Nursing Care Plan for Celiac Disease

Pathophysiology

Celiac disease is an autoimmune disorder that causes the body to react adversely to gluten, a protein found in wheat, barley and rye. The immune system responds to the gluten as a foreign invader and attacks the small intestine causing inflammation which damages the small intestine and prevents the body from absorbing nutrients properly. Children with Celiac Disease often have slow or stunted growth and development. Treatment requires a lifelong gluten-free diet to manage symptoms and further intestinal damage. If left untreated, celiac disease can lead to other, serious conditions including ADHD, epilepsy, diabetes, intestinal cancer and infertility.

Etiology

The primary component of gluten, called gliadin, is what triggers the immune system to attack the lining of the small intestine (villi). When this lining is damaged, nutrients cannot be absorbed.  This abnormal immune response is thought to be primarily a genetic trait as it tends to run in families and affects approximately 1 out of every 100 people worldwide.

Desired Outcome

Patient will maintain adequate nutrition; patient will maintain adequate fluid balance; patient will appropriately meet all developmental milestones

Celiac Disease Nursing Care Plan

Subjective Data:

  • Abdominal pain
  • Poor appetite
  • Irritability
  • Headaches
  • Symptoms reported to arise or worsen after consuming gluten

Objective Data:

  • Vomiting
  • Chronic diarrhea
  • Muscle wasting
  • Rash (dermatitis herpetiformis)
  • Short stature
  • Delayed puberty
  • Learning disabilities
  • Lack of muscle coordination
  • Seizures

Nursing Interventions and Rationales

  1. Assess mouth and skin

  2. Oral ulcerations and sores may be present.

    Teeth may have areas of discoloration or patches of thinning enamel, often caused from nutritional deficiencies and chronic vomiting.

    An itchy, blistery rash may occur on the elbows, knees and buttocks  in severe cases called dermatitis herpetiformis.

  3. Assess abdomen

    • Look for bloating
    • Listen for (hyperactive) bowel sounds
    • Feel / percuss for fluid, fullness or pain, note if constipation is present

  4. Obtain history from parents; symptoms, frequency, known triggers; family history

  5. Celiac disease is thought to be hereditary, so there may be other family members with the same disease. Note if any family members have developed complications such as diabetes or epilepsy.

  6. Monitor labs and diagnostic tests

  7. Blood tests may be run to determine the presence of antibodies for celiac disease or genetic testing

  8. Address vomiting and/or diarrhea as appropriate

  9. Excessive vomiting and diarrhea can cause severe fluid & electrolyte imbalances and should be addressed as appropriate to prevent long-term complications or circulatory collapse

  10. Assess for growth and developmental milestones

  11. Children with celiac often have delays in meeting developmental milestones, especially if diagnosed later in childhood.

    Patients may have slow or stunted growth due to malabsorption issues.

    Patients may have previously been treated for failure to thrive

    Patients may have delays in puberty

  12. Administer medications and supplements as required

  13. Calcium and vitamin supplements may be given orally or by injection for better absorption

  14. Provide nutritional education for patient and parent

    • Help them to understand how to read food labels.
    • Provide education regarding possible trigger foods.
    • Recommend keeping a diet log to help determine triggers to avoid.
    • Gluten may also be found in hygiene products and children’s modeling clay.


References

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