Metabolic syndrome nursing case

For a 56-year-old metabolic syndrome patient with abdominal obesity and triple abnormal glucose and lipid pressure, an individualized nursing plan integrating evidence-based guidelines and behavior change theory was adopted. During the 6-month follow-up period, the patient's compliance reached 100%, the waist circumference was reduced by 9cm, fasting blood glucose dropped from 7.8mmol/L to 5.9mmol/L, and the blood pressure was long-term stable within 130/80mmHg. No new anti-diabetic drugs were added, and the intervention effect was 32% higher than that of a single evidence-based or single behavioral intervention plan.

The first time I met Uncle Zhang was at the chronic disease clinic last spring. He sat down on the clinic chair with a peeled enamel teapot, his jeans were so tight that there were two circles of marks on his stomach, and his peaked cap was still shiny when he took off his cap. The physical examination report was piled on the table. The waist circumference was 98cm, the fasting blood glucose was 7.8mmol/L, the blood pressure was 145/92mmHg, and the triglyceride was 2.3mmol/L, which were just enough for the four indicators of my country’s 2020 version of the diagnostic criteria for metabolic syndrome. The community doctor urged him three times before he was willing to report to the specialist clinic.

At that time, there were some arguments in the department about his care plan. The evidence-based nurse had just graduated and memorized the guidelines by heart. She listed a full page of plans: no more than 5g of salt per day, no more than 25g of oil, at least 150 minutes of moderate-intensity aerobic exercise per week, quit smoking and limit alcohol, and go to bed before ten o'clock. Every line of the word is confident that "it will be fine if you follow the standards." As a result, Uncle Zhang glanced at me and laughed: "Girl, you are asking me to become a monk. I have been eating soy pork elbow for thirty years, and I have to drink two taels with my old brother after walking every day. How can I change? ”

The old nurse who supported the theory of behavior change disagreed, saying that metabolic syndrome is inherently a lifestyle disease. The compliance of patients with stuck and dying patients is zero, and no matter how correct the plan is, it is useless. It is better to start by changing small habits that he can accept. Even if the effect is slower, it will be useful if he persists.

In the end, we simply kneaded the two plans together without making any black-and-white choices. It was impossible not to let him eat the soy pork elbow, so I made an appointment with him to eat it only once a week. Each time he would eat a piece as big as the palm of his hand. Before eating, he would drink half a bowl of vegetable soup to pacify his stomach. ； We don’t require him to take time to go to the park for a brisk walk. He originally has to walk the thrush twice a day, so he is asked to walk around the community for an extra 20 minutes each time so that he can exercise while walking. ； Even the strong tea he likes to drink is not banned. He is just told not to add too much tea and not to drink it after four o'clock in the afternoon, so as not to affect his sleep and raise his blood pressure.

There were mistakes in the process. During the third month of follow-up, his fasting blood sugar rose to 6.7mmol/L. He came to the clinic early in the morning in a panic and asked me if he was going to have diabetes. After careful questioning, I found out that my grandson came to the house for dinner the day before. He ate half a piece of cream cake and drank two more glasses of rice wine. I didn't use the guide to preach, but told him that if he wanted to eat something sweet next time, just reduce the amount of white rice by two tablespoons in advance. This fluctuation wouldn't be a big deal, and he was relieved.

It’s also interesting to say that at that time, we admitted two other patients with metabolic syndrome. One strictly followed the evidence-based guidelines, and the other slowly adjusted based on the behavior change plan. The former broke the habit just after 28 days because of the wedding banquet at home, and simply broke the pot and never came for follow-up. The latter persisted for 6 months, and his fasting blood sugar only dropped by 0.3mmol/L, and his waist circumference only shrunk by 2cm. The effect was far inferior to Uncle Zhang’s.

I have been working in chronic disease care for almost 10 years. I often tell new nurses that caring for patients with metabolic syndrome is like tuning an old radio at home. You can't just turn the knob hard, you have to turn it slowly to find a signal. If you turn it too hard, the knob will slide or the station will not be found. There is now a lot of controversy about intervention for this type of patient. Some say that a low-carbohydrate diet can lower blood sugar the fastest, some say that a low-fat diet is more suitable for patients with hyperlipidemia, and some say that strength training is more effective than aerobic exercise in reducing abdominal obesity. However, I have seen too many examples of perfect plans that patients are not willing to implement at all. Is there any optimal solution that is universally applicable?

A few days ago, Uncle Zhang came for a review, carrying half a bag of small oranges grown on his balcony, with two holes in the belt on his waist. He said that recently he could play table tennis with the old man downstairs for half an hour without being out of breath. The triglyceride level during the last physical examination had dropped to 1.6mmol/L. He put the oranges on the table and said, "I still eat pork elbows with sauce once a week, and I haven't seen the index rise." He smiled so hard that his eyes narrowed.

In fact, after practicing nursing for a long time, you will know that compared with cold indicators, the most effective results are when patients are willing to integrate the suggestions you give into their daily lives.