Running Head: CELIAC DISEASE 1

Celiac Disease

Allison Vaughan, Ashlee Madrid, Kaitlyn Almaraz

Pediatric Nursing

Professor D’Amato

July 19, 2016

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Abstract

This paper discusses the medical syndrome known as Celiac Disease. It begins by discussing the

definition and pathophysiology of Celiac Disease. Statistical data will be presented as stated by

Hatfiel (2014). The paper will also include clinical manifestations of the disease, methods of

diagnoses, treatment options, and nursing care.

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Celiac Disease

Celiac Syndrome is a group of complex intestinal malabsorptive disorders. Intestinal

malabsorption with the clinical manifestation of steatorrhea is a medical condition brought about

by various causes. The most common causes are Cystic Fibrosis, a major dysfunction of all

exocrine glands, and gluten-induced enteropathy. This paper will focus on the malabsorptive

disorder caused by gluten-induced enteropathy.

Pathophysiology

The pathophysiology of Celiac Disease is based in the intestinal tract. Idiopathic Celiac

Disease is a basic defect of metabolism caused by the ingestion of wheat or rye gluten. The

ingestion of wheat or rye gluten triggers an allergic reaction in the body. The body responds by

attacking both the gluten cells and the delicate villi in the intestinal tract. As the villi become

damaged the body is unable to absorb the nutrients it needs. Fat becomes especially difficult to

absorb which leads to the clinical manifestation of steatorrhea or foul, fatty stools. According to

Hatfield (2014) the exact cause of Celiac Disease is unknown. However, the author states that

“the most acceptable theory is that of an inborn error of metabolism with an allergic reaction to

the gliadin fraction of gluten (a protein factor in wheat) as a contributing or possibly the sole

factor” in the cause of Celiac Disease (Nancy T. Hatfield, 2014, pg. 841).

Statistics

The statistical evidence suggests that severe cases of Celiac Disease in the United States

and Western Europe are rare. However mild cases of the disease related to ingestion of rye,
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wheat, and sometimes oat gluten are relatively common. Mild cases of the disease have been

reported in as many as 3-13 per 1000 children in the United States (Hill, 2012). According to the

University of Chicago Celiac Disease Center the average length of time it takes for a

symptomatic person to be diagnosed with Celiac Disease in the United States is four years. “This

type of delay dramatically increases an individual’s risk of developing autoimmune disorders,

neurological problems, osteoporosis and even cancer” (University of Chicago, 2005).

Clinical Manifestations

There are a myriad of symptoms that characterize the clinical manifestation of Celiac

Disease. The way in which the disease presents also varies widely from person to person. This is

one reason that Celiac Disease can be difficult to diagnose. Signs usually do not present prior to

the first year of life and thus it is difficult to diagnose Celiac Disease in infancy. Some of the

most common symptoms of Celiac Disease include chronic diarrhea, steatorrhea (foul, bulky,

greasy stool), progressive malnutrition, anorexia, an unhappy disposition, failure to thrive, and

retarded growth and development. Chronic respiratory infections also sometimes accompany this

disease. This complication seems to be caused by the allergic reaction that the body has to wheat

and rye gluten. The respiratory tract is especially susceptible to allergens in the body and thus

can become infected with repeated exposure. There are two tell tale physical signs of the severe

manifestation of the disease in children. These include a distended abdomen accompanied by

thin, wasted legs and buttocks.

In the chronic manifestation of the disease the child may experience a celiac crisis which

should be considered a medical emergency. This crisis is often triggered by an upper respiratory
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tract infection. Due to the repeated exposure to the allergen (gluten) that occurs in chronic Celiac

Disease the respiratory tract becomes infected. The child begins vomiting uncontrollably and

passing large, watery stools. This quickly leads to a state of severe dehydration, and this can lead

to an acute medical emergency. Parenteral fluid therapy is required to treat acidosis and to restore

normal fluid balance.

Diagnosis

When it comes to diagnosing Celiac Disease, there are several different steps that can be

taken. One is a trial gluten-free diet, where all gluten is eliminated from the diet in efforts to see

if there are any improvements in health. Results are usually seen several weeks after starting the

trial gluten-free diet, they include; overall condition of health with a gain in weight and

improvement of the nature of stools. Conclusive diagnosis can be made by a biopsy of the

jejunum through endoscopy that show changes in the villi (Hatfield, 2014). This biopsy will

show any changes like flat or damaged villi of the intestine, as the damage is caused by the

injestion of wheat in patients with Celiac Disease. Another way to diagnose Celiac Disease is by

serum screening. Serum screening is measuring the blood for levels of Immunoglobulin A and

Immunoglobulin G antigliadin antibodies. Antibodies are seen as a result of the immune system

fighting viruses, bacteria or toxins. If levels of these antibodies are found in the blood, the

condition is present. The serum screening can also aide in the progress of treatment.

Treatment

Treatment of Celiac Disease is started by the child being put on a gluten-free and low fat

diet. A diet of skim milk, glucose and banana flakes are used when the condition is severe. Lean
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meats, pureed vegetables, fruits are gradually added to the diet (Hatfield, 2014). There is also a

list of foods that the child should avoid if they have Celiac Disease and that includes; wheat

products, malted milk drinks, many baby foods, breads, cakes and pasteries unless made with

cornmeal. Since this diet has so many food restrictions it is important for the child to take

supplements of Vitamin A and Vitamin D to maintain adequate nutrition. There is no cure for

Celiac Disease, although, excluding wheat, rye and oat from the diet has good results for the

individual or child. Omitting wheat products is essential for the child with Celiac Disease, even

through adolescence because continuing to injest wheat could inhibit growth.

Nursing Care

The primary focus of nursing care for a child with Celiac Disease is to help the caregivers

maintain a restricted diet for the child. This diet is known as the gluten-free diet. Family teaching

for the caregiver and the child should include information regarding the disease and the need for

long-term management, as well as guidelines for a gluten-free diet (Hatfield, 2014). The

caregiver must be taught how to read the list of ingredients on labels in order to avoid sources of

gluten in packaged foods. The diet of a school- aged child or adolescent may be much harder to

be monitored than the diet of a young child because of different foods that are given at school. As

a result, a growing child might need additional nursing support in order to help with their dietary

modifications.

Nursing Process : Assessment

The first part of the nursing process is assessment of the child. The assessment begins by

carefully interviewing the caregiver to determine the underlying cause of the malnutrition and
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nutritional problems. As a nurse, you need to determine if the problem lies in the caregiver’s

“inability to give proper care, if this can be attributed to lack of information, financial problems,

indifference, or other reasons, but it is important to not make assumptions” (Hatfield, 2014). If

food allergies are suspected, ask the caregiver for a history of food intake, stools, and voidings.

After the interview, a physical examination of the child will need to be done. This includes

observation of skin turgor, skin condition, signs of emaciation, weight, temperature, apical pulse,

and respirations.

Nursing Process: Outcome Identification and Planning

The major goals of the child with malnutrition and nutritional problems include Focusing

on increasing nutritional intake, improving hydration, Monitoring elimination, and Maintaining

skin turgor. Other goals include improving the caregiver’s knowledge about the child’s nutrition.

Nursing Process: Implementation

Promoting Adequate Nutrition

It is important to provide a relaxing and comfortable environment for the child, so they will be
more encouraged to eat. If the child is being fed formula, provide a nipple that is not too hard or
small-holed because this will cause frustration to the child. Schedule feedings every 2-3 hours
because babies can tolerate small, frequent meals better. Feedings should be limited to 20- 30
minutes long.

Improving Fluid Intake

To check fluid status you can check the fontanelles each shift and weigh the child daily in the
early morning. The oral mucous membranes should be pink and moist. In some cases, IV fluids
may be needed to correct fluid and electrolyte imbalance. Always document intake and output.
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Monitoring Elimination Patterns

The nurse needs to document intake and output as well as the character, frequency and amount of
stools and report any unusual characteristics of urine or stools.

Promoting Skin Integrity

It is important to change soiled diapers to prevent skin breakdown. The nurse can use A&D
ointment or lanolin for dry, reddened skin.

Providing Family Teaching

The nurse needs to teach the caregiver the essential facts of infant and child nutrition.If
malnutrition is due to economic factors, make referrals for social services or the Woman, Infant,
and Children program. If the caregiver does not speak English, provide other teaching materials
and make sure they are understood.

Nursing Process: Evaluation

Goal: The child’s nutritional intake will be adequate for normal growth.

Expected outcomes: The child

- Gains 0.75 to 1 oz (22 to 30 g) per day if younger than 6 months of age.

- Gains 0.5 to 0.75 oz (13 to 22 g) per day if older than 6 months of age.

Goal: The child will show interest in feedings.

Expected Outcomes: The child

- Demonstrates ability to extend the amount of time feeding without showing signs of tiring

- Eats meals and snacks (older child).

Goal: The child’s fluid intake will improve

Expected Outcomes: The child’s

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- Fontanelles are of normal tension

- Skin turgor is good

- Mucous membranes are pink and moist

Goal: The child’s urine & bowel output will be normal for his/her age

Expected outcomes: The child’s

- Hourly urine output is 0.5 to 1 mL/kg

- Stool is soft and of normal character

Goal: The child’s skin will remain intact

Expected outcomes: The child’s

- Skin shows no signs of redness or breakdown

- Skin at the IV infusion site shows no signs of redness or induration

Goal: The family caregivers will verbalize a beginning knowledge of appropriate nutrition for a
growing child.

Expected outcome: The family caregivers state essential facts about child nutrition

Nursing Diagnosis

● Imbalanced nutrition: Less than body requirements related to inadequate intake of

nutrients secondary to lack of adequate food sources, or lack of knowledge of caregiver.

● Deficient fluid volume related to insufficient fluid intake.

● Impaired skin integrity related to malnourishment.

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● Deficient knowledge of caregivers related to understanding of the child’s nutritional

requirements.

References

Hatfield, N. T. (2014). Celiac Syndrome. Introductory Maternity & Pediatric Nursing (3rd ed.,

pp. 840-842). Philadelphia, PA: Wolters Kluwer Health.

University of Chicago. 2005. “Celiac Disease Facts and Figures”. Retrieved July 10, 2016

(http://www.uchospitals.edu/pdf/uch_007937.pdf).