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Nursing Care Plan for Celiac Disease

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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 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

The patient will maintain adequate nutrition; the patient will maintain adequate fluid balance; the 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

  • Assess mouth and skin
  Oral ulcerations and sores may be present. Teeth may have areas of discoloration or patches of thinning enamel, often caused by nutritional deficiencies and chronic vomiting. An itchy, blistery rash may occur on the elbows, knees, and buttocks in severe cases called dermatitis herpetiformis.  
  • Assess abdomen
 

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

 

  • Obtain history from parents; symptoms, frequency, known triggers; family history
  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.  
  • Monitor labs and diagnostic tests
  Blood tests may be run to determine the presence of antibodies for celiac disease or genetic testing  
  • Address vomiting and/or diarrhea as appropriate
  Excessive vomiting and diarrhea can cause severe fluid & electrolyte imbalances and should be addressed as appropriate to prevent long-term complications or circulatory collapse  
  • Assess for growth and developmental milestones
  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  
  • Administer medications and supplements as required
  Calcium and vitamin supplements may be given orally or by injection for better absorption  
  • 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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  • Question 1 of 3

The nurse caring for a two-year-old diagnosed with celiac disease knows which of the following symptoms are associated with this diagnosis? Select all that apply.

  • Question 2 of 3

A five-year-old has been admitted to the pediatric ward with possible celiac crisis. The nurse caring for this child knows that which of the following nursing interventions would be given top priority?

  • Question 3 of 3

A client with celiac disease is on a gluten-free diet while in the hospital. The nurse checks the tray before serving the client dinner. Which of the following foods would need to be removed before serving this client? Select all that apply.

Module 0 – Nursing Care Plans Course Introduction
Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

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