kg, with a waist circumference of 97cm. The physical examination just met the four diagnostic criteria for metabolic syndrome. When he got the report, he was so scared that he had insomnia for three days in a row.

There were some minor disagreements during the discussion of the case. Sister Li, who has worked in chronic disease care for 20 years, insists on following the guidelines: no more than 5g of salt and 25g of oil per day, 150 minutes of moderate-intensity exercise per week, smoking cessation and limiting alcohol. If you meet the target, you will definitely be able to achieve it. Xiao Zhou, who just graduated, retorted directly: "Sister, you see he doesn't even have time to have breakfast, so you ask him to get up half an hour early every day to make low-fat meals? When he was first given such high demands, he had to give up after only three days. ”

To be honest, I wasn't sure at that time. Of the dozen or so young patients I had managed before who followed the standardized plan, less than one-third managed to last for three months. In the end, we simply gave in. The guideline was the bottom line, but how to implement it had to follow the rhythm of his life.

He was not asked to directly replace the heavy takeout with boiled vegetables, so he made a note every time when ordering, "Leave half the salt and sauce." When the takeout was delivered, he poured half a cup of warm water and ran the vegetables through the water before eating. A third of the oil could be filtered out, so the taste was not much different, and he did not have to open the fire himself. He used to order a cup of iced Americano with 3 pumps of syrup every afternoon. We didn't force him to drink black coffee directly. We first changed it to add 1 pump. After drinking it for two weeks, he found it too sweet, so he offered to change it to one without sugar. Now he is obsessed with making hand-brewed coffee at home on weekends.

The exercise program did not assign him tasks such as running five kilometers or going to the gym. He was asked to stand up to get a drink of water every 40 minutes, walk around his work station for two minutes, and get off the subway two stops early after get off work and walk for 15 minutes. He had already made an appointment with a friend to play badminton on Saturday, so he was asked to play for an extra half hour without taking extra time to exercise. He hardly felt any burden.

At the end of the first month he almost gave up. I stayed up for 3 days in a row to catch up on the Double 12 promotion, and ate late-night barbecue 4 times with the team. I gained 2.1kg in weight. When I came for a follow-up check-up, I couldn't even lift my head. I said, "I knew I couldn't hold on, so I might as well prescribe medicine." I looked through his food records and didn't tell him anything. If I were to stay up for three days, I'd like to eat something heavy to slow down. I'm not a robot, so there's no need to be so harsh on myself. Just tell him to walk 10 minutes more every day for the next week and slowly burn off the extra calories without feeling guilty.

His eyes lit up at that time, and he said that when he went to another hospital before, the doctor immediately scolded him for not having self-discipline when he heard that he ate barbecue, and he didn't want to see him again.

Interestingly, we later reviewed the data of metabolic syndrome patients in the department in the past two years. For those who were cared for according to standardized guidelines, the compliance rate for the three-month intervention was only 32%. However, for young patients like Lao Zhang who had scene adaptation, the compliance rate could reach 67%. It’s not that the traditional guidelines are wrong. For elderly patients who are retired at home and have enough time to arrange diet and exercise, the compliance with standardized plans is actually higher. It’s just that for office workers with completely irregular life rhythms, “a stupid method that can be adhered to” is much more useful than a “perfect standard plan”.

I have been working as a chronic disease nurse for almost 8 years. I used to think that "patients not following medical advice" was all the patient's problem. Later, I slowly figured out that we cannot ask a person who works hard every day to suddenly overturn his life and start over, living according to a healthy template. Just like teaching a person who can't swim to get into the water, you can't just throw the person into a 10-meter-deep pool and say, "You won't choke if you follow the movements." You have to let him splash around in the shallow water for a while and slowly get the feeling.

A few days ago, Lao Zhang sent me a WeChat message, saying that all the indicators found in the company's physical examination were normal, and that he had invited three colleagues from the same department who had beer bellies to come to our outpatient clinic for intervention. At the end, he added, "Now I drink coffee without sugar and it tastes pretty good."

In fact, the most satisfying thing about nursing is never to lower any indicator to the normal range. It is to make patients feel that getting sick is not something that the sky will fall on. There is no need to force yourself to become a "perfect patient" all at once. If you slowly change your habits, the results will come naturally.