What are the nursing issues for metabolic syndrome?

First, the collaborative management and control of multiple metabolic indicators is easy to focus on one thing at the expense of the other. Second, patients' self-management willingness and mobility generally cannot keep up with the requirements. The 42-year-old private company owner I just picked up last month is a typical example. When he came for a physical examination, his abdominal circumference was 102cm, fasting blood sugar was 7.3mmol/L, triglyceride was 2.8mmol/L, and blood pressure was 142/95mmHg. He just met the diagnostic criteria for metabolic syndrome. He didn't care. He said that he had stayed up a few extra nights recently for socializing and just took two days off. He didn't take it seriously at all.

If you tell him about this situation, he won't listen at all if you tell him about insulin resistance and long-term target organ damage. He will drink more wine and eat late night snacks later. No matter how closely you keep an eye on the indicators during hospitalization, he will be back to the baseline level within a week after discharge. It's quite a headache.

In addition to the problem of patient cognition, the difficulty in care is that metabolic syndrome is not just hypertension or diabetes. You cannot just focus on one indicator. To use an inappropriate metaphor, it is like four faucets leaking at the same time at home. You only block the blood pressure. Regardless of blood sugar, blood lipids and weight, the leaking water will still damage the "furniture of the house" such as blood vessels and pancreas. There was an old retired patient who took antihypertensive drugs every day without stopping to measure his blood pressure, but couldn't do without braised pork and iced Coke. After half a year, his fasting blood sugar soared to 10mmol/L, and his triglyceride level nearly reached 6mmol/L. He eventually developed acute pancreatitis and was admitted to the hospital. The previous nursing care of just monitoring his blood pressure was like a useless effort.

There are also differences in the academic community on the boundaries of nursing intervention for early-stage patients. Some experts believe that as long as the indicators have not reached the point of diagnosis of diabetes or hypertension, lifestyle intervention alone is enough. Do not use drugs indiscriminately to increase the burden on the liver and kidneys. Some of our colleagues on the clinical frontline feel that most people now simply cannot do strict nursing care for more than half a year. For diet and exercise control, it is better to use low-dose lipid-lowering and hypoglycemic drugs as a transition early, which can reduce long-term cardiovascular risks. Our department was still arguing about this when discussing similar cases last week. In the end, there was no unified conclusion. We can only explain the pros and cons of the two options to the patient, and choose based on his actual situation and wishes.

Another small problem that is easily overlooked is that many patients tend to go to extremes once they take it seriously. For example, they only eat boiled vegetables every day and run five kilometers on an empty stomach. Within half a month, they either faint from hypoglycemia or suffer from gout caused by a sharp increase in uric acid, which disrupts the original metabolic rhythm. At this time, care must be taken in time. It is much better to adjust slowly than to rush for quick success.