Celiac disease is a chronic autoimmune disorder in which the ingestion of gluten damages the small intestine. This nursing diagnosis focuses on identifying and managing celiac disease symptoms, preventing complications, and maintaining a strict gluten-free diet for optimal patient outcomes.
Causes (Related to)
Celiac disease can affect patients in various ways, with several factors contributing to its severity and progression:
- Genetic predisposition (HLA-DQ2 and HLA-DQ8 genes)
- Autoimmune response to gluten proteins
- Environmental triggers such as:
- Viral infections
- Pregnancy
- Severe emotional stress
- Surgery
- Associated conditions include:
- Type 1 diabetes
- Thyroid disorders
- Rheumatoid arthritis
- Down syndrome
- Turner syndrome
Signs and Symptoms (As evidenced by)
Celiac disease presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Chronic diarrhea or constipation
- Abdominal pain and bloating
- Fatigue and weakness
- Unexplained weight loss
- Joint pain
- Brain fog and difficulty concentrating
- Anxiety and depression
- Mouth ulcers
- Skin rash (dermatitis herpetiformis)
Objective: (Nurse assesses)
- Documented weight loss
- Laboratory evidence of malnutrition
- Anemia (iron, folate, or B12 deficiency)
- Decreased bone density
- Delayed growth in children
- Dental enamel defects
- Elevated tissue transglutaminase antibodies
- Positive intestinal biopsy findings
Expected Outcomes
The following outcomes indicate successful management of celiac disease:
- The patient will maintain a stable weight or achieve healthy weight gain
- The patient will demonstrate strict adherence to a gluten-free diet
- The patient will show improved nutritional status
- The patient will report decreased gastrointestinal symptoms
- The patient will maintain adequate energy levels
- The patient will avoid complications
- The patient will demonstrate an understanding of disease management
Nursing Assessment
Monitor Nutritional Status
- Track weight changes
- Assess dietary intake
- Monitor laboratory values
- Document vitamin/mineral deficiencies
- Evaluate malabsorption signs
Assess Gastrointestinal Function
- Monitor bowel movements
- Document abdominal pain
- Assess for bloating
- Check for signs of malabsorption
- Note any food intolerances
Evaluate Psychological Status
- Assess anxiety levels
- Monitor for depression
- Check coping mechanisms
- Document stress levels
- Evaluate social support
Check for Complications
- Monitor for osteoporosis
- Assess for anemia
- Watch for other autoimmune conditions
- Check for skin manifestations
- Monitor growth in children
Review Risk Factors
- Document family history
- Assess genetic predisposition
- Note associated conditions
- Review medication history
- Check immune system status
Nursing Care Plans
Nursing Care Plan 1: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to malabsorption due to celiac disease as evidenced by weight loss, fatigue, and laboratory evidence of nutritional deficiencies.
Related Factors:
- Malabsorption syndrome
- Villous atrophy
- Dietary restrictions
- Limited knowledge of gluten-free diet
Nursing Interventions and Rationales:
- Monitor weight and nutritional intake daily
Rationale: Tracks nutritional status and effectiveness of interventions - Collaborate with dietitian for meal planning
Rationale: Ensures adequate nutrition while maintaining a gluten-free diet - Provide education about gluten-free diet
Rationale: Promotes dietary compliance and prevents complications
Desired Outcomes:
- The patient will demonstrate weight gain or maintenance
- The patient will maintain adequate nutritional intake
- The patient will verbalize understanding of gluten-free diet requirements
Nursing Care Plan 2: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to nutritional deficiencies and dermatitis herpetiformis as evidenced by skin rash and irritation.
Related Factors:
- Autoimmune response
- Nutritional deficiencies
- Compromised immune system
- Presence of dermatitis herpetiformis
Nursing Interventions and Rationales:
- Assess skin condition daily
Rationale: Early detection of skin complications - Implement skin care protocol
Rationale: Prevents skin breakdown and promotes healing - Monitor for new rash development
Rationale: Indicates disease activity and need for intervention
Desired Outcomes:
- The patient will maintain skin integrity
- The patient will demonstrate improved skin condition
- The patient will verbalize understanding of skin care measures
Nursing Care Plan 3: Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic disease management and lifestyle changes as evidenced by expressed concerns and reported stress about dietary restrictions.
Related Factors:
- Chronic illness diagnosis
- Required lifestyle modifications
- Social implications of dietary restrictions
- Fear of complications
Nursing Interventions and Rationales:
- Provide emotional support and counseling
Rationale: Helps patient cope with diagnosis and changes - Teach stress management techniques
Rationale: Reduces anxiety and improves coping skills - Connect patient with support groups
Rationale: Provides peer support and resources
Desired Outcomes:
- The patient will report decreased anxiety levels
- The patient will demonstrate effective coping mechanisms
- The patient will utilize support resources effectively
Nursing Care Plan 4: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to new diagnosis and complex dietary requirements as evidenced by questions about disease management and expressed uncertainty about food choices.
Related Factors:
- New diagnosis
- Complex dietary restrictions
- Limited exposure to the condition
- Information overload
Nursing Interventions and Rationales:
- Provide comprehensive disease education
Rationale: Increases understanding and promotes self-management - Teach label-reading skills
Rationale: Enables proper food selection - Demonstrate meal-planning techniques
Rationale: Promotes dietary compliance
Desired Outcomes:
- The patient will demonstrate an understanding of celiac disease
- The patient will correctly identify gluten-free foods
- The patient will verbalize confidence in disease management
Nursing Care Plan 5: Risk for Social Isolation
Nursing Diagnosis Statement:
Risk for Social Isolation related to dietary restrictions and lifestyle changes as evidenced by expressed concerns about social eating and activities.
Related Factors:
- Dietary restrictions
- Fear of cross-contamination
- Limited social dining options
- Anxiety about social situations
Nursing Interventions and Rationales:
- Assess the social support system
Rationale: Identifies available resources and support - Provide strategies for social situations
Rationale: Increases confidence in social settings - Connect with support groups
Rationale: Creates community with others sharing similar experiences
Desired Outcomes:
- The patient will maintain social relationships
- The patient will participate in social activities
- The patient will demonstrate effective strategies for social situations
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
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- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Rubin JE, Crowe SE. Celiac Disease. Ann Intern Med. 2020 Jan 7;172(1):ITC1-ITC16. doi: 10.7326/AITC202001070. PMID: 31905394.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Taylor AK, Lebwohl B, Snyder CL, Green PHR. Celiac Disease. 2008 Jul 3 [updated 2019 Jan 31]. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2024. PMID: 20301720.
