Metabolic syndrome nursing diagnosis

"Acute cardiovascular and cerebrovascular events" is listed as an independent nursing diagnosis. There is still controversy in the academic circle and there is no unified conclusion yet.

I have been working at a community chronic disease management station for three years, and have encountered anywhere from 100 to 80 patients with metabolic syndrome. I am particularly impressed by the practicality of this diagnosis. What impressed me most was a 42-year-old private company boss who came last year. He was holding a half-cup of a thickened iced Americano and a briefcase under his arm. When he sat down, the first thing he said was, "I don't have time for long-term care. Just give me some medicine. I have to go abroad to discuss projects next week." When he was evaluated, it was found that his waist circumference was 96cm, his fasting blood sugar was 6.9mmol/L, his triglycerides were 2.8mmol/L, and his blood pressure was 142/95mmHg. He just met the three diagnostic thresholds for metabolic syndrome and belonged to a typical high-risk group.

Speaking of which, I have to mention the current differences in academic circles. One group is the orthodox group that strictly follows the standards of NANDA (North American Nursing Diagnosis Association) and believes that nursing diagnosis must be a problem that nurses can intervene independently. "Potential complications: acute cardiovascular and cerebrovascular events" are cooperative issues that need to be handled with doctors and cannot be considered independent nursing diagnosis. At most, a risk warning can be marked in the nursing record. ； The other group is the clinical pragmatist group in the endocrinology departments of many tertiary hospitals in China. They believe that the risk of sudden myocardial infarction and cerebral infarction in patients with metabolic syndrome is 2-3 times higher than that of the general population. Listing this potential complication as an independent diagnosis can force nurses to pay more attention to blood pressure and blood sugar every time they make rounds. Even asking "Have you had chest tightness or dizziness today?" can reduce many accidents. After staying there for a long time, I actually feel that both sides are reasonable. Our current approach is to write the official medical record according to NANDA standards, but on everyone's nursing bedside card, cardiovascular and cerebrovascular risks will be marked with a red pen at the top. After all, if something goes wrong, no standard is as important as human life.

Oh, by the way, there is another pitfall that new nurses can easily fall into: no matter whether the patient is a 20-year-old chubby guy who loves milk tea or a 70-year-old sugar patient with bad teeth, the same four diagnoses are given regardless of the actual situation. Last month, I met an aunt who was 165cm and 55kg. She looked thin, but her abdominal circumference was 92cm, and her blood sugar and triglycerides were both high. She was a typical metabolic syndrome of abdominal obesity. The nurse who just joined the job wrote "Malnutrition: higher than the body's requirements." The aunt became anxious on the spot and said, "I usually only eat less than half a bowl of rice in one meal and rarely touch meat. Why am I over-nutritional?" ”Later, we adjusted the priority of diagnosis and put "lack of knowledge: lack of awareness related to abdominal obesity" as the first priority. We showed her an ultrasound image of visceral fat and made it clear that her fat was accumulated in the belly and wrapped around the organs, which was more harmful than subcutaneous fat. Only then was she willing to cooperate with the subsequent dietary adjustments.

To be honest, when making nursing diagnosis of metabolic syndrome, you really cannot just focus on the numbers on the test sheet. There used to be an old man whose weight, blood sugar, and blood lipids were only borderline high, but he would get out of breath after walking two steps a day and had to rest twice when he climbed the third floor. If you just put "activity intolerance" at the bottom according to the indicators and set a goal of walking 6,000 steps a day, he will definitely not be able to persist, and he will easily injure his knees. We later adjusted him to doing Baduanjin twice a day for 20 minutes each. After practicing for half a month, he said he was no longer out of breath when walking, and he even asked to increase the amount.

In fact, to put it bluntly, nursing diagnosis is a unified standard when written on paper, and it can only be used on patients. Don’t just use a template to apply to everyone. First, chat with the patient for 10 minutes about daily life. Ask him if he usually goes out to socialize, if he has the habit of getting up for midnight snacks when he is hungry, if he gets out of breath when walking upstairs, and if he has been dizzy or sleepy recently. These soft details are sometimes more accurate than hard indicators. After all, as nurses, our ultimate goal is not to write medical records in compliance with regulations, but to really help patients reduce risks, right?