Celiac Disease

Notes

Description
  • Also called Gluten-Sensitive Enteropathy.Celiac Dse
  • Is a disease of the small intestine marked by atrophy of the villi and microvilli caused by an immune-mediated inflammatory response to gluten, a protein found in common grains such as wheat, rye, oats, and barley.
  • The cause is unknown, but genetic, environmental, and immunologic elements maybe involved.
  • The disease is triggered by surgery, pregnancy, viral infection, or severe emotional distress.
  • It is most common in young children ages 6 to 24 months but can occur at any age.
  • Symptoms typically diminish or disappear in adolescence and reappear in early adulthood.
  • Complications include impaired growth, inability to fight infections, electrolyte imbalance, clotting disturbance, and possible predisposition to malignant lymphoma of the small intestine.

celiacdisease1

Assessment
Ages 3 to 9 months
  1. Acutely ill; severe diarrhea and vomiting
  2. Irritability
  3. Possible failure to thrive
Ages 9 to 18 months
  1. Slackening of weight followed by weight loss
  2. Abnormal stools
    • Pale, soft, bulky
    • Offensive odor
    • Greasy (steatorrhea)
    • May increase in number
  3. Abdominal distention
  4. Anorexia, discoloration of teeth
  5. Muscle wasting: most obvious in buttocks and proximal parts of extremities
  6. Hypotonia, seizures
  7. Mood changes: ill humor, irritability, temper tantrums, shyness
  8. Mild clubbing of fingersClubbed fingers
  9. Vomiting: usually occurs in the evening
  10. Aphthous ulcers, dermatitis
Older Child and Adult
  1. Signs and symptoms are commonly related to nutritional or secondary deficiencies resulting from disease.
    • Anemia, vitamin deficiency (A, D, E, K)
    • Hypoproteinemia with edema
    • Hypocalcemia, hypokalemia, hypomagnesemia
    • Hypoprothrombinemia from vitamin K deficiency
    • Disaccharide (sugar) intolerance
    • Osteoporosis due to calcium deficiency
  2. Anorexia, fatigue, weight loss.
  3. May have colicky abdominal pain, distention, flatulence, constipation, and steatorrhea.
Diagnostic Evaluation
  1. Small bowel biopsy, which demonstrates characteristic abnormal mucosa.
  2. Hemoglobin, folic acid, and Vitamin K levels may be reduced.
  3. Prothrombin time may be prolonged.
  4. Elevated immunoglobulin (Ig) A endomysium antibodies and IgA anti-tissue transglutaminase antibodies.
  5. Total protein and albumin may be decreased.
  6. 72 hour stool collection for fecal fat is increased.
  7. D-xylose absorption test – decreased blood and urine levels.
  8. Sweat test and pancreatic function studies may be done to rule out cystic fibrosis in child.
Therapeutic Intervention
  1. Dietary modifications includes a lifelong gluten-free diet, avoiding all foods containing wheat, rye, barley, and possibly, oats.
  2. In some cases, fats maybe reduced.
  3. Lactose and sucrose may be eliminated from diet for 6 to 8 weeks, based on reduced disaccharidase activity.
The Gluten-free Diet: Some Examples

In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. The following chart is based on the 2006 recommendations. This list is not complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. People with celiac disease should always read food ingredient lists carefully to make sure the food does not contain gluten.

Allowed Foods
amaranth
arrowroot
buckwheat
cassava
corn
flax
Indian rice grass
Job’s tears
legumes
millet
nuts
potatoes
quinoa
rice
sago
seeds
sorghum
soy
tapioca
teff
wild rice
yucca
Foods To Avoid
wheat

  • including einkorn, emmer, spelt, kamut
  • wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein
barley
rye
triticale (a cross between wheat and rye)
Other Wheat Products
bromated flour
durum flour
enriched flour
farina
graham flour
phosphated flour
plain flour
self-rising flour
semolina
white flour
Processed Foods that May Contain Wheat, Barley, or Rye*
bouillon cubes
brown rice syrup
candy
chips/potato chips
cold cuts, hot dogs, salami, sausage
communion wafers
French fries
gravy
imitation fish
matzo
rice mixes
sauces
seasoned tortilla chips
self-basting turkey
soups
soy sauce
vegetables in sauce

* Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.

Nursing Intervention
  1. Monitor dietary intake, fluid intake and output, weight, serum electrolytes, and hydration status.
  2. Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as protein, fats, vitamins, and minerals.
  3. Maintain NPO status during initial treatment of celiac crisis or during diagnostic testing.
  4. Provide parenteral nutrition as prescribed.
  5. Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown.
  6. Encourage small frequent meals, but do not force eating if the child has anorexia.
  7. Use meticulous hand washing technique and other procedures to prevent transmission of infection.
  8. Assess for fever, cough, irritability, or other signs of infection.
  9. Teach the parents to develop awareness of the child’s condition and behavior; recognize changes and care for child accordingly.
  10. Explain that the toddler may cling to infantile habits for security. Allow this behavior, it may disappear as physical condition improves.
  11. Stress that the disorder is lifelong; however, changes in the mucosal lining of the intestine and in general clinical conditions are reversible when dietary gluten is avoided.

 

 


Sources:
National Science Foundation and ADAM for images
Nursing crib.com

Exam

Welcome to your MSN Exam for Celiac Disease! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 15 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Focus on the type of protein that individuals with celiac disease must avoid, which is found in certain grains.

1 / 15

1. Nurse Martinez is preparing discharge instructions for the parents of 8-year-old Lucas, who has been diagnosed with celiac disease. The nurse is emphasizing the importance of dietary management. Which food item should Nurse Martinez advise the parents to ensure Lucas avoids?

💡 Hint

Focus on a symptom that is indicative of fat malabsorption, a common issue in celiac disease.

2 / 15

2. Nurse Thompson is conducting an assessment on a client who has been diagnosed with celiac disease. She is aware that certain clinical findings are commonly associated with this condition. Which of the following is Nurse Thompson likely to observe in this client?

💡 Hint

Consider which of these food options does not contain gluten, a protein that must be avoided in a celiac disease diet.

3 / 15

3. Nurse Adams is counseling Mrs. Johnson, who is learning how to manage her 8-year-old son's newly diagnosed celiac disease through dietary changes. To assess Mrs. Johnson's understanding of the gluten-free diet necessary for celiac disease, Nurse Adams asks her to select a suitable meal option for her son. Which choice indicates that Mrs. Johnson has understood the dietary instructions?

💡 Hint

Consider the type of food that contains gluten, a protein that individuals with celiac disease must avoid.

4 / 15

4. Nurse Martinez is providing dietary education to a patient recently diagnosed with celiac disease. She explains the types of food that must be avoided to manage the condition effectively. Which food group should Nurse Martinez emphasize as being problematic for people with celiac disease?

💡 Hint

Consider the gastrointestinal symptoms that are exacerbated during a celiac crisis.

5 / 15

5. Nurse Jackson is caring for Jamie, a 10-year-old child with celiac disease, who is experiencing a celiac crisis triggered by an upper respiratory infection. The nurse is conducting an assessment to monitor Jamie's condition. Which symptom is Nurse Jackson most likely to observe in Jamie during this crisis?

💡 Hint

Consider the nature of celiac disease and how its management relates to the duration of dietary restrictions.

6 / 15

6. Nurse Taylor is educating the parents of 7-year-old Sam, who has recently been diagnosed with celiac disease, about the dietary restrictions he needs to follow. After the session, the parents express their understanding of the diet's duration. Which statement shows they have understood correctly?

💡 Hint

Focus on the non-invasive, lifestyle-based approach that is essential for managing this particular digestive disorder.

7 / 15

7. In a discussion about managing celiac disease, Nurse Patel is explaining to her patient the primary method of treatment. She emphasizes the importance of this approach in controlling symptoms and preventing complications. What should Nurse Patel identify as the mainstay of treatment for celiac disease?

💡 Hint

Consider the type of grains that are safe for individuals with celiac disease, who must avoid gluten.

8 / 15

8. Nurse Martinez is counseling a client diagnosed with celiac disease about suitable meal options. She wants to suggest a meal that aligns with the dietary restrictions of this condition. Which meal selection should Nurse Martinez recommend?

💡 Hint

Consider the diverse range of complications that can result from the chronic inflammatory process and malabsorption associated with celiac disease.

9 / 15

9. In a seminar on the long-term effects of celiac disease, Nurse Cooper is discussing the potential complications that can arise if the condition is not well-managed. She asks the attendees to identify which complications are associated with celiac disease. What should be the correct response?

💡 Hint

Consider the nature of celiac disease and its potential association with other autoimmune disorders.

10 / 15

10. Nurse Garcia is caring for Lisa, a 35-year-old patient diagnosed with celiac disease. During a health education session, Lisa expresses concern about the possibility of having other health conditions associated with celiac disease. Nurse Garcia plans to discuss this with Lisa. Which of the following conditions is Lisa at risk for?

💡 Hint

Think about the diagnostic procedure that directly examines the part of the body most affected by celiac disease.

11 / 15

11. During a health education session, Nurse Green explains to her patients the diagnostic process for celiac disease. She outlines the various methods used to confirm the diagnosis. Which method should she mention as the standard approach to diagnosing celiac disease?

💡 Hint

Think about the range of physical and emotional factors that can potentially initiate the onset of autoimmune disorders in susceptible individuals.

12 / 15

12. Nurse Thompson is discussing with a group of nursing students the various triggers that can potentially activate celiac disease in genetically predisposed individuals. She asks the students to identify which circumstances might trigger the onset of this autoimmune disorder. Which option should they choose?

💡 Hint

Consider the range of gastrointestinal and systemic symptoms that can be associated with celiac disease.

13 / 15

13. Nurse Roberts is conducting a seminar on celiac disease and its symptoms. She presents a case study and asks the participants to identify which symptom is associated with celiac disease. What is the correct response?

💡 Hint

Think about a congenital condition affecting the colon that can lead to delayed passage of meconium in newborns.

14 / 15

14. Nurse Lee is assessing a newborn who has not passed meconium within the first 24 hours after birth. She recalls that this symptom could be indicative of a specific condition. Which of the following conditions should Nurse Lee consider as a potential diagnosis?

💡 Hint

Focus on which food option is naturally gluten-free and therefore safe for a child with celiac disease.

15 / 15

15. Nurse Lee is educating the parents of a young child diagnosed with celiac disease about appropriate dietary choices. She emphasizes the importance of selecting foods that are safe and beneficial for their child. Which of the following food items should Nurse Lee recommend for inclusion in the child's diet?