Metabolic syndrome nursing issues and nursing measures

The core pain points in current clinical care for metabolic syndrome focus on Patients have insufficient compliance with lifestyle intervention, difficulty in linkage management and control of multiple metabolic indicators, and delayed early warning of complications. For the three types of problems, the clinically proven and effective core response framework is "individualized hierarchical intervention + multidisciplinary collaborative management + dynamic risk tracking". There is no standardized plan that is universally applicable and needs to be flexibly adjusted based on the patient's age, occupation, and living habits.

To be honest, I have been working in chronic disease nursing for almost 7 years, and I have seen as many as 800 patients with metabolic syndrome. The most troublesome thing is not that the indicators are difficult to adjust, but that the patients do not take the disease seriously at all. Last week, I met a 42-year-old Internet operator in the clinic. He was 175cm tall and weighed almost 180cm. His abdominal circumference was 96cm. His fasting blood sugar was 6.9mmol/L, triglyceride 3.4mmol/L, and blood pressure 146/93mmHg. He already met the diagnostic criteria for metabolic syndrome. After reading the report, he waved his hand and said, "I just worked overtime recently, just take a two-day rest." He even refused to prescribe medicine. This kind of cognitive bias is the first hurdle encountered in nursing. There are now two different schools of thought in the academic world on how to change the patient's consciousness: European and American nursing schools prefer "motivational interviewing", which does not first explain the rationale, but first explores the patient's own willingness to change - for example, young people want to wear their previous jeans, middle-aged and elderly people want to be stronger and help their children take care of their children. Starting from this point of view is much more useful than forcing a health manual. ； "Family-bound intervention" is more commonly used in primary care in China. The patient's spouse and children are included in the follow-up group, and the whole family controls salt and oil together. It is suitable for patients with particularly poor compliance. There is no difference between the two methods, and both can be effective if selected for the right group of people. I used to manage a young man who loved to drink Coke. I initially asked him to give up Coke but he refused to agree. Later, when I found out that he was planning to have a child, I told him that drinking one less Coke a day would improve his sperm motility by several points. Within two months, I took the initiative to replace Coke with sugar-free sparkling water. The effect was much more effective than saying "Coke raises blood sugar" ten times.

In addition to the patient's subjective lack of cooperation, the pathological characteristics of metabolic syndrome itself also add a lot of trouble to nursing care. The essence of this disease is a systemic metabolic disorder caused by insulin resistance. It is like a blocked sewer pipe at home. It cannot be solved by turning on a faucet. Many patients control their diet and blood sugar, but uric acid rises again. ； I tried my best to lose weight by walking. After half a month, my meniscus was so painful that I dared not move. After lying down for a week, my weight increased by 3 pounds, and my blood sugar also rebounded. There used to be a 62-year-old aunt who walked 10,000 steps a day in order to lower her blood sugar, which resulted in water accumulation in her knees. Later, we worked with the nurse from the sports rehabilitation department to adjust her plan. She started with non-weight-bearing exercises such as elliptical machines and swimming for 20 minutes each time. The nutrition department replaced her previous white porridge with multigrain porridge and added high-quality protein. After 3 months, her blood sugar stabilized, she lost 8 pounds, and her knees no longer hurt. It should also be mentioned here that many current nursing programs like to implement "one size fits all" and issue the same diet and exercise chart to all patients. In fact, it is completely unnecessary. For example, for patients with gout and hyperlipidemia, they should not be allowed to eat too much deep-sea fish oil, which is commonly used to lower blood lipids. On the contrary, it may increase uric acid. All measures must be based on the patient's specific indicators, and you cannot rely on the guidelines.

Another issue that is easily overlooked is early warning of complications. There are almost no obvious symptoms in the early stages of metabolic syndrome. Many people think, "I'm fine if I don't feel dizzy or in pain." By the time they feel it, target organ damage has often occurred. Last year, there was a 38-year-old programmer who usually only measured his blood pressure and thought that he would be fine if he took antihypertensive medicine on time. However, during his annual physical examination, he discovered that the amount of microalbumin in his urine was three times higher than the standard, indicating that he had early kidney damage. There are now different options for early warning methods: traditional quarterly biochemical examinations are highly accurate, but have poor timeliness, and the three-month blank period in between can easily cause problems. ； Nowadays, popular home wearable devices can measure blood sugar and blood pressure in real time, and the data is synchronized to the nurse station, but the error rate is high, which can easily cause unnecessary panic to patients. The current practice in our department is to equip medium- and high-risk patients with simple fingertip blood glucose meters and urine microalbumin test strips, and test them 1-2 times a week and upload them to the follow-up group. We will call to remind abnormal data, and review biochemistry every two months, which not only reduces the frequency of patients visiting the hospital, but also controls the risk in the bud. After more than a year of piloting, the incidence of kidney damage and cardiovascular events in patients with metabolic syndrome in the jurisdiction has dropped by nearly 30%.

To put it bluntly, the care of metabolic syndrome is never a unilateral matter for nurses, nor can it achieve results by relying on strict control. When we intervene with patients now, we never ask him to completely give up milk tea and late-night snacks at the very beginning. Instead, we first ask him to replace the take-out white rice with multi-grain rice, change the milk tea from full sugar to three-thirds of sugar and add a portion of boiled vegetables, and slowly incorporate good habits into his daily life. Some patients joked with us before, saying that when they go to buy steamed buns, they now habitually ask, "Is this made from coarse grains or refined noodles?" and that's enough. After all, our ultimate goal in nursing is never to make patients live as cold slaves to indicators, but to enable them to live their own lives comfortably and healthily.