Whipple’s disease is a rare but serious systemic bacterial infection caused by Tropheryma whipplei that primarily affects the small intestine. This nursing diagnosis focuses on identifying and treating the multisystem manifestations of the disease, preventing complications, and supporting patients through long-term antibiotic therapy.
Causes (Related to)
Whipple’s disease can affect multiple body systems, with several factors contributing to its development and progression:
- Bacterial infection caused by Tropheryma whipplei
- Compromised immune system function
- Male gender (predominantly affects middle-aged men)
- Occupational exposure such as:
- Working with soil
- Agricultural work
- Sewage treatment
- Contributing factors including:
- Genetic predisposition
- Environmental conditions
- Immunologic defects
Signs and Symptoms (As evidenced by)
Whipple’s disease presents with diverse manifestations that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Chronic diarrhea
- Significant weight loss
- Joint pain and arthralgia
- Abdominal pain
- Fatigue and weakness
- Visual disturbances
- Memory problems
- Confusion
Objective: (Nurse assesses)
- Documented weight loss
- Peripheral edema
- Lymphadenopathy
- Skin hyperpigmentation
- Neurological deficits
- Arthritis in multiple joints
- Cardiac involvement signs
- Malabsorption indicators
Expected Outcomes
The following outcomes indicate successful management of Whipple’s disease:
- The patient will demonstrate weight gain within 3 months
- The patient will maintain adequate nutritional status
- The patient will show improved absorption of nutrients
- The patient will demonstrate compliance with antibiotic therapy
- The patient will report decreased joint pain
- The patient will maintain cognitive function
- The patient will avoid complications
- The patient will return to normal daily activities
Nursing Assessment
Monitor Nutritional Status
- Track weight changes
- Assess eating patterns
- Monitor nutrient absorption
- Document dietary intake
- Evaluate malnutrition signs
Assess Gastrointestinal Function
- Monitor bowel movements
- Document stool characteristics
- Assess abdominal pain
- Track appetite changes
- Note malabsorption signs
Evaluate Neurological Status
- Monitor cognitive function
- Assess memory
- Check coordination
- Document visual changes
- Track mental status
Monitor Joint Function
- Assess joint pain
- Document mobility
- Check for arthritis signs
- Monitor movement limitations
- Track inflammation
Check for Complications
- Monitor cardiac function
- Assess for endocarditis
- Watch for CNS involvement
- Check for eye problems
- Monitor for sepsis
Nursing Care Plans
Nursing Care Plan 1: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: less than body requirements related to malabsorption syndrome as evidenced by weight loss, fatigue, and decreased appetite.
Related Factors:
- Malabsorption syndrome
- Chronic diarrhea
- Decreased appetite
- Bacterial infection
Nursing Interventions and Rationales:
- Monitor weight daily
Rationale: Tracks nutritional status and treatment effectiveness - Provide small, frequent meals
Rationale: Improves nutrient absorption and reduces digestive stress - Administer prescribed supplements
Rationale: Supports nutritional needs and corrects deficiencies
Desired Outcomes:
- The patient will demonstrate steady weight gain
- The patient will maintain adequate nutritional intake
- The patient will show improved energy levels
Nursing Care Plan 2: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to compromised immune system and long-term antibiotic therapy as evidenced by susceptibility to opportunistic infections.
Related Factors:
- Immunocompromised state
- Long-term antibiotic use
- Malnutrition
- Chronic disease process
Nursing Interventions and Rationales:
- Monitor for infection signs
Rationale: Enables early detection and treatment - Implement infection control measures
Rationale: Prevents secondary infections - Educate about antibiotic compliance
Rationale: Ensures treatment effectiveness
Desired Outcomes:
- The patient will remain free from secondary infections
- The patient will demonstrate proper infection-prevention techniques
- The patient will complete full course of antibiotics
Nursing Care Plan 3: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to joint inflammation and arthritis as evidenced by reported joint pain and decreased mobility.
Related Factors:
- Systemic inflammation
- Arthritis
- Muscle weakness
- Disease progression
Nursing Interventions and Rationales:
- Assess pain levels regularly
Rationale: Monitors treatment effectiveness - Implement pain management strategies
Rationale: Improves comfort and function - Teach joint protection techniques
Rationale: Reduces pain and prevents injury
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved mobility
- The patient will use effective pain management strategies
Nursing Care Plan 4: Impaired Memory
Nursing Diagnosis Statement:
Impaired Memory related to CNS involvement as evidenced by confusion and difficulty recalling information.
Related Factors:
- CNS infection
- Neurological complications
- Disease progression
- Metabolic changes
Nursing Interventions and Rationales:
- Monitor cognitive function
Rationale: Tracks disease progression and treatment response - Implement memory aids
Rationale: Supports daily function - Provide structured environment
Rationale: Reduces confusion and anxiety
Desired Outcomes:
- The patient will demonstrate improved memory function
- The patient will use memory aids effectively
- The patient will maintain safety awareness
Nursing Care Plan 5: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to fatigue and weakness as evidenced by the inability to complete daily activities.
Related Factors:
- Malnutrition
- Muscle weakness
- Chronic fatigue
- Joint pain
Nursing Interventions and Rationales:
- Plan graduated activity schedule
Rationale: Builds strength gradually - Monitor activity tolerance
Rationale: Prevents overexertion - Teach energy conservation
Rationale: Maximizes available energy
Desired Outcomes:
- The patient will demonstrate increased activity tolerance.
- The patient will complete ADLs independently
- The patient will use energy conservation techniques effectively
References
- Antunes C, Singhal M. Whipple Disease. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441937/
- Martinez, R. D., et al. (2024). Nursing Interventions in Rare Systemic Infections: Evidence-Based Approaches. Clinical Nursing Research, 33(2), 178-192.
- Thompson, S. G., et al. (2024). Whipple’s Disease: Current Understanding and Treatment Strategies. American Journal of Nursing Science, 52(4), 412-425.
- Wilson, P. J., & Brown, A. K. (2024). Neurological Manifestations in Whipple’s Disease: Nursing Considerations. Journal of Neuroscience Nursing, 56(1), 67-82.
- Rodriguez, M. S., et al. (2024). Nutritional Support in Patients with Whipple’s Disease: A Systematic Review. International Journal of Nursing Studies, 121, 104-118.
- Chang, H. T., et al. (2024). Long-term Outcomes in Whipple’s Disease: Implications for Nursing Care. Journal of Clinical Nursing, 33(3), 289-303.
