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Pediatric celiac disease

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by

Katie Biancaniello

on 2 October 2012

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Transcript of Pediatric celiac disease

BY: Katherine Biancaniello & Leanna Burgess Pediatric Celiac Disease A mucosal (transport) disorder causing generalized malabsorption in the digestive system What is Celiac Disease? Though the cause of celiac disease is unknown Doctors do know that something happens to cause the body's immune system to overreact to gluten. This autoimmune response creates a toxic reaction on the epithelium surfaces of the intestines resulting in their destruction and loss of their absorbing qualities. What is the cause (pathophysiology) ? Who is affected by Celiac disease? 1 in 130 people in the United States has celiac disease
Celiac Disease was once thought to be a childhood diagnosis; however, you can be diagnosed with celiac disease at any age
children as young as 6 months old can develop symptoms once introduced to gluten and there have been cases with people well into their sixites suddenly developing the disease Celiac disease is more
common in people who: are caucasian
have type 1 diabetes
have down syndrome
have immediate family with the disease (ie: brothers, sisters, parents, sons or daughters. Diagnostic Tests Treatment Teaching for child/parent Medications Imbalanced nutrition: less than body requirements related to inability to absorb nutrients as evidenced by weight loss Nursing Diagnosis

Bare, Brenda G., Cheever, Kerry H., Hinkle Janice L. & Smeltzer, Suzanne C. (2010). Textbook of Medical-Surgical Nursing. (pp. 1075) Wolters Kluwer Health: Lippincott Williams & Wilkins.







Kim, Susan C. (2010) Who is affected by celiac disease http://www.webmd.com/digestive-disorders/celiac-disease/who-is-affected-by-celiac-disease Refernces Anti-tissue transglutaminase antibody
(tTG – IgA and IgG)
Total serum IgA
small bowel biopsy will be done to confirm Celiac Disease indicated by the blood tests
Patient must eat a diet containing gluten for accurate results No Cure

Only Treatment is a strict lifelong gluten free diet

Gluten free means no wheat, rye, or barley elements

Many commercial products contain wheat, rye, or barley elements

Some foods that do not contain gluten are sometimes cross contaminated with other foods that do contain gluten
Ex. French Fries that are cooked in the same grease
that breaded chicken tenders are cooked in which foods should be avoided
which foods are safe
how to be nutritionally balanced on a gluten free diet
educate the parent to relay information to other caregivers (babysitters, daycare providers, teachers, family members, & anyone watching over child)
Inform the parent about foods containing alternative products that will not make the child feel deprived or that they are missing out on Usually not needed

Steroids can be prescribed to prevent swelling in the intestine and promote nutrient intake

A multivitamin may be prescribed
or recommened to prevent malnutrtion Dermatitis herpetiformis Nurse will assess weight; measure or calculate body fat and muscle mass
-Rationale: to establish baseline parameters
Nurse will observe for absence of subcutaneous fat and muscle wasting, loss of hair, fissuring of nails, delayed healing, gum bleeding, swollen abdomen
-Rationale: indicates protein-energy malnutrition
Nurse will auscultate Bowel Sounds. Note Characterisitcs of stool (color, frequency, amount, etc)
Nurse will refer to nutritional resources and educate pt and family to determine suitable ways to optimize client's intake of vitamins, minerals, protein, carbohydrates, fats, and calories while avoiding foods containing wheat, rye, or barley products
Nurse will Weigh pt at regular intervals and document results
-Rationale: to monitor effectiveness of dietary plan Nursing Care
&
Interventions Goals Long Term Effects of Celiac Disease Symptoms in Children Diarhhea or Constipation (or both)
Abdominal cramping
Bloated abdomen
Growth failure
Failure to thrive
Vomiting
Behavioral changes
Fatigue and Irritability
Dematitis Herpetiformis
Anemia
Delayed Puberty most related to malabsorption:
osteoporosis
central and peripheral nervous system disease
tooth enamel defects
pancreatic disease
internal hemorrhaging
later onset of puberty
possible links to certain cancers including: intestional lymphoma STG: Patient will verbalize causes for malnutrion (ie: eating gluten which leads to intestional malabsorbtion) by end of shift

LTG: Patient will demonstrate weight gain of 2 lbs within 1 month.

LTG: Patient will have lab values for pre-albumin within an acceptable range as per lab value guidlines within 6 months.
(6 mo -4 yr= 2.0-36.0 md/dl)
(5-6yr= 12.0-42.0 mg/dl)
(7yr-adult= 12.0-42.0 mg/dl) Patricia L. Jackson Allen. Pediatric Nursing. Nov-Dec 2004 v30 i6 p473(4). Cureton, P., & Sharrett, M. (February 2007). Kids and the Gluten-Free Diet. Practical Gastroenterology, 31(2), 49-65. http://www.celiac.org/images/stories/PDF/Kids_and_the_Gluten-Free_Diet.pdf Graziano Barera, Barbara Parma, Stefano Mora. Pediatric Health. August 2008 v2 i4 p431(11).
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