Enlightenment of metabolic syndrome nursing work

The core inspiration of metabolic syndrome nursing work is to completely break the three-point standardized intervention logic of "weight control + sugar control + fat control" in the past, and shift to a "layered adaptation and dynamic adjustment" model centered on patients' real-life scenarios. At the same time, it is necessary to find a balance point that suits the individual between the "indicator first" clinical school and the "compliance first" humanistic nursing school to truly reduce the patient's long-term cardiovascular event risk.

Lao Zhou, a 42-year-old online ride-hailing driver who just completed a follow-up visit last week, is a typical example of putting this revelation into practice. When he was diagnosed with metabolic syndrome three months ago, his BMI was 28.7, his fasting blood sugar was 6.8mmol/L, his triglycerides were 2.3 times the normal value, and he also had grade one hypertension. At that time, he was prescribed a low-salt, low-fat, low-sugar diet according to the guidelines, which required 150 minutes of moderate-intensity exercise per week, and was supervised by his family. As a result, when he was rechecked a month later, the indicators were slightly higher - he worked the evening shift, sat for 12 hours a day, and had all his meals at roadside fast food restaurants. How could he have time to make his own fat-reducing meals? During the peak period, he didn’t even have time to drink water, let alone take the whole time to exercise. He didn’t even read the missionary manual he was given. He said he gave up immediately after seeing so many requirements.

Speaking of this case, I remembered that Corey held a case discussion meeting last month. At that time, two groups of nursing colleagues had a quarrel over the scale of intervention. The head nurse with a background in internal medicine stationed in the clinical guideline group said that the intervention target card must be strictly adhered to. If the target is not met, education and education must be repeatedly strengthened, and family members may even be contacted for supervision. "If the target is not lowered now, the risk of myocardial infarction and cerebral infarction will be three times higher in 10 years. The data is here, and being soft-hearted will harm the patient." But Sister Zhang, who has been in the management of chronic diseases for 12 years, directly responded: "Brother Wang who opened a home-cooked restaurant last time, you asked him not to eat heavy oil and salt. He had to try more than 20 dishes every day, but he couldn't do it. In the end, he stopped coming for follow-up and even stopped taking antihypertensive drugs. Which one is more harmful? ”

Both sides are supported by solid data, and there is no absolute right or wrong. The core of the problem has never been "whether the intervention is strict or not", but "whether the intervention is suitable for the patient's real life." Later, we changed the plan for Lao Zhou: instead of asking him to change the recipe, we asked him to ask for an extra portion of blanched vegetables every time he bought fast food, only put half of the sauce package in, and replaced the carbonated drinks with sugar-free sparkling water or mineral water. ； We didn’t ask him to take time to exercise. We just asked him to get out of the car and walk for 5 minutes every time he was waiting for an order. That’s enough, 10 times a day, even if he walked around the car twice. Don't tell me, he didn't feel any burden at all during the follow-up. During this review, he lost 4 pounds, his fasting blood sugar dropped to 6.1mmol/L, his triglycerides were cut in half, and his blood pressure stabilized within the normal range.

Oh, by the way, we had a patient who was a chef who cooked Shandong cuisine. The idea we gave him was to only take a sip and taste the food when trying it, and try not to swallow it. He was happy about it. He said that after working as a chef for 20 years, he never thought he could do this. He always felt that this job was destined to be entangled with the "three highs". On the contrary, for retired patients who have plenty of time and strong self-discipline, we will give more stringent intervention plans, such as making a "diet check list" for the aunt who loves square dancing, and teaming up with her dance partners to PK the results of sugar control. They are more active than young people in completing the tasks.

The academic community has also been discussing this direction: some studies believe that too low an intervention goal will make patients relax their vigilance, which is not conducive to long-term indicator control. Some studies believe that a completion rate of 50% is better than 0%, and at least it can prevent patients from rejecting follow-up. Our own experience is that we don’t need to worry about which theory is right, but first determine the patient’s acceptance level – if he frowns when he hears that he needs to “give up milk tea and quit late-night snacks”, ask him to start changing from “drinking less milk tea per week”, which is better than scaring people away at the beginning.

I have been doing metabolic syndrome nursing for almost 7 years, and the biggest feeling is that we are never the examiners who give patients exam papers, and we don’t have to hold the standard answer cards in the guide to determine whether they are qualified. We are more like people who build ladders for them, first find a step that they can step on tiptoe, and then slowly move up - after all, this is a chronic disease that has to deal with the body for 20 to 30 years. The prerequisite for winning a marathon is that you must first be willing to stand on the starting line.