Portfolio II: Objective 3
Pathophysiology and Symptoms
Celiac Disease is a chronic, immunologic, gastrointestinal disease affects the pediatric population. According to Ricci & Kyle (2009), children usually present with symptoms by age 2. In children with this disorder, an inflammatory reaction from eating gluten causes damage to the villi of the small intestine. With this damage, the villi are hindered from absorbing nutrients, and malnutrition occurs (Ricci & Kyle, 2009). Silano, Agostoni, and Guandalini (2010) present evidence that the timing of introduction of gluten containing foods to infants can play a part in the development of celiac disease. They recommend introduction of small amounts of gluten while breastfeeding, no earlier than 4 months, and before 7 months. Introducing gluten when the gastrointestinal system is mature enough to handle it, yet not yet with antigens or aversion established, is the goal.
Signs and symptoms of celiac disease include diarrhea, constipation, and steatorrhea (Ricci & Kyle, 2009). Weight loss or failure to thrive are common. Anemia, irritability, delayed onset of puberty, dental disorders, and various nutritional deficiencies can occur (Ricci & Kyle, 2009). Poor muscle tone, thin extremities, and abdominal distention are other signs of Celiac disease (Ricci & Kyle, 2009).
Labs & Treatments
In response to gluten, antibodies in the bloodstream can be diagnostically found by screening. Intestinal biopsy confirms celiac disease by showing villous atrophy in the small intestine (Ricci & Kyle, 2009). The treatment for Celiac disease is a strict gluten-free diet. Patients must avoid all gluten containing foods such as most wheat products and many commercially prepared foods. Patient and family education is very important, as the gluten-free diet needs to be followed for life and if not followed can cause damage. Cederborg, Hultman, & Magnusson (2012) found that once diagnosis is made, many parents and children readily adapt to the gluten free diet by seeking out information and because of the ease of gluten free foods available now.
Medications are usually not needed, and the strict gluten free diet prevents damage to the intestine and malnourishment. Sometimes, vitamin supplements are needed to combat deficiencies (Harris, Park, Voltaggio, & Lam-Himlin, 2012).
Nursing Goals/ Interventions
Nursing goals include maintaining adequate nutrition for the growth and health of the child. The nurse should ensure the child and parents understand the nature of the disease and the gluten free diet protocol. Patient teaching and education is very important. Another nursing goal is promoting emotional stability of the child, and interventions include providing emotional support, understanding, listening, and encouraging the child to partake in developmentally appropriate activities to maintain as much normalcy as possible.
