Metabolic syndrome nursing issues and nursing measures

[Core conclusions first] In current clinical and community chronic disease care scenarios, the three most prominent nursing problems of metabolic syndrome are concentrated in three dimensions: insufficient long-term compliance of patients, missed screening for hidden complications, and poor adaptability of standardized intervention plans.； The corresponding core nursing logic is not to force patients to completely overturn their original living habits, but to adopt the idea of ​​"minimum adjustment first, dynamic monitoring and follow-up, and family participation" to control indicators and delay the occurrence and development of complications without significantly reducing the quality of life.

Last week, I met a 42-year-old building materials boss at a community chronic disease follow-up point. He is 172cm tall, weighs almost 180kg, has an abdominal circumference of 9cm, and his blood pressure, fasting blood sugar, and triglycerides are all at the critical line, which is typical of metabolic syndrome. He flipped through two pages of the diet and exercise guide he got at the hospital before throwing it away, saying, "I have to drink and eat late-night snacks with my clients every day. If you ask me to eat boiled vegetables and walk 10,000 steps, I can't do it."

This is actually the most common first nursing pain point: poor patient compliance. Ten years ago, the mainstream view in the industry was to "strictly implement a standardized intervention plan". Calculate 1,800 calories per day for patients, accounting for 50% carbohydrates, 20% protein, and 30% fat. The requirements are accurate to grams. Exercise must be continuous for 30 minutes a day at moderate intensity. Failure to do so means that the patient is "not self-disciplined." However, in recent years, the behavioral medicine-oriented chronic disease care school does not agree with this idea at all. Instead, it believes that "the plan that patients can adhere to is the effective plan", and there is absolutely no need to engage in "shock transformation". Just like the building materials boss I mentioned earlier, I didn't ask him to quit drinking. I only asked him to replace high-alcohol liquor with low-alcohol liquor every time he socializes, and reduce the amount of alcohol consumed by 1/3. When eating vegetables, take two bites of green leafy vegetables before eating meat. He doesn't need to walk 10,000 steps after meals every day, just walk around the community for 10 minutes. I came for a follow-up visit last month. He has lost 4 pounds and his blood pressure has stabilized at around 130/80. He said, "There is no pressure and he can do this."

Of course, this does not mean that the traditional strict plan is useless. I have met a patient who works as an accountant before. He is very careful in his work and has time to prepare meals. He followed the recipe with precise calories and he followed it very well. His blood lipids became normal in 3 months. Therefore, there is no right or wrong between the two plans. It just depends on whether they are suitable for the patient's life rhythm.

Speaking of which, we have to mention the second nursing issue that is easily overlooked: delayed early warning of complications. Many people think that metabolic syndrome means "get fatter, have high blood pressure, and don't worry about it if you don't feel any discomfort." But in fact, its target organ damage is caused quietly. The year before last, I had taken care of a 62-year-old aunt who had been diagnosed with metabolic syndrome for 3 years. Every follow-up visit she would only take her blood pressure, saying, "My blood sugar and blood lipids were normal last time, so there is no need to waste money." Later, I brought her a urine microalbumin test strip every time I went for a follow-up visit, and asked her to take a morning urine test at home. After 3 months of testing, a weak positive was found, and she was transferred to the nephrology department for early-stage diabetic nephropathy. Because she was discovered early, it was reversed after half a year of intervention. Currently, there are two different operating ideas in the industry for complication screening: Specialist care in tertiary hospitals generally requires patients to undergo a full set of biochemistry, urine microalbumin, electrocardiogram, and fundus examination every three months. It is highly sensitive and can detect very early problems, but the cost is relatively high and the time cost requirements are also high. ； Community care now recommends a combination of "simple screening at home + a full set of annual physical examinations". You usually measure blood pressure, blood sugar, and urine test strips at home, and go to the hospital for a comprehensive examination every year. It is more cost-effective and easier to adhere to. Ordinary families can choose according to their own circumstances.

Another problem that many people have not noticed is that the individualized adaptability of the nursing plan is too low. When searching for metabolic syndrome care on the Internet, all the words are "walk 10,000 steps a day", "eat no refined sugar", "less oil and less salt", without considering individual differences at all. Just like a while ago, there was a 70-year-old man with degenerative knee disease that hurt after walking 2,000 steps. The previous nurse asked him to walk 10,000 steps a day. After walking for half a month, his knees hurt so much that he couldn't go downstairs. The index did not improve, but new problems appeared. I later changed the plan for him. He didn’t need to walk. He sat at home and lifted a 1L mineral water bottle every day to practice his upper limbs. When watching TV series, he stepped on the elliptical machine for 20 minutes, which was enough for 30 minutes of activity. In two months, he lost 5 pounds and his triglycerides also dropped a lot.

To be honest, I have been doing chronic disease care for almost 8 years, and my deepest feeling is that there is no "standard answer" to care for metabolic syndrome. It is like tailoring clothes. No matter how good the one-size-fits-all style is, the effect will be different on different people. There is no need to force yourself to compare with others. People can control their sugar quickly. If you follow their recipes, you might end up starving and suffering from hypoglycemia, which is not worth the loss.

Oh, by the way, here’s another little experience: when doing nursing care, it’s best to involve the whole family. There was a mother who had metabolic syndrome and had to control sugar, but her child ate cakes and milk tea every day, and she couldn't help it. Later, I asked her husband to accompany her to control sugar. The family did not buy high-sugar snacks, and the whole family put half a spoon less oil when cooking. Not only did she control her own indicators well, but her husband's previously high uric acid also dropped, killing two birds with one stone.

In the end, there is nothing too mysterious to conclude. Metabolic syndrome is a chronic disease bound to bad living habits. The essence of nursing is not to be a "supervisor" every day to control what the patient cannot eat or touch. It is nothing more than to help everyone find the most comfortable rhythm and adjust slowly without forcing yourself to change all of a sudden. Walking steadily is much more important than walking fast.