Nursing Care Plan (NCP) for Celiac Disease

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Outline

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.

    Writing a Nursing Care Plan (NCP) for Celiac Disease

    A Nursing Care Plan (NCP) for Celiac Disease starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

We are going to work on the nursing care plan together for celiac disease. So, the pathophysiology celiac disease is an autoimmune disorder and it causes your body to react adversely to gluten. And that is just a protein that’s found in wheat, barley, and rye. So some nursing considerations that we want to keep on the forefront. We want to keep track of fluid management. These patients often have a lot of vomiting and diarrhea, so we want to make sure that their fluid status is on the positive end. We want to make sure we avoid gluten and teach the patients which foods contain gluten and which ones to separate and keep out of their diet. We want to replace those electrolytes that are lost with vomiting and diarrhea. The desired outcome for these patients is that we want this patient to maintain adequate nutrition. 

It’s very important that the patient maintain adequate fluid balance as well as appropriately meet all developmental milestones, because there definitely are some developmental milestones that could be missed with celiac disease. So subjective data, the patient’s going to come in, we’re going to see the patient and the patient is going to tell us a few things. What are some things that you think the patient would be concerned about or, uh, what have, uh, presenting the symptoms? Well, if they consume gluten, we can definitely say that there’s going to be some abdominal pain. It just upsets your stomach. They also want to have a poor appetite. They don’t want those symptoms. So in order to avoid those symptoms, they just won’t eat. They’re going to be irritable. They are going to complain of constant headaches and these symptoms are going to arise or worsen after they consume gluten. So we wouldn’t say gluten equals no objective data. What are some things that we’re going to observe from the patients? Well, the patient is going to have some vomiting, some diarrhea, they’ll have some muscle wasting, and they’ll have a rash. Also these patients with celiac disease are short, so they will typically have a short stature. As far as their height. They also have some delayed puberty and some learning disabilities. Oftentimes these patients present with lack of muscle coordination and, in some of the severe cases, they will be at risk for seizures. 

So, for this patient, what are some things that we want to be mindful of as far as our nursing intervention? Well, the first nursing intervention that is important is assessment. We want to assess the mouth and the skin. The reason why is because these patients are always vomiting. And what is vomit? It has a lot of acid from the stomach. So the teeth may have areas of this coloration often caused by nutritional deficit; deficiencies and chronic vomiting. Itchy blistery rash may occur on the elbows, knees, and buttocks in severe cases. And that actually has a name called dermatitis. We also want to make sure that we address the vomiting or the diarrhea as appropriate. The excessive vomiting and diarrhea can cause severe fluid and electrolyte imbalances, and it should be addressed as soon as possible. We want to prevent long-term complications or circulatory collapse. So we want to keep fluids positive. We want that balance to be positive. We want to do things to decrease vomiting and diarrhea. 

We’re going to administer medications and supplements as required. These patients are not able to eat the same foods as other people, because a lot of foods do contain gluten. We want to make sure that they’re getting supplementation for those foods and those supplements that they aren’t able to get via eating. So calcium and vitamin supplements may be given orally or by injection for better absorption. We want to provide education regarding possible trigger foods. We want to recommend keeping a dialogue in order to determine triggers to avoid. So oftentimes these patients and their family members will just keep a diet log. And this is just telling what they eat for breakfast, lunch, dinner, and snack. And then we’ll see, okay, Hey, you should probably stay away from this. Cause this is definitely a trigger food. It’s all about education. 

We want to assess the patient once again for growth and developmental milestones. Children with celiac disease often have delays in meeting developmental milestones, especially if they’re diagnosed later in childhood. And that just comes from a lack of certain minerals and vitamins that are essential to development as children. So gluten-free foods are the way to go. This here, you see, is a picture of a week and you know what we don’t want and we cannot have. There are many gluten-free foods that patients with celiac disease can enjoy, so they can have fruits, vegetables, beans, lentils, meat, and corn-based products that also contain no gluten. Rice, soy and nuts are also gluten free. So there is a wide variety of foods that the patients with celiac disease can still enjoy and have a satisfying diet. Some key points. Let’s focus on these key points because these are essential to ensuring that you understand the content for celiac disease. 

So the pathophysiology, once again, celiac disease is an autoimmune disorder. So that means it’s against your body. It’s just your body reacting adversely to gluten that’s found in wheat, barley and rye. The patient is going to complain of abdominal pain. They’re going to have a poor appetite. They’re going to be irritable with headaches. Some objective data that we are going to be able to see is vomiting, diarrhea, learning disabilities. There’s going to be a rash on the elbows, knees or buttocks, some diet considerations. That’s what is prime for managing these patients? We want the patients to avoid gluten and we will use supplements in this case to increase vitamin absorption, fluid and electrolytes. These patients are chronically dehydrated. So we want to make sure we administer IV fluids for dehydration, and we replace electrolytes that were lost with vomiting and diarrhea. We love you guys. NOw, go out and be your best selves today and,as always, happy nursing.

 

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