Metabolic syndrome nursing issues and nursing measures

The three core issues in the current clinical care of metabolic syndrome are poor adaptability of multi-metabolic abnormality linkage intervention, insufficient long-term patient compliance, and difficulty in implementing early screening of complications.； The corresponding core nursing direction is "individualized hierarchical intervention, fine-tuning of behavior instead of rigid requirements, and dynamic full-cycle follow-up." There is no universal standardized nursing plan, and measures adapted to patients' life scenarios are the most efficient.

Last month, I met a 42-year-old courier, Brother Zhang, at the general practitioner chronic disease follow-up post. He is 172cm tall, weighs 180kg, and has a waist circumference of 96cm. His blood pressure was found to be 148/96mmHg, triglyceride 3.2mmol/L, and fasting blood sugar 6.7mmol/L, which is typical of metabolic syndrome. Before, he searched for a care plan on the Internet. He stopped eating carbohydrates and ran 5 kilometers every day. He persisted for three days before fainting on the way to deliver the package. He was sent to the hospital to check for hypoglycemia, but he no longer dared to make any intervention.

This is actually the most common problem in metabolic syndrome care: patients’ cognitive biases are too extreme. Or they think "it's just fat, don't worry about it if it doesn't hurt", and rely on their youth to carry on. By the time complications such as myocardial infarction, diabetic nephropathy, etc. occur, it's already too late. ； Either when you see a few abnormal indicators, you feel that you are about to get seriously ill, and you are overly anxious, and you are prone to resort to extreme intervention methods. The academic community has always had different views on this point. Traditional health education advocates explaining the dangers of the disease thoroughly and raising patients' attention. However, in recent years, more and more clinical studies have found that over-emphasis on complications will actually lead to a "break the pot" mentality in patients. This is especially true for young people who are under high work pressure. Once they hear that they need to avoid food and exercise regularly throughout their lives, they directly give up intervention.

In addition to cognitive problems, the disease characteristics of metabolic syndrome itself also add a lot of trouble to nursing care. It is not a single disease, but a combination of abdominal obesity, hypertension, hyperglycemia, and blood lipid disorders. It is easy to focus on one and lose sight of the other during care. The ketogenic diet, which was very popular in the nutrition department in the past two years, can indeed quickly reduce body fat and improve insulin resistance. However, among the cases tracked by the cardiology department, there are many patients with coronary plaques. After ketosis, low-density lipoproteins soared, which actually increased the risk of myocardial infarction. The two departments had held a special discussion before, but in the end no unified conclusion was reached. The plan could only be adjusted according to the specific indicators of the patients, and there was no way to directly apply unified standards. The difficulty of follow-up is also an old problem. Many patients stopped follow-up as soon as their indicators returned to normal. After half a month of eating and drinking, the indicators immediately rebounded, and the previous intervention was all in vain.

In response to these problems, we have been slowly adjusting our nursing ideas in recent years and no longer have one-size-fits-all standardized requirements. Take Brother Zhang as an example. He runs outside every day and has no conditions to cook for himself. We didn’t send him a leaflet that said “daily intake of 200g of staple food and 500g of vegetables” was useless. I gave him three small requests that could be implemented directly: spend an extra dollar every time when ordering food and add a side of boiled vegetables, replace half of the white rice with multi-grain rice, replace full sugar with sugar-free when drinking iced drinks, and climb two more floors when delivering packages every day. Don't worry, Brother Zhang didn't feel any resistance at all when carrying out these small and effortless requirements. After three months of persistence, he lost 12 pounds, his blood pressure dropped to 135/85mmHg, and his fasting blood sugar returned to 5.8mmol/L. It was much more effective than letting him eat boiled vegetables every time before.

We have also adjusted the requirements for monitoring. Previously, patients were asked to measure blood pressure and blood sugar every day, but most people found it troublesome after less than a week. Our current advice to patients is to measure their waist circumference on an empty stomach (2cm above the navel, no more than 90cm for men and 85cm for women) one morning a week, and measure fasting blood sugar and blood pressure every two weeks. Compliance has been directly improved by more than 60%. Oh, by the way, many patients now ask whether the monitoring data from smart watches can be used. This is also a new controversial point in nursing in recent years: some people think that smart devices can increase the frequency of monitoring and keep track of changes in indicators at any time. ； Some people think that inaccurate data will mislead patients. We generally recommend a compromise: it can be used as a daily reference, but you should go to a community hospital for venous blood calibration every 1-2 months, and do not rely entirely on the values ​​​​of smart devices to adjust medication.

I have been working in chronic disease care for almost 7 years, and I have seen too many patients who shouted "I can definitely persist" at the beginning but gave up halfway. I have also seen many patients who originally thought they could not change, but finally slowly adjusted their indicators to normal. The one who impressed me the most was a 62-year-old aunt who wanted to eat braised pork all the time, but her children refused to listen. We later told her that she didn’t have to quit completely. She just had to remove the fat every time she ate. She only had to eat it twice a week. After dinner, she would go downstairs to dance in the square for half an hour. She felt that this request was not difficult, so she agreed. Now she has persisted for almost a year, and her blood lipids have not only become normal, but she has also lost 8 pounds. Everyone she meets says that our method works. We have also set up a follow-up group to provide daily tips every week, such as which sugar-free drinks are better in summer and how to do exercises that can be completed in 10 minutes at home in winter. Patients can also consult privately if they have questions, which is much better than coming to the hospital for a review every six months.

In fact, the care of metabolic syndrome is difficult to say and easy to say. The difficulty is that there is no standard answer that can be applied to everyone. After all, everyone’s living habits, work rhythm, and physical foundation are different.； The simple thing is that as long as you find the right small incision that the patient can accept and slowly adjust it, most people can control the index. After all, nursing is never about presenting problems to patients, but about helping them find a healthy lifestyle that suits them.