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.
- Complications related to malabsorption include:
- Iron-deficiency anemia. This occurs due to the malabsorption of iron.
- B12 and folate deficiency anemia. Vitamin B12 and folate are absorbed in the ileum, the last part of the small intestines.
- 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.
- Malnutrition. Severe lack of much needed nutrients, vitamins, and minerals can cause malnutrition.
- 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.
- 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.
- 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:
- 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.
- 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.
- Medications. Steroids may be prescribed to treat intestinal inflammation.
Nursing Diagnosis for Celiac Disease
Nursing Care Plan for Celiac Disease 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.
| Celiac Disease Nursing Interventions | Rationales |
| 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 for Celiac Disease 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.
| Celiac Disease Nursing Interventions | Rationale |
| 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. |
Nursing Care Plan for Celiac Disease 3
Nursing Diagnosis: Nausea related to gastric irritation secondary to Celiac disease, as evidenced by expression of nausea, increased heart rate, and respiration, cold and clammy skin, increased swallowing, and gagging sensation.
Desired Outcomes:
- The patient will express decreased severity or elimination of nausea.
- The patient will be able to identify foods that may trigger nausea.
- The patient will be able to exhibit strategies to prevent nausea.
| Celiac Disease Nursing Interventions | Rationale |
| Monitor the patient’s hydration status, daily weights, blood pressure, intake and output, and skin turgor. | Nausea is frequently associated with vomiting, and in this case, diarrhea which can alter a patient’s hydration status due to fluid loss. |
| Put the emesis basin where the patient can reach easily. | Vomiting and nausea are closely related. If the nausea is psychogenic, keep the emesis basin out of sight but within reach of the patient. |
| Educate and help the patient maintain good oral hygiene. | Anorexia and excessive salivation are connected with nausea. Oral hygiene aids in the relief and comfort of the illness. |
| Ensure that the patient’s diet is free of causative agents such as barley, rye, oats, and wheat while providing vital elements such as protein, lipids, vitamins, and minerals. | The causative agents will trigger the disease and may worsen the patient’s symptoms. Balanced nutrition is still a priority for the patient while alleviating the symptoms. |
| Ensure that the patient’s environment is free from strong odors including perfumes, dressings, and emesis. | Strong and offensive odors might contribute to nausea. |
| Allow the patient to use non-pharmacological nausea management methods including relaxation, guided visualization, music therapy, diversion, or deep breathing exercises. | These treatments have helped patients with nausea, but they must be used before it begins. |
| Include cold water, ice chips, ginger products, and room-temperature broth or bouillon in the patient’s diet as tolerated. | These help with hydration. Ginger, whether in the form of ginger ale, ginger tea, or candied ginger, soothes nausea. Fluids that are excessively cold or too hot may be uneasy or uncomfortable to drink. |
| Give the patient small amounts of gluten-free meals that the patient desires regularly. | This method will aid in the maintenance of the patient’s nutritional status. An empty stomach might aggravate nausea in certain patients. |
| Keep the patient upright while eating and for 1 to 2 hours after meals. | This can assist to reduce the risk of aspiration. |
| Keep the patient’s room well-ventilated and assist the patient in getting some fresh air if possible. | A well-ventilated space or having a fan nearby facilitates breathing. |
| Educate the patient about the importance of changing position slowly and softly. | Excessive or abrupt movement may worsen nausea. |
| Educate the patient on the importance of taking prescription medications exactly as prescribed. | Taking medicines according to the instructions of the healthcare provider decreases nausea. |
| Educate the patient or caregiver on nausea-relieving fluid and food options. | By recognizing dietary considerations to consider while nauseated, patients and caregivers can encourage proper hydration and nutritional status. |
| Inform the patient or caregiver that if nausea or vomiting develops or persists for more than 24 hours, they should seek medical attention. | Vomiting regularly can cause dehydration, electrolyte imbalances, and nutritional deficiencies. |
Nursing Care Plan for Celiac Disease 4
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to possible dermatitis secondary to Celiac disease.
Desired Outcomes:
- The patient will be able to prevent dermatitis herpetiformis by having a gluten-free diet.
- The patient will avoid any possible skin breakdown.
- The patient and significant others will learn strategies on how to prevent pressure ulcers.
| Celiac Disease Nursing Interventions | Rationale |
| Assess the patient’s overall skin condition. | Skin condition assessment gives baseline data for potential interventions for the nursing diagnosis Risk for Impaired Skin Integrity. |
| Assess the patient’s mouth for oral sores and skin for the formation of itchy bumps and blisters known as dermatitis herpetiformis. | Oral ulcerations and sores are possible. Teeth discoloration or spots of weakening enamel are common side effects of dietary deficits and frequent vomiting. Dermatitis herpetiformis is characterized by an itchy, blistery rash on the elbows, knees, and buttocks. |
| Advise the patient to strictly follow the diet restrictions and maintain a gluten-free diet meal plan. | Dermatitis herpetiformis symptoms can be successfully controlled with a gluten-free diet and medications to relieve pain. |
| Determine the patient’s awareness of pressure sensations. A typical observation is when the patient changes positions away from pressure points every few minutes; this happens spontaneously even while sleeping | Patients who are oblivious to feeling tend to do nothing, resulting in prolonged pressure on skin capillaries and, ultimately, skin ischemia. |
| Examine the patient for fecal/urinary incontinence. After each loose stool, provide attentive skin care and use emollients. | Skin breakdown enzymes may be present in feces. Urine contains urea, which quickly converts to ammonia and is corrosive to the skin. Skin deterioration is accelerated by the use of diapers and incontinence pads. The use of emollients or lubricants is beneficial to prevent skin breakdown due to friction. |
| Encourage the patient to walk if he or she is able. | Ambulation relieves the strain on the skin caused by immobility, reducing the elements that can lead to compromised skin integrity. |
| Cleanse, dry, and moisturize the patient’s skin twice daily, especially bony prominences, or as suggested by incontinence or perspiration. Avoid using boiling water. If a powder is desired, use medical-grade cornstarch rather than talc. | A skin that is smooth and supple is more resistant to harm. These precautions keep moisture away from the skin. Talc, which can cause lung damage, should be avoided. |
| Educate the patient and caregiver on the causes of pressure on the skin. | This information can help the patient or caregiver find ways to avoid skin deterioration. |
| Emphasize to the patient the significance of turning, mobility, and ambulation. | These will boost their sense of efficacy and may increase adherence to the suggested interventions. |
| Arrange a patient consultation with a nutritionist. | The dietician can help the patient and family with gluten-free food preferences so that they can reach their nutritional and hydration goals. |
| Educate the patient and caregivers on the importance of appropriate skin care. | Educating patients and caregivers on maintaining skin integrity increases their sense of self-efficacy and avoids skin breakdown. |
Nursing Care Plan for Celiac Disease 5
Nursing Diagnosis: Ineffective Coping related to situational crisis secondary to Celiac disease, as evidenced by expressions of inability to cope, discouragement, anxiety, insufficient skills to meet goals, emotional tension, and depression.
Desired Outcomes:
- The patient will recognize their disruptive behaviors and identify ways to inhibit them from effectively coping.
- The patient will communicate suitable coping techniques and resources to avoid poor coping.
- The patient will express confidence in dealing with stressors.
| Celiac Disease Nursing Interventions | Rationale |
| Determine the patient’s stressors. | Evaluate the patient’s thoughts about their new diagnosis, understanding of medicine or procedure, feeling burdened with childcare or returning to work, recent losses, or changes in their relationships. |
| Monitor the patient for nonverbal signs of stress. | Patients may be reluctant to disclose their stressors. Distant, irritable, and easily distracted patients may develop. |
| Allow the patient to have uninterrupted times of sleep and rest. | Exhaustion caused by the disease tends to exaggerate problems, interfering with the patient’s ability to deal with stress. |
| Assess how the patient handles everyday stressors. | Assess hobbies, support systems, or beliefs that help the patient cope with daily stress through talk, such as exercise, crafting, religion, music, and so on. |
| Determine the patient’s support system and accessible resources. | When confronted with challenging problems alone, they can appear intimidating. Examine the patient’s living circumstances, family members, carers, and community resources. |
| Assess the patient’s perspective on the disease process. | The patient may not have an accurate comprehension of the stressful circumstance. They may be having an overly dramatic reaction or may not completely comprehend the gravity of their situation. It is important for the nurse to deliver accurate information and to assist the patient in coping. |
| Utilize therapeutic communication and active listening at all times. | Nurses can establish trusting connections with patients and further examine barriers to their ability to cope by using tactics such as active listening, reflecting open-ended inquiries, and even silence. |
| Educate the patient about the procedures to be done, the disease, and the goals of the treatment. | Giving the patient detailed information about their illness’s signs and symptoms, what to expect after a test or surgery, and projected outcomes allows them to feel more in control of their care without the extra stress of the unknown. |
| Utilize the availability of stress and relaxation techniques. | After determining which activities the patient does to cope with stress, the nurse can suggest alternatives such as reading, music, diversion, and guided visualization. |
| Provide the patient with positive responses without false reassurance. | When necessary, the nurse must educate the patient honestly and communicate the severity of the problem. By commenting on success such as improved vital signs, activity levels, or lab results, the nurse can also alleviate worries and prevent additional stress. |
| Arrange for the assistance of other professionals. | If a patient is deeply religious, arranging for a visit from a religious leader of their faith may be beneficial. Other forms of support, such as pet therapy or music therapy, may also be beneficial. |
More Nursing Diagnosis for Celiac Disease
- 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. (2022). 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. (2020). 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
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