Metabolic syndrome nursing rounds

There is no universal nursing plan. It must be based on the patient's actual life scenario, linking the four-dimensional adjustments of diet, exercise, medication, and emotion, and giving priority to controlling the core cause of abdominal obesity instead of controlling individual indicators alone. Only in this way can the long-term risk of cardiovascular and cerebrovascular accidents be truly reduced.

The patient who just checked out 3 beds in our department last Tuesday is a typical case of metabolic syndrome: a 42-year-old delivery boy from the same city who has been running orders for 6 years. His waist is so thick that he cannot button the bottom button of his work clothes. When he was admitted, his systolic blood pressure was 148mmHg, his fasting blood sugar was 7.4mmol/L, and his triglycerides were 2.3 times the normal value. He was still confused: "I climb stairs and walk 20,000 steps every day, how can I still get this rich disease?" ”

The nurse who was doing rounds that day had just finished memorizing the guide and opened her mouth to give advice: "You have a wrong diet. From now on, you should not exceed 5g of salt and 25g of oil every day. You should do at least 150 minutes of moderate-intensity exercise every week, preferably jogging and swimming." ”Before he finished speaking, the patient retorted: "I run 12 hours a day, how can I have time to go to the swimming pool? When I eat, I only buy fast food from the roadside. How much salt can I still keep an eye on the boss? ”

The head nurse, who has been working in chronic disease care for 20 years, laughed at that time. She took out her mobile phone to show the patient the "exclusive care list for takeaways" that she had saved for almost three years: "I don't let you cook by yourself. Next time you order fast food, ask for an extra box of free water. Rinse the vegetables before eating them. Don't touch sweet, sour or braised dishes." Don't sit and check your phone while waiting for your meal. Do squats for 5 minutes against the wall on the side of the road. If you do it 6 times a day, it will take 30 minutes. It will reduce your belly more than running for half an hour. ”The patient patted his thigh and said that this could be done.

Interestingly, there is actually a lot of noise in the industry about nursing intervention for metabolic syndrome. One group is strictly evidence-based and sticks to the quantitative standards of the "Dietary Guidelines for Chinese Residents" and "Guidelines for the Prevention and Treatment of Metabolic Syndrome". Even 1g more salt and 10 minutes less exercise are not enough. ； The other school is the humanistic nursing school, which believes that compliance is the first priority. For example, some patients like to drink a few sips of wine. If you force them to quit, they will secretly drink more. It is better to relax to two times a week and no more than one or two liters of white wine each time, so that they can persist for a long time. I was standing in the middle - a 62-year-old retired teacher I had managed last year. She said that she ate according to the guidelines and danced for an hour every day, but her blood pressure and blood sugar could not be lowered. Later, when I looked through her mobile phone album, I found that she drank porridge with pickles every morning, and bought a candied date cake as a snack after dancing. I still thought, "I haven't eaten fat meat, so what's the point of being so sweet?" Later, she was not asked to change her exercise habits, so she replaced porridge with oatmeal, pickles with cucumbers, and snacks with cherry tomatoes. Within three weeks, her waistline dropped by 3cm, and her blood pressure stabilized at 130/80.

There is also the low-carb diet that has been a hot topic recently, and it is also justified by public opinion: some studies have shown that low-carb can quickly improve insulin resistance, and can reduce body fat rate by 5 points in 3 months.； There are also studies saying that long-term low-carb diet will increase uric acid and increase the burden on the kidneys. Our current approach is never to directly recommend a plan to the patient. Instead, we first do an insulin release test. If the resistance is particularly severe, we first try a medium-to-low-carb diet for four weeks - that is, reducing the usual amount of polished rice and noodles by half and replacing them with mixed beans and sweet potatoes. We test fasting and postprandial blood sugar three times a week. If uric acid rises, we will immediately adjust it back without forcing it.

I have managed more than 30 patients with metabolic syndrome myself, and I have figured out a small rule that is not included in the guide: Don't list more than a dozen precautions for the patient as soon as he comes in. He will not remember it. Just change one small habit during each ward round. For example, this time I asked him to change the sugary drinks he drinks every day to light tea, and next time I asked him to change his sleep from 12 a.m. to 11:30 a.m., and slowly grind it out, it would be much more effective than stuffing him with a bunch of demands at once. I once had a sales patient who drank iced Coke every day. I told him that every time he wanted to drink Coke, he would take a sip of sparkling water with lemon and slowly lose weight. He quit Coke in 3 months, lost 8 pounds, and his blood sugar returned to the normal range.

Oh, by the way, during last week’s ward round, an aunt dragged me and asked: “Do I have to take medicine for the rest of my life for this disease? ”I told her that as long as your waist circumference can be reduced to less than 85cm and your blood pressure and blood sugar are stable, maybe the medicine can be gradually reduced. She now walks downstairs for 20 minutes after eating every day. Last week, her waist circumference was 86cm, which was 1cm off. She was so happy that she stuffed a steamed corn bun for each of us at the nursing station.

In fact, to put it bluntly, the nursing rounds for metabolic syndrome are never about us standing by the bedside and reading the guide. Instead, we squat down and work with the patient to find the "small loopholes" in his life: some people's loopholes are staying up late every day to play mahjong, some people drink and socialize every day, and some people are used to adding two spoons of oil when cooking. If you plug this loophole, it will be more effective than any number of medicines prescribed. After all, in the final analysis of chronic disease care, the battle is not whose guidelines can be memorized, but whose plan can make patients really stick to it.