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.
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.
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
- Abdominal pain
- Poor appetite
- Symptoms reported to arise or worsen after consuming gluten
- Chronic diarrhea
- Muscle wasting
- Rash (dermatitis herpetiformis)
- Short stature
- Delayed puberty
- Learning disabilities
- Lack of muscle coordination
Nursing Interventions and Rationales
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.
- 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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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