Metabolic syndrome

Assessment-Physical Findings

Abdominal obesity (see Why abdominal obesity is dangerous) Criteria for diagnosis (See Diagnosing metabolic syndrome)

Overview-Causes

Acquired factors (See "Risk factors") Genetic predisposition

Treatment-Surgery

Bariatric surgery to treat obesity

Nursing Considerations-Associated Nursing Procedures

Blood glucose monitoring Blood pressure assessment Nutritional screening Oral drug administration Venipuncture Weight measurement

Nursing Considerations-Monitoring

Cardiovascular status Blood glucose levels Weight Nutritional intake Blood pressure Ordered laboratory tests

Overview

Cluster of symptoms triggered by insulin resistance: abdominal fat; obesity; high blood pressure; and high levels of blood glucose, triglycerides, and cholesterol Associated with increased risk of diabetes, heart disease, and stroke Commonly unrecognized Also known as syndrome X, insulin resistance syndrome, dysmetabolic syndrome, and multiple metabolic syndrome

Overview-Complications

Coronary artery disease Diabetes Hyperlipidemia Stroke Premature death

Treatment-Activity

Daily physical activity of at least 30 minutes of moderate-intensity exercise with some resistance exercise training

Assessment-History

Familial history Hypertension Abdominal obesity Sedentary lifestyle Poor diet Fatigue Aches and pains Polyuria Polydipsia Angina

Nursing Considerations-Nursing Diagnoses

Fatigue Imbalanced nutrition: More than body requirements Risk for decreased cardiac perfusion Risk for injury Risk for unstable glucose level

Diagnostic Test Results-Laboratory

Glucose level is elevated above 100 mg/dL. Low-density lipoprotein (LDL) and triglyceride levels are increased; triglyceride levels above 150 mg/dL. HDL level is decreased (below 40 mg/dL in males; below 50 mg/dL in females). Blood tests show hyperinsulinemia. Serum uric acid level is elevated.

Treatment-Diet

Low alcohol intake Low-cholesterol, saturated fats, and trans fats High in complex carbohydrates (grains, beans, vegetables, fruit) and low in refined carbohydrates (soda, table sugar, high-fructose corn syrup) Low calorie diet; reduction by 500 calories per day to achieve weight loss of 0.5 kg/week

Overview-Incidence

Metabolic syndrome affects 30% to 40% of adults older than age 20; about 40% of cases are found in adults older than 60. Males and females are affected equally.

Overview-Risk Factors

Obesity High fat, high-carbohydrate diet Insufficient physical activity Aging Hyperinsulinemia/impaired glucose tolerance Previous heart attack

Treatment-Medications

Oral antidiabetic agents such as metformin, rosiglitazone maleate or pioglitazone hydrochloride Antihypertensives including angiotensin converting enzyme (ACE) inhibitors such as ramipril and angiotensin II receptor blockers such as losartan potassium (if intolerant to ACE inhibitor) Statins if LDLs are elevated, such as simvastatin or atorvastatin calcium Niacin to raise low HDL-C levels. Fibrate if triglycerides are high and/or if HDLs are low Fish oil and plant sterol esters to lower cholesterol Daily aspirin to reduce cardiovascular risk Orlistat as a first-line agent for obesity; sibutramine as a second-line agent

Nursing Considerations-Nursing Interventions

Promote lifestyle changes; encourage increased activity levels; and give appropriate support. Assist patient in preparing schedule of administration for prescribed medications. Work with patient to identify appropriate food choices for improved diet. Obtain blood glucose levels and lipid profile as ordered. Assist patient in dietary modifications, as indicated; enlist the aid of a dietitian to assist with meal planning and food choices.

Overview-Pathophysiology

The body breaks food down into basic components, one of which is glucose. Glucose provides energy for cellular activity. Excess glucose is stored in cells for future use. It's guided into storage cells by insulin, which is secreted by the pancreas. In those with metabolic syndrome, glucose doesn't respond to insulin's attempt to guide it into storage cells. This is called insulin resistance. Adipose cell enlargement and infiltration of macrophages into adipose tissue leads to release of pro-inflammatory cytokines and promotes insulin resistance. To overcome this resistance, the pancreas produces excess insulin, which causes damage to arterial lining. Excessive insulin secretion also promotes fat storage deposits and prevents fat breakdown. This series of events can lead to diabetes, blood clots, and coronary events.

Treatment-General

Weight-reduction program Risk factor/lifestyle modification

Patient Teaching-General

disorder, diagnosis, and treatment, including risk factors and medications principles of a healthy diet, including calorie restrictions and the importance of increased intake of fruits, vegetables, and whole grains relationship of diet, inactivity, and obesity to metabolic syndrome benefits of increased physical activity, including prescribed exercise regimen prescribed medication, such as statins or antihypertensives, administration, frequency possible adverse effects of prescribed medications such as orthostatic hypotension with antihypertensives or muscle pain with statins danger signs and symptoms such as chest pain and the need to notify practitioner immediately importance of adhering to medication therapy regimen and follow-up care and laboratory testing to evaluate the condition and the effectiveness of medications.

Nursing Considerations-Expected Outcomes

express feelings of increased energy identify appropriate food choices according to a prescribed diet and maintain a healthy weight maintain adequate cardiac tissue perfusion avoid complications associated with the disorder demonstrate control of blood glucose levels.