Celiac Disease

Celiac Disease Nursing Care Plans and Diagnosis Interventions

Celiac Disease NCLEX Review Care Plans

Nursing Study Guide on Celiac Disease

Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a serious autoimmune condition that is characterized by the presence of an immune response that is triggered by ingesting gluten.

The damage is noted on the villi of the small intestines.

These are tiny finger-like structures that help in the absorption of nutrients.

Putting this in context, celiac disease, if left untreated, can cause malnutrition.

Gluten is a protein that is found in many foods, including wheat, rye, and barley. Celiac disease can develop at any age.

It has a high genetic predisposition and is usually related to other autoimmune disease.

It affects about 1 in 100 people worldwide.

Signs and Symptoms of Celiac Disease

Celiac disease manifests differently in adults and in children. Celiac disease in most children is undiagnosed until adulthood.

The signs and symptoms include the following:

  • Nausea and vomiting
  • Chronic diarrhea
  • Bloated stomach
  • Gas
  • Constipation

As a result of reduced absorption, the following may also be noted in children:

  • Failure to thrive
  • Damage to tooth enamel
  • Weight loss
  • Anemia
  • Irritability
  • Short stature
  • Delayed puberty
  • Neurological symptoms including ADHD, some learning disabilities, lack of muscle coordination and seizures

In adults, celiac disease manifests as follows:

  • severe or occasional diarrhea and/or constipation
  • fatigue due to malabsorption of nutrients
  • weight loss, still due to malabsorption of nutrients
  • recurrent bloating
  • abdominal pain
  • persistent unexplained nausea and vomiting

Other symptoms not related to digestive system include:

  • Anemia due to malabsorption
  • Bone condition including osteoporosis and osteomalacia
  • Dermatitis herpetiformis – presence of itchy, blisters usually on the elbows, knees, chest, scalp and bottom.
  • Headaches and fatigue
  • Neurologic symptoms such as numbness and tingling in feet and hands
  • Hyposplenism or reduced spleen function

Causes of Celiac Disease

The exact cause of celiac is still unknown.

However, predisposing factors are thought to have caused celiac in most cases.

Infant feeding practices, infections, surgery, pregnancy, childbirth, and emotional stress are all believed to trigger the start of an autoimmune response of the body to gluten.

The autoimmune response is directed to the component of gluten called gliadin.

This autoimmune response causes the body to attack gluten as if it is a threat to the body.

The response causes the inflammation of the lining of the intestines. It then results to the destruction of villi in the small intestines where the absorption of nutrients, vitamins, and minerals take placed.

Once damaged, the small intestine’s ability for absorption is reduced no matter the amount of food ingested.

The risk factors of celiac disease are as follows:

  • Family history of celiac disease or dermatitis herpetiformis
  • Having other autoimmune disease including Type 1 diabetes and autoimmune thyroid disease
  • Having autoimmune-related conditions like down syndrome
  • Having microscopic colitis

Complications of Celiac Disease

If celiac is left untreated, or if the person diagnosed with it carries on eating gluten, complications may happen.

  1. Complications related to malabsorption include:
  2. Iron-deficiency anemia. This occurs due to the malabsorption of iron.
  3. B12 and folate deficiency anemia. Vitamin B12 and folate are absorbed in the ileum, the last part of the small intestines.
  4. Osteoporosis. Calcium, which builds up bone mass, is absorbed in the intestines. Malabsorption secondary to villi destruction causes osteoporosis. Reduced absorption of Vitamin D, a vitamin that  is important in the absorption of calcium, also contributes to the development of osteoporosis.
  5. Malnutrition. Severe lack of much needed nutrients, vitamins, and minerals can cause malnutrition.
  6. Lactose intolerance. It is likely that a person with celiac disease will also have lactose intolerance. It is a condition that is characterized by the body’s lack of enzyme lactase to digest milk sugar called lactose.
  7. Cancer. Though very rare, cancer may occur secondary to celiac disease. Cancer of the small bowel cancer, small bowel lymphoma, and Hodgkin lymphoma are some examples of cancer that could be associated with celiac disease.
  8. Non-responsive celiac disease. In some cases, symptoms of celiac disease persist due to the contamination of food with gluten. It is helpful for the person with celiac disease to speak to a dietician at this point.

Diagnosis of Celiac Disease

  • Two blood tests can be performed to determine the presence of celiac disease. It is recommended that gluten still be included in the diet until the diagnosis is made. Removing gluten in the diet can cause false negative results.
  • Serology testing- to identify the presence of antibodies indicating autoimmune reaction to gluten.
  • Genetic testing – to test for human leukocyte antigen (HLA-DQ2 and HLA-DQ8) which is helpful in ruling out celiac disease.
  • If blood tests suggest celiac disease, further diagnostic procedures are then ordered.
  • Endoscopy – involves the insertion of a camera to the stomach and intestines through the mouth. It allows the clinician to visualize the internal structures. The clinician usually takes a sample of the intestines to test for the damage to the villi.
  • Capsule endoscopy – a more sophisticated procedure than traditional endoscopy; used to visualize the entirety of the intestines. A capsule containing a camera takes pictures as it is ingested.

Treatment for Celiac Disease

There is no known cure for Celiac disease; however, the following are effective ways to manage celiac disease and maintain optimal quality of life:

  1. Dietary changes. A strict gluten-free diet is the number one treatment for celiac disease. This includes avoiding wheat, barley, malt, rye, and other gluten-containing foods. A dietician is the best source of information as to what foods to avoid. It is also important to understand that gluten hides in small amounts in some foods.
  2. Supplements. Vitamin and mineral supplementation may be required for nutritional deficiencies. Some of the vitamins and minerals recommended for Celiac disease patients include: Vitamin B-12,  vitamin D, vitamin K, zinc, copper, folate, and iron.
  3. Medications. Steroids may be prescribed to treat intestinal inflammation.

Nursing Care Plans for Celiac Disease

Nursing Care Plan 1

Nursing Diagnosis: Diarrhea related to intestinal inflammation secondary to Celiac disease as evidenced by loose, watery stools, abdominal cramping and pain, increased urgency to defecate, and increased bowel sounds

Desired Outcome: The patient will be able to return to a more normal stool consistency and frequency.

InterventionsRationales
Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.To monitor the patient’s bowel pattern.
Ensure that the patient has a gluten-free diet.A strict gluten-free diet is the number one treatment for celiac disease. This includes avoiding wheat, barley, malt, rye, and other gluten-containing foods.
Administer medications for Celiac disease as prescribed.Steroids may be prescribed to treat intestinal inflammation. Anti-diarrheals and antispasmodics may also help  
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Avoid cold drinks. Check if the patient is in any fluid restriction before doing so.To help ensure that the patient will not have dehydration due to severe diarrhea. Cold drinks can increase intestinal motility.
Help the patient to select appropriate dietary choices to avoid gluten-containing foods. Encourage him or her to reduce the intake of milk products.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of Celiac disease. Many patients with Celiac disease are also lactose intolerant.
For severe diarrhea, start the patient on a nothing by mouth status, and gradually progress to clear liquids, followed by bland diet, and the low residue diet. The patient can then have a low fat/residue, low fiber diet on a long-term basis, as recommended by the dietitian.Nothing by mouth (NBM) status can help rest the bowel by decreasing peristalsis. Gradual progression from NBM up to a low fat and low fiber, gluten-free diet can help manage the symptoms of Celiac disease.  

Nursing Care Plan 2

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to reduced absorption of nutrients secondary to Celiac disease, as evidenced by diarrhea, abdominal pain and cramping, weight loss, nausea and vomiting, and loss of appetite

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explore the patient’s daily nutritional intake and food habits (e.g. mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to Celiac disease.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to avoid gluten-containing foods. Encourage him or her to reduce the intake of milk products.To relieve abdominal pain and cramping, alleviate diarrhea, and to promote healthy food habits. To avoid flare ups of Celiac disease. Many patients with Celiac disease are also lactose intolerant.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Celiac disease.  
Administer supplements of vitamins and minerals as prescribed.Vitamin and mineral supplementation may be required for nutritional deficiencies. Some of the vitamins and minerals recommended for Celiac disease patients include: Vitamin B-12,  vitamin D, vitamin K, zinc, copper, folate, and iron.

Other Nursing Diagnoses:

  • Ineffective Coping
  • Risk for Deficient Fluid Volume
  • Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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