Metabolic syndrome nursing issues and nursing measures

At present, the four most prominent clinical nursing problems of metabolic syndrome are "insufficient treatment compliance caused by patients' cognitive biases, hidden risks of complications caused by the superposition of multiple metabolic index abnormalities, difficulty in long-term implementation of lifestyle correction, and vicious cycles of metabolic disorders caused by psychological stress." The corresponding core nursing principles are not unified "sugar control, fat control and exercise", but individualized layered intervention as the core, taking into account the balance between disease control and patients' quality of life, in order to achieve long-term benefits.

I have been working as a specialist nurse in the Department of Endocrinology for almost 8 years. I have encountered at least thousands of patients with metabolic syndrome, ranging from retired elderly people in their 60s to young girls in their early 20s who just started working. I have seen too many detours due to incorrect care plans. Take Brother Zhang, who came for a follow-up visit last month. He is a 42-year-old middle-level enterpriser with a height of 175cm, a weight of almost 180cm, and a waist circumference of 96cm. According to the diagnostic standards of the International Diabetes Federation, he has abdominal obesity plus high blood sugar, high blood pressure, high blood lipids and high uric acid, which is exactly what he needs to be diagnosed with metabolic syndrome. He had been under strict control at home for three months, eating boiled vegetables every meal, and forcing himself to run 5 kilometers after get off work. As a result, he was so hungry that he felt dizzy all day long, and fluid accumulated in his knees from running. When he checked, his blood lipids did not drop much, but his uric acid increased by 100 μmol/L, and he was about to collapse.

In fact, many patients were like Brother Zhang when they were first diagnosed. They either thought it was a "disease of wealth" and could be cured by eating less and moving more, or they were frightened and overly anxious by the risks of "myocardial infarction, stroke, and renal failure" mentioned on the Internet. Both extreme perceptions were big pitfalls in the road to care. In fact, the academic community has always had different nursing tendencies on this point: the traditional concept tends to explain the risks thoroughly and rely on serious health education to force patients to follow doctor's instructions. This is indeed useful for patients with extremely weak health awareness. ； However, in recent years, more and more studies have shown that excessive risk intimidation can actually cause patients to have an escape mentality. It is better to empathize with his life difficulties first, and then slowly adjust. There is no absolute right or wrong between the two methods. It all depends on the group of people who are suitable for it.

Don't underestimate the fact that this disease is just "several indicators are high at the same time". Its hidden complications are often much more dangerous than a single three highs. Many people don’t know that long-term irregular menstruation in women, polycystic ovary syndrome, unprovoked sexual decline in middle-aged men, and non-alcoholic fatty liver disease that is often detected in physical examinations may all be essentially related to metabolic syndrome. There was a 28-year-old girl who suffered from amenorrhea for almost half a year. After a year of hormone adjustment in the gynecology department, it was to no avail. Later, she was transferred to our department and was diagnosed with insulin resistance caused by metabolic syndrome. After adjusting the direction of care and adding intervention to control weight and improve metabolism, her menstruation returned to normal in less than three months. Therefore, when nursing, you cannot just focus on blood sugar and blood pressure. You must connect all the abnormal signals throughout the body, otherwise it is easy to miss the problem.

The biggest headache is the implementation of lifestyle intervention. After all, now everyone is either 996 or socializing. How can it be possible to cook according to recipes every day and find time to go to the gym? Corey has discussed many times before: Should he strictly require the patient to completely change his appearance, or should he try to make minimal adjustments to his original life? “Those who are strict say that as long as they can stick to it, the results will be good, while those who are loose say that no matter how good the plan is, it will be in vain. Later, we found a middle line: first find out the bottom line of the patient's life. For example, if the taxi driver sits for 12 hours a day, don't force him to run after get off work. When waiting for customers, he can stand on tiptoes and clench his fists for 5 minutes each time. In a day, he can still have more than half an hour of activity. ； For a salesperson who often has to socialize, there is no need to force him to completely abstain from alcohol and hot pot. It is okay to eat once or twice a month. When eating, drink more water and try to replace the wine with sugar-free tea. It is better than him breaking the jar.

There are also psychological problems that are easily ignored, which are really invisible catalysts for metabolic disorders. I once had a 50-year-old aunt. After she was diagnosed, her blood sugar was tested at home four times a day. It was 0.1mmol/L higher than before, so she couldn't eat or sleep. During the recheck, her insulin resistance index was even higher than when she was first diagnosed. This was because anxiety caused cortisol to spike, which in turn increased the metabolic burden. Later, we asked her to change her blood sugar measurement to twice a week. As long as the overall trend was going down, she didn't have to worry about single fluctuations. She felt relaxed and the index stabilized quickly.

Now when we do nursing programs, we never give out the same leaflets to everyone. First, ask the patient clearly about his or her work nature, eating habits, exercise base, and even whether he has time to cook and whether he can afford medicine for chronic diseases, and then tailor a plan. For example, patients with strong self-discipline can be equipped with a smart bracelet to track their exercise and sleep, and try a short-term low-carb diet to lose weight quickly, and first see the results to build confidence. ； For patients who are afraid of trouble, I give them a few simple requirements: reduce their waist circumference by 3cm, change the milk tea they usually drink from full sugar to three-thirds of sugar, and drink less alcohol once a week. If you do this, it will be better than anything else. Of course, not all situations can be relaxed. If it has been found that there are plaques in the coronary arteries, or the fasting blood sugar has reached the diagnostic standard of diabetes, the strict bottom line must not be compromised. At this time, the pros and cons must be explained thoroughly, and help him find the most comfortable intervention method within the controllable range.

After doing metabolic syndrome care for so long, my biggest feeling is that this disease is essentially a chronic disease tied to long-term living habits. The core of care is never to give the patient a bunch of "no eating and no doing" prohibitions, nor is it to force the person to become an ascetic who eats boiled vegetables every day, but to help him find a way to peacefully coexist with his body - after all, a plan that can last a lifetime is a truly useful plan.