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Nursing Care Plan (NCP) for Celiac Disease

Nursing Care Plan (NCP) for Celiac Disease

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Study Tools For Nursing Care Plan (NCP) for Celiac Disease

Celiac Disease Pathochart (Cheatsheet)
Example Care Plan_Celiac Disease (Cheatsheet)
Blank Nursing Care Plan_CS (Cheatsheet)

Outline

Lesson Objective for Celiac Disease

  • Understanding Celiac Disease:
    • Comprehend the pathophysiology and immunological basis of celiac disease, including the role of gluten intolerance and its impact on the small intestine.
  • Recognition of Signs and Symptoms:
    • Identify the common signs and symptoms associated with celiac disease, such as gastrointestinal issues, nutritional deficiencies, and extra-intestinal manifestations.
  • Dietary Management:
    • Learn effective strategies for dietary management, including gluten-free nutrition, to prevent symptom exacerbation and promote overall well-being.
  • Complication Prevention:
    • Understand the potential complications of untreated celiac disease and learn preventive measures to mitigate long-term health risks.
  • Holistic Patient Care:
    • Develop skills in providing holistic care for individuals with celiac disease, considering both the physical and psychosocial aspects of their health.

Pathophysiology of Celiac Disease

  • Immune Response to Gluten:
    • Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye.
    • The immune system mistakenly recognizes gluten as a threat in genetically predisposed individuals, leading to an abnormal immune response.
  • Intestinal Damage:
    • The immune response targets the small intestine’s lining, causing inflammation and damage to the villi—small finger-like projections responsible for nutrient absorption.
    • Villous atrophy and flattening result in a decreased surface area for nutrient absorption.
  • Nutrient Malabsorption:
    • Impaired villi compromise the absorption of essential nutrients, such as vitamins, minerals, and fats.
    • Malabsorption can lead to nutritional deficiencies and a range of symptoms, affecting various organ systems.
  • Clinical Manifestations:
    • Celiac disease can present with a diverse array of symptoms, including gastrointestinal issues (diarrhea, abdominal pain), fatigue, weight loss, dermatitis herpetiformis (skin rash), and neurological symptoms.
  • Long-Term Complications:
    • Untreated celiac disease may lead to long-term complications, such as osteoporosis, anemia, infertility, and an increased risk of certain autoimmune diseases and malignancies.

Etiology of Celiac Disease

  • Genetic Predisposition:
    • Celiac disease has a strong genetic component, with specific human leukocyte antigen (HLA) genotypes, particularly HLA-DQ2 and HLA-DQ8, associated with an increased risk.
    • Individuals inheriting these genetic factors from family members have a higher susceptibility to developing celiac disease.
  • Environmental Trigger (Gluten Exposure):
    • Gluten, a protein found in wheat, barley, and rye, acts as the environmental trigger for celiac disease.
    • In genetically susceptible individuals, the ingestion of gluten initiates an abnormal immune response, leading to the development of the condition.
  • Immune System Response:
    • Celiac disease is characterized by an autoimmune response, where the immune system mistakenly targets and attacks the body’s own tissues, specifically the small intestine.
    • This response is triggered by the interaction between gluten and the genetic factors associated with celiac disease.
  • Age of Gluten Introduction:
    • The timing of gluten introduction to an infant’s diet may influence the development of celiac disease.
    • The introduction of gluten during early infancy, especially in genetically predisposed individuals, has been linked to an increased risk of celiac disease.
  • Other Environmental Factors:
    • Besides genetic and gluten-related factors, environmental factors such as infections and early childhood events may contribute to the development of celiac disease.
    • The interplay between genetic susceptibility and environmental triggers plays a key role in the etiology of the disease.

Desired Outcome for Celiac Disease

  • Gluten-Free Lifestyle:
    • Adherence to a strict gluten-free diet to prevent exposure to gluten-containing foods and substances.
  • Resolution of Symptoms:
    • Relief and resolution of gastrointestinal symptoms such as diarrhea, abdominal pain, bloating, and fatigue.
  • Healing of Intestinal Mucosa:
    • Improvement and normalization of the intestinal mucosa, as observed through follow-up biopsies, indicating reduced inflammation and damage.
  • Nutritional Status Optimization:
    • Attainment and maintenance of optimal nutritional status, including the normalization of vitamin and mineral levels, especially those commonly affected by malabsorption.
  • Prevention of Complications:
    • Prevention or reduction of complications associated with untreated celiac disease, such as malnutrition, osteoporosis, infertility, and the development of other autoimmune conditions.

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 Assessment for Celiac Disease

 

  • Clinical History:
    • Obtain a detailed medical history, including gastrointestinal symptoms, family history of celiac disease, and associated autoimmune conditions.
  • Dietary History:
    • Assess the patient’s typical diet to identify sources of gluten and evaluate their understanding of a gluten-free diet.
  • Physical Examination:
    • Conduct a thorough physical examination, focusing on signs of malnutrition, such as weight loss, muscle wasting, and nutritional deficiencies.
    • Assess the patient’s skin for any rashes or lesions. Clusters of itchy bumps or scabs may be dermatitis herpetiformis.
  • Laboratory Tests:
    • Order and interpret laboratory tests, including serologic markers (e.g., anti-tissue transglutaminase antibodies, anti-endomysial antibodies) and nutrient levels (vitamins, minerals) to aid in diagnosis and assess nutritional status.
  • Intestinal Biopsy:
    • Collaborate with the healthcare team to arrange for an intestinal biopsy to confirm the diagnosis and assess the extent of mucosal damage.
  • Assessment of Complications:
    • Evaluate for complications associated with celiac disease, such as osteoporosis, anemia, and infertility, through appropriate diagnostic tests.
  • Psychosocial Assessment:
    • Explore the patient’s emotional and psychological well-being, addressing concerns related to dietary restrictions, lifestyle changes, and the impact of the disease on mental health.
  • Patient Education:
    • Assess the patient’s knowledge and understanding of celiac disease, its management, and the importance of adhering to a gluten-free lifestyle. Provide educational resources as needed.

 

Implementation of Nursing Care Plan for Celiac Disease 

 

  • Nutritional Counseling:
    • Collaborate with a registered dietitian to develop a personalized, gluten-free diet plan, educating the patient on safe food choices and alternatives to gluten-containing products.
  • Medication Administration:
    • Administer prescribed medications, such as supplements for nutrient deficiencies or medications to manage associated conditions like osteoporosis and skin rash.
  • Monitoring and Symptom Management:
    • Regularly monitor the patient for signs of symptom improvement or exacerbation, addressing any emerging issues promptly. Manage symptoms through appropriate interventions.
  • Education and Lifestyle Modification:
    • Provide ongoing education on celiac disease, emphasizing the importance of strict adherence to a gluten-free diet. Assist the patient in making necessary lifestyle modifications to support overall well-being.
  • Health Promotion:
    • Assess the patient’s hepatitis B and influenza immunization status, as appropriate. Encourage infection prevention practices, such as hand hygiene. 
  • Coordination of Care:
    • Facilitate communication and coordination among healthcare providers, ensuring a multidisciplinary approach to address both the gastrointestinal and potential extraintestinal manifestations of celiac disease.

Nursing Interventions and Rationales for Celiac Disease

 

  • 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.

Evaluation of Nursing Care Plan for Celiac Disease

 

  • Symptom Assessment:
    • Regularly assess the patient for changes in symptoms related to celiac disease, such as gastrointestinal complaints, fatigue, or dermatologic manifestations.
  • Dietary Adherence:
    • Evaluate the patient’s adherence to a gluten-free diet through dietary recalls, discussions, and monitoring nutritional markers to ensure optimal nutrient intake.
  • Nutritional Status:
    • Monitor nutritional markers, such as vitamin and mineral levels, to assess improvements or deficiencies. Adjust interventions as needed to address any identified nutritional issues.
  • Quality of Life:
    • Assess the patient’s overall quality of life, considering both physical and psychosocial aspects. Evaluate the impact of celiac disease management on daily functioning and well-being.
  • Collaboration with Healthcare Team:
    • Evaluate the effectiveness of interdisciplinary collaboration among healthcare providers in managing celiac disease and its associated conditions. Ensure that coordinated care contributes to positive patient outcomes.

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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