What are the nursing issues for metabolic syndrome?

Interventions caused by cognitive biases are difficult to implement, it is difficult to adapt nursing plans with superimposed abnormalities in multiple indicators, and there are also gaps in long-term follow-up.

A 42-year-old Internet programmer who was just admitted last week weighs 90 kilograms, has a fasting blood sugar of 6.8mmol/L, a blood pressure of 146/94mmHg, and triglycerides more than twice the normal value. After the diagnosis, his first reaction was, "I don't feel any discomfort except being a little fatter. I don't need to worry about it if I am not sick." He was given a prescription for diet and exercise, and then went to eat hot pot and drink cold beer with his colleagues. This type of cognitive bias is particularly common. Many people think that metabolic syndrome is "sub-healthy" and do not know that it is a precursor to diabetes, myocardial infarction, and cerebral infarction. Some patients go to the other extreme and buy various health care products that "clear blood vessels" and "lower the three highs" as soon as they are diagnosed. Instead, they suffer liver and kidney damage. Interestingly, there is currently no unified consensus on the health education standards for newly diagnosed patients in the industry. One group supports directly explaining the long-term serious complications and relying on risk reminders to increase patients' attention. The other group believes that over-emphasis on severe diseases will make patients anxious. Both sides are supported by clinical data, and the conclusion is not yet final.

Once the patient's ideological work is really solved, there will be a lot of headaches at the implementation level. I met a 62-year-old Aunt Zhang before, who suffers from high blood pressure, high blood sugar, and high uric acid. The dietary requirements of the three diseases have a lot of "fighting" points: high uric acid requires limiting the intake of seafood and soy products, high blood pressure requires strict salt control and less oil, and diabetes requires avoiding refined carbohydrates that raise blood sugar. For three days, she made up three recipes found on the Internet, and finally came to the outpatient clinic to tell me that she really didn't know what to eat and simply didn't want to worry about it. In this case, we can’t force the patient to completely overturn his lifelong eating habits, right? Now when we make a nursing plan, we don’t just throw out a cold, general recipe. We first chat with the patient for half an hour about their daily routine, asking them what they usually like to eat, who cooks at home, and whether there are any ethnic or religious dietary taboos. Then we adjust the plan little by little. For example, if you like sweet food, you can replace white sugar with a low-glycemic sugar substitute. If you like meat, you can replace braised pork ribs with braised chicken legs. Taking your time is better than asking the patient to lie flat all at once.

Another problem hidden under the water is the gap in long-term management. During the period when many patients were in the outpatient clinic to adjust their indicators, they came to check their blood pressure and blood sugar every day. They took medicine and exercised regularly, and their indicators stabilized immediately. However, as soon as they returned home and no one was watching, they returned to their original shape within two months. Last year, there was a 38-year-old business executive who came to see a doctor. He weighed 92 kilograms and his triglycerides were three times higher. He followed us for three months and then dropped it back to the normal range. As a result, he came back for a reexamination at the beginning of this year. Not only did his triglycerides return to the previous level, but he also found carotid artery plaque. He said that after returning home, he would not be able to avoid traveling for business and socializing every day, and no one reminded him to take medicine on time, and he couldn't find time for exercise. Many community hospitals now organize metabolic syndrome patient groups. They post some easy-to-understand information every week, remind everyone to measure indicators every half month, and hold regular offline patient exchange meetings to allow well-controlled patients to share their experiences. This is much more effective than the previous follow-up calls alone, but there are also difficulties. For example, many elderly people living alone do not know how to use smart phones, and the messages in the group cannot be seen at all. They can arrange for volunteers to come to follow up. There is not enough manpower in the community. So far, no perfect solution has been found for this problem.

In fact, to put it bluntly, metabolic syndrome is essentially a lifestyle disease. The core of nursing care is never to focus on the indicators and adjust medication, but to accompany the patient to break away from the bad living habits that have been developed over the years. The detailed problems that need to be dealt with here are much more complicated than what is written in textbooks.