Metabolic syndrome nursing case

This case uses stratified personalized nursing intervention for a 42-year-old male patient with metabolic syndrome who has abdominal obesity, abnormal glucose and lipid metabolism, and hypertension. The 3-month follow-up showed that the patient's core index compliance rate reached 82%, which is much higher than the baseline level of 37% of routine care for the same population. It verifies that the long-term benefits of the three-dimensional non-pharmacological intervention of "diet-exercise-psychology" are better than simple drug control. However, there are significant individual differences in the adaptability of different nutrition schools, and there is currently no universal optimal nursing path.

The patient is a back-end developer for an Internet company. When he came to the chronic disease clinic for the first time, he was carrying a half-drunk iced Coke and a navy blue T-shirt with some yellow braised chicken oil marks on the collar. When he sat down, the first thing he said was, "Doctor, am I going to have diabetes?" My mom was hospitalized last week with diabetes." Looking through his physical examination report: waist circumference 96cm, resting blood pressure 146/93mmHg, fasting blood sugar 6.9mmol/L, triglyceride 2.8mmol/L, moderate fatty liver, which meets the diagnostic criteria for metabolic syndrome in the "China Type 2 Diabetes Prevention and Treatment Guidelines (2020 Edition)". I bought fish oil and ate it for half a year, but the indicators did not move at all, and instead gained 3 pounds.

At that time, the two nurses in charge of follow-up in Corey even argued about his nursing plan. Xiao Zhou, who has just passed the registered dietitian certification exam, advocates going straight to a low-carbohydrate diet, cutting out all refined sugars and refined rice noodles, replacing them with slow carbohydrates such as oats and quinoa, and doing aerobic exercise for more than half an hour at least three times a week. He says that this plan can reduce the index the fastest. Sister Li, who has been working as a community nurse for 10 years, disagrees, saying that she has met too many 996 office workers like this. Let alone cooking multi-grain rice, it is good to be able to eat takeout on time. If you are given so many prohibitions at once, you will have to give up in less than half a month. It is better to start with the changes that "do not need to spend extra time".

In the end, we did not impose any standardized plan and completely adapted it to his life rhythm: by default, he replaced the white rice with half multi-grain rice for takeout, drank no more than 1 bottle of full-sugar Coke per week, and replaced the rest with sugar-free sparkling water. He got off the subway two stops before get off work every day and walked briskly for 20 minutes. He didn’t have to take time to go to the gym. He didn’t even mention quitting smoking at the beginning - he said that he couldn’t survive without smoking one cigarette while writing code. We said that he would smoke two less cigarettes first and take his time. To be honest, I didn’t have high hopes at the beginning. Too many patients had promised well and just turned around and did what they did. Unexpectedly, he came for a review in the first month and he had almost stopped drinking coke. He lost 2 pounds and his blood pressure dropped to 138/88.

When he came in the second month, he had a droopy face. He said that during the department team building last week, he couldn't help but drink two cups of full-sugar milk tea. When he got home at night, his fingertip blood sugar soared to 7.8. He was so scared that he couldn't sleep all night and felt that all his efforts had been wasted. We quickly vaccinated him: there is no such thing as "breaking the habit" in the care of metabolic syndrome. It is much better to eat what you want occasionally than to overeat in the end without feeling guilty. He followed the adjustment plan so easily and closely. If he occasionally wanted to eat hot pot and fried chicken, he would ask in the follow-up group in advance. We would never say "no eating", we would only say "just boil more meat and vegetables, and don't drink the sweet soda that goes with it."

The results of the 3-month review were better than we expected: waist circumference dropped to 88cm, fasting blood sugar 5.6mmol/L, triglyceride 1.7mmol/L, resting blood pressure 130/82mmHg, and moderate fatty liver disease turned into mild. Of course, some colleagues do not approve of our approach, saying that this kind of "loose" personalized care is too labor-intensive. We spent more than 20 hours on one-on-one follow-up visits. It is impossible to promote it on a large scale in community health service centers with tight manpower. It is better to directly prescribe statins and metformin to patients, and the indicators will drop quickly and save trouble. This is actually true. We are now also trying to make the adjustment logic of this type of case into a small program. After the patient fills in his/her schedule and eating habits, it can automatically generate adapted suggestions for small changes, in order to reduce labor costs.

After working in chronic disease care for 8 years, my biggest feeling is that caring for metabolic syndrome never just involves giving patients a "no-food list". You have to get into his life first and see: Does he have time to cook for himself? Do you have time to spare an hour for exercise? Will his family hold him back? If he doesn't get off work until 12 o'clock every day, and you force him to get up and run 3 kilometers every day and cook three fat-reducing meals by himself, that's not caring, it's making things difficult.

This case is not considered a benchmark case in the files of our department, and there is no template that can be directly copied for homework, but at least it reminds us: compared with the falling numbers on the test sheet, the patient's willingness to slowly adjust with you is the most effective "medicine" in metabolic syndrome care.