Whipple’s Disease Nursing Care Plans Diagnosis and Interventions
Whipple Disease NCLEX Review and Nursing Care Plans
Whipple’s disease is a rare infection caused by the bacteria Tropheryma whipplei. It can affect any organ system in the body, although it is most noted to affect the gastrointestinal system.
Whipple’s disease affects the metabolism of fats. In the gastric system, the bacteria inhibit the proper absorption of nutrients, causing weight loss and problems with the immune system.
Whipple’s disease is more common in men than women with about 4:1 case ratio.
There are also more cases found in people with European and American heritage aged between 30 and 80 years compared to other races.
Whipple’s disease is curable when diagnosed and treated properly; however, if left untreated, it can lead to serious complications.
Signs and Symptoms of Whipple’s Disease
The clinical manifestations of Whipple’s disease vary greatly from person to person due to the possible differences of organ system affected.
The following are the common symptoms noted in majority of cases:
- Weight loss
- Joint pain
Other signs and symptoms may include the following:
- Neurological symptoms
- Eye or facial muscle abnormalities
- Memory loss
- Visual impairment
- Abnormal bleeding
- Abdominal pain
- Loss of appetite
- Darkening of skin in scars or in areas exposed to the sun
- Enlarged lymph nodes
Causes of Whipple’s Disease
Primarily caused by the bacteria Tropheryma whippelei, Whipple’s disease is still being studied as it is unknown how the infection occurs.
There are studies that suggest the said bacteria may be a part of the normal flora in the body.
One study showed the presence of this bacteria in 35% of saliva sample from 40 healthy patients.
Also, it is reported that the bacteria are commonly found in soil and water. Research shows that the disease occurs in people working in jobs with frequent contact with soil such as in agriculture and construction.
Another theory suggests that a genetic defect may predispose people to react differently to the bacteria causing a cascade of symptoms.
Complications of Whipple’s Disease
- Malabsorption. Malabsorption refers to the improper absorption of nutrients in the intestines. The infection in Whipple’s disease causes damage to the villi in the lining of the small intestines responsible for the absorption of nutrients. This leads to a range of problems such as weakness, malnutrition, joint pain, and fatigue.
- Death. In some cases, Whipple’s disease is recognized and diagnosed late which delays proper treatment. Deaths are continued to be reported and are thought to be caused by the spread of infection in the brain due to the delay in treatment.
Diagnosis of Whipple’s Disease
The diagnosis of Whipple’s disease may be tricky due to the possible multi-system involvement.
Suspicion should be raised when there is treatment-resistant arthralgia combined with gastrointestinal problems and/or neurological symptoms and heightened inflammatory markers.
The definitive diagnosis for Whipple’s disease is through histology and polymerase chain reaction (PCR).
- Physical Examination – to identify the presence of the signs and symptoms such as darkened skin and tenderness of the abdomen.
- Laboratory tests – a series of lab tests is helpful in determining and ruling out associated conditions. Lab tests may include a full blood count, serum albumin, CRP, and ESR.
- Biopsy – analysing a tissue sample of the intestinal wall under a microscope is gold standard in the diagnosis of Whipple’s disease. If the test comes back negative, a sample from an enlarged lymph node will be confirmatory. A biopsy sample is often taken through an endoscopic procedure. However, another way of testing for the presence of the bacteria is through a DNA-based test known as polymerase chain reaction.
Treatment for Whipple Disease
Antibiotics treatment is the primary treatment option for Whipple’s disease. In addition to this, symptom relief is also performed.
The following are the treatment methods for people with Whipple’s disease:
- Antibiotics treatment. Just like other bacterial infections, Whipple’s disease is treated with antibiotics. Treatment with antibiotics is normally started at a regular course of two weeks and is normally given intravenously. However, another type of antibiotic is prescribed after the first course which will be taken orally for up to a year or two. This is because of the possibility of recurrence and reinfection. Regular monitoring and follow up is necessary while on treatment to watch out for side effects. If symptoms reappear, the antibiotic should be reviewed and changed.
- Symptomatic relief. The signs and symptoms of Whipple’s disease usually improve after a week or two and then completely go away after a month. Treatment to relieve symptoms such as antipyretics for fever and pain killers for joint pain may be necessary.
- Supplementation. Whipple’s disease is highly associated with malnutrition and malabsorption. The intake of nutritional meals and supplements such as vitamins and minerals may be necessary to meet the nutritional demands of the body and provide energy to the patient.
- Regular monitoring and follow up. Regular follow up is required for people diagnosed with Whipple’s disease even after years of getting the infection.
Nursing Diagnosis for Whipple’s Disease
Whipple’s Disease Nursing Care Plan 1
Nursing Diagnosis: Acute Pain related to infection secondary to Whipple’s disease as evidenced by pain score of 10 out of 10, verbalization of joint pain, guarding sign
Desired Outcome: The patient will have a pain score of 0 out of 10.
|Whipple’s Disease Nursing Interventions||Rationales|
|Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing.||To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.|
|Administer analgesics/ pain medications as prescribed. Administer antibiotics as prescribed.||To provide pain relief to the patient. To treat the underlying infection.|
|Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic.||To assess the effectiveness of treatment.|
|Provide more analgesics at recommended/prescribed intervals.||To promote pain relief and patient comfort without the risk of overdose.|
|Elevate the head of the bed and encourage the patient to sit in semi Fowler’s position. Encourage pursed lip breathing and deep breathing exercises.||To relieve shortness of breath and help in lung expansion. To promote optimal patient comfort and reduce anxiety/ restlessness.|
|Refer the patient to a pain specialist as required.||To enable to patient to receive more information and specialized care in pain management if needed.|
Whipple’s Disease Nursing Care Plan 2
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to malabsorption of nutrients and decrease food intake secondary to Whipple’s disease as evidenced by weight loss, diarrhea, joint pain, poor muscle tone and lack 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.
|Whipple’s Disease Nursing Interventions||Rationale|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term goals of weight gain.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Administer analgesics as prescribed.||To provide pain relief, as acute pain may result to disinterest in eating and eventual lack of proper nutrition.|
|Administer supplements, nutritional meals and drinks/shakes as prescribed.||Whipple’s disease is highly associated with malnutrition and malabsorption. The intake of nutritional meals and supplements such as vitamins and minerals may be necessary to meet the nutritional demands of the body and provide energy to the patient.|
|Instruct the patient to avoid carbonated beverages and gas-producing food.||To reduce abdominal distention which can worsen acute pain.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet.|
Whipple’s Disease Nursing Care Plan 3
Nursing Diagnosis: Activity intolerance related to acute pain as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Whipple’s Disease Nursing Interventions||Rationales|
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.|
|Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.|
More Nursing Diagnosis for Whipple Disease
- Disturbed Sensory Perception (Visual)
- Risk for Bleeding
- Risk for Infection (Post-surgery)
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. (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
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