Please enable JavaScript.
Coggle requires JavaScript to display documents.
Celiac Disease (Gluten sensitive enteropathy) (Nursing Care (Anxiety(r/t…
Celiac Disease
(Gluten sensitive enteropathy)
Nursing Care
Risk for fluid volume deficit
(r/t diarhea)
Monitor VS, particularly HR & BP (monitoring for hypovolemia)
Monitor fluid loss (diarhea)
Urge the patient to drink the amount of prescribed fluid
Risk for infection
Use meticulous hand washing technique and other procedures to prevent transmission of infection
Assess for fever, cough, irritability, or other signs of infection.
Provide meticulous skin care after each loose stool and apply lubricant to prevent skin breakdown.
Risk for imbalanced nutrition
(r/t poor gastrointestinal absorption of nutrients, weight loss )
Check skin turgor
Check for dry mucous membranes
Administer IV fluids if ordered by physician
Monitor for electrolyte imbalance (labs)
Monitor for consistent weight loss
Teach patient importance of maintaining Gluten-free Diet
Make sure that the diet is free from causative agent, but inclusive of essential nutrients, such as protein, fats, vitamins, and minerals.
Anxiety
(r/t possible malignant complications and autoimmune associations
Teach family members to develop an awareness of their family members condition and behavior.
Help family members recognize changes and help care for the family member accordingly.
Help the patient understand that although the disorder is lifelong, changes in the mucosal lining of the intestine are reversable as well as general clinical conditions when dietary gluten is avoided.
Recognize awareness of the patients anxiety
Be supportive to promote therapeutic communication.
Familiarize the patient with new environments and procedures.
Pain
r/t gastrointestinal complications (bloating, diarrhea, constipation, muscle cramps).
Use NSAIDs at by MD prescription to provide mild to moderate pain relief.
Foresee the need for pain relief.
Acknowledge reports of pain relief.
Get rid of additional stressors.
Deficient knowledge
r/t new diagnosis, misconseptions
Educate patient regarding symptoms that they can experience and how to control them.
Connect patient with additional resources outside of the hospital.
Educate patient on good oral hygiene.
What is it?
An immune disease of the small intestine caused by gluten.
What causes it?
(Pathophysiology)
The body produces antibodies against Gliadin (gluten), moving T-Lymphocytes into the small intestine causing inflamation that damages intestinal lining.
Absorption is Disrupted
Iron & Vitamin B12
are not absorbed causing anemia.
Fats
are not absorbed either and leave the body in the stool (
steatorhea
).
Water
is not absorbed and exits the body as diarhea.
Gliadin binds with human leukocyte antigen (HLA) and patients with celiac disease have a susceptibility to HLA-DQ2 and HLA-DQ8
The enzyme transglutaminase 2 (TG2) deamidates gliadin by converting glutamine into negatively charged glutamate ions, increasing the immunogenicity of gliadin
Gliadin peptides are presented in the intestinal lamina propria by way of the HLA molecules, initiating the inflammatory response, causing plasma cells to produce IgA and IgG antibodies that begin to attack gliden antigens
Cytotoxic intraepithelial lympghocytes migrate and activate natural killer cell receptors causing epithelial damage and villous atrophy in the small intestines. This chain reaction causes disturbing GI symptoms (see clinical manifestations to the left)
Genetic predisposition
Autoimmune disease
Clinical Manifestations
Systemic
Weight loss
Osteopenia, osteoporosis, and fractures
Chronic fatigue
Amenorrhea
Persistent anemia
Infertility
Muscle Cramps
Discoloration and loss of tooth enamel
Autoimmune Associations
Arthritis
Thyroid disease
Peripheral neuropathy, ataxia and epilepsy
Sjogren’s syndrome
Aphthous stomatitis/ulcers
Chronic active hepatitis, primary biliary cirrhosis, sclerosing
Dermatitis herpetiformis (DH)
Cholangitis
Malignancies
Esophageal carcinoma
Papillary thyroid cancer
Small intestinal adenocarcinoma
Melanoma
Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types)
Gastrointestinal
Recurring abdominal pain
Constipation
Bloating
Chronic Diarrhea
Gas
Diagnostic testing
Next comes antibody testing. Certain antibodies are more abundant in a patients with celiac disease, the most common and accurate antibody tested is the
IgA antitissue transglutaminase antibody (IgA-tTG)
High levels of this antibody show in about 98% of patients who have Celiac disease.
Achieving a final, concrete diagnosis includes a
small bowel biopsy via endoscopy. Under a microscope the tissue will appear flattened showing the villi are damaged
Treatment
Folic acid is prescribed to assist in regeneration of intestinal cells
Gluten containing foods are high in many B vitamins to vitamin B supplements may be necessary.
90% of patients who begin following a gluten-free diet are cured of their symptoms, intestinal damage beings to heal, and further intestinal damage is prevented.
Lack of absorption can cause deficiencies in magnesium, iron, and calcium. Blood tests should be done and supplements should be prescribed accordingly.
Diagnostic testing typically begins by ruling out other gastrointestinal conditions with the similar symptoms