What is the most appropriate initial dietary recommendation for a patient with celiac disease to prevent symptoms related to gluten exposure?

B) Follow a strict gluten-free diet

A) Increase intake of processed foods

B) Follow a strict gluten-free diet

A patient with celiac disease presents with mild microcytic anemia and low serum ferritin levels. What is the most appropriate initial nursing intervention to address this patient's anemia?

B) Educate the patient on the importance of adhering to a strict gluten-free diet.

A) Encourage the patient to increase their intake of red meat and leafy greens.

B) Educate the patient on the importance of adhering to a strict gluten-free diet.

C) Recommend the patient take a daily multivitamin with iron.

D) Advise the patient to limit their physical activity until anemia improves.

What is the primary dietary modification for a patient with celiac disease to reduce gastrointestinal symptoms?

C) Consuming a gluten-free diet

A patient with celiac disease reports improved symptoms after adhering to a gluten-free diet and iron supplementation. She mentions occasional joint pain and fatigue. What is the most appropriate nursing action to address these new symptoms?

B) Suggest additional laboratory tests for vitamin D and calcium levels

A) Recommend increasing iron supplementation

B) Suggest additional laboratory tests for vitamin D and calcium levels

C) Advise the patient to discontinue the gluten-free diet temporarily

D) Instruct the patient to reduce physical activity to manage fatigue

What is the primary reason for a vitamin D supplement in a patient with celiac disease and vitamin D deficiency?

B) To improve calcium absorption

A patient with celiac disease has been diagnosed with a vitamin D deficiency. Which of the following interventions should the nurse prioritize to help address this deficiency?

B) Advise the patient to start a daily vitamin D supplement

A) Recommend the patient to increase intake of gluten-containing grains

B) Advise the patient to start a daily vitamin D supplement

C) Suggest reducing calcium intake to prevent interference with vitamin D absorption

D) Encourage a high-protein diet to enhance nutrient absorption

Which of the following is an important dietary consideration for a patient diagnosed with celiac disease?

B) Following a gluten-free diet

Which vital sign finding indicates that the patient's response to vitamin D supplementation and dietary changes is stable?

B) Heart rate of 90 beats per minute

C) Respiratory rate of 24 breaths per minute

Celiac - Nursing Case Study

Pathophysiology

• Primary mechanism: In celiac disease, the ingestion of gluten (a protein found in wheat, barley, and rye) triggers an immune response in genetically predisposed individuals. The immune system mistakenly attacks the lining of the small intestine, specifically the villi, which are crucial for nutrient absorption.

• Secondary mechanism: This immune-mediated damage leads to villous atrophy (flattening of the intestinal villi), resulting in decreased surface area for absorption. This impairs the body's ability to absorb essential nutrients, such as iron, calcium, and vitamins, leading to various nutritional deficiencies.

• Key complication: If left untreated, ongoing intestinal damage can lead to minor complications like anemia and osteoporosis due to poor nutrient absorption, emphasizing the importance of a strict gluten-free diet to prevent further damage and associated health issues.

Patient Profile

Demographics: 28-year-old female, office manager

History:

• Key past medical history: Diagnosed with Celiac Disease 6 months ago

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Abdominal discomfort and bloating

• Key symptoms: Mild abdominal pain, occasional diarrhea, fatigue

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.4°F

Section 1

Initial assessment findings:

During the initial assessment, the nurse conducted a thorough physical examination and collected additional information to better understand the patient's current condition. The abdominal examination revealed mild tenderness in the lower abdomen without any guarding or rebound tenderness, suggesting that the discomfort is likely related to her celiac disease rather than an acute abdominal condition. Auscultation of the abdomen indicated normal bowel sounds, which is consistent with her stable condition despite the presence of occasional diarrhea. The patient reported that her symptoms are more pronounced after accidental gluten exposure, often occurring when dining out or consuming processed foods that may contain hidden sources of gluten.

Laboratory results provided further insight into her nutritional status. A complete blood count (CBC) showed a mild microcytic anemia, with a hemoglobin level of 11.5 g/dL and a mean corpuscular volume (MCV) of 78 fL, suggesting iron deficiency. This aligns with the malabsorption issues commonly seen in celiac disease. Serum ferritin was found to be low at 15 ng/mL, indicating depleted iron stores. Other basic metabolic panel results were within normal limits, ruling out significant electrolyte imbalances. The assessment emphasized the need for dietary education and possibly iron supplementation to address her mild anemia and prevent further complications. The patient expressed motivation to adhere more strictly to a gluten-free diet, recognizing its importance in managing her condition.

Section 2

Two weeks after the initial assessment, the patient returned for a follow-up appointment, demonstrating a positive response to the dietary education provided by the nursing team. She reported being more vigilant in avoiding gluten, especially when dining out, and had started reading food labels more carefully. She noted a significant reduction in gastrointestinal symptoms, with fewer episodes of diarrhea and abdominal discomfort. The patient also began taking an over-the-counter iron supplement as recommended, aiming to improve her iron deficiency anemia. During the follow-up visit, her vital signs were stable: blood pressure was 118/74 mmHg, heart rate was 72 bpm, and her temperature was 98.6°F.

Repeat laboratory tests showed some improvement in her iron status. Her hemoglobin level had increased slightly to 12.0 g/dL, and her serum ferritin had risen to 20 ng/mL, indicating a positive trend in iron replenishment. While still below optimal levels, these improvements suggest that the combination of dietary adherence and iron supplementation is beginning to address the malabsorption issues associated with her celiac disease. The patient appeared encouraged by these results, expressing a commitment to continue her current regimen.

The nursing team emphasized the importance of ongoing monitoring and dietary compliance to prevent further complications. They provided the patient with additional resources, including a list of safe dining options and gluten-free food brands, to support her management plan. The patient was advised to schedule another follow-up appointment in three months to reassess her nutritional status and ensure her condition continues to stabilize. The team also discussed the possibility of consulting a dietitian for more personalized dietary guidance if needed. This ongoing support aims to empower the patient in managing her celiac disease effectively, minimizing the risk of future complications.

Section 3

Three months after her last appointment, the patient returned for her scheduled follow-up visit. She reported a continued commitment to her gluten-free diet and shared that she had experienced further improvement in her symptoms. Episodes of diarrhea had become rare, and abdominal discomfort was minimal. She mentioned feeling more energetic overall, attributing this change to the dietary adjustments and iron supplementation. Her adherence to the gluten-free diet was evident from her diligent efforts in meal planning and selecting gluten-free options when eating out. Vital signs during this visit remained stable, with a blood pressure of 116/72 mmHg, a heart rate of 70 bpm, and a temperature of 98.4°F.

The latest laboratory results revealed further positive trends. Her hemoglobin level had increased to 12.5 g/dL, and her serum ferritin had improved to 30 ng/mL. These results indicated ongoing improvement in her iron status and suggested that her intestinal healing was supporting better nutrient absorption. The nursing team noted these improvements and praised the patient's efforts in adhering to her treatment plan. They reinforced the importance of maintaining her current dietary habits and continuing her iron supplementation to achieve optimal nutrient levels.

However, the patient reported experiencing occasional joint pain and fatigue, which she found concerning. The nursing team discussed these new symptoms, considering the possibility of other nutritional deficiencies or autoimmune conditions that sometimes accompany celiac disease. They recommended additional laboratory tests to evaluate her vitamin D and calcium levels and suggested a referral to a rheumatologist for further assessment if the symptoms persisted. By addressing these new concerns promptly, the nursing team aimed to ensure comprehensive care and prevent potential complications, guiding the patient through her ongoing management journey.

Section 4

Three weeks after the additional evaluations were ordered, the patient returned to review her new diagnostic results. The lab tests revealed a vitamin D deficiency, with her serum 25-hydroxyvitamin D level measuring at 18 ng/mL, below the recommended level of 30 ng/mL. Her calcium levels were found to be within normal limits, indicating that despite the vitamin D deficiency, her body was maintaining adequate calcium levels for the time being. These findings suggested that her occasional joint pain and fatigue could be partly attributed to the low vitamin D levels, a common issue in individuals with celiac disease due to malabsorption.

In response to these results, the nursing team collaborated with the physician to develop a plan to address the vitamin D deficiency. The patient was advised to begin a daily vitamin D supplement, starting with a higher dose of 2000 IU per day, with plans to re-evaluate her levels in three months. The nursing team emphasized the importance of continuing her gluten-free diet to support overall intestinal health and absorption of nutrients. They also encouraged her to safely increase her exposure to sunlight, as appropriate, to naturally boost her vitamin D levels.

Throughout these discussions, the patient expressed relief in having a possible explanation for her symptoms and was motivated to incorporate the recommended changes. The nursing team provided educational materials on vitamin D-rich foods that are safe for her to consume and reassured her of their ongoing support. By addressing the vitamin D deficiency, the team aimed to alleviate her symptoms and prevent further complications, demonstrating a proactive approach in managing her celiac disease and enhancing her overall quality of life.

Section 5

Three months later, the patient returned for a follow-up appointment to evaluate her response to the vitamin D supplementation and ongoing gluten-free diet. During the initial assessment, the nurse observed that the patient appeared more energetic and reported a noticeable reduction in joint pain and fatigue. Her skin had a healthier tone, and she expressed feeling more optimistic about managing her condition. Vital signs were stable, with a blood pressure of 118/76 mmHg, heart rate of 72 beats per minute, and a normal respiratory rate of 16 breaths per minute.

Lab results showed an improvement in her vitamin D status, with her serum 25-hydroxyvitamin D level rising to 28 ng/mL, nearing the recommended level of 30 ng/mL. This positive change indicated that the supplementation and dietary modifications were effectively addressing her deficiency. Encouraged by these results, the nursing team collaborated with the physician to continue the current vitamin D regimen while planning another evaluation in three months. They also reinforced the importance of adhering to her gluten-free diet and maintaining her current lifestyle changes.

As the patient prepared to leave, the nursing team provided additional resources on managing celiac disease, emphasizing the need for regular follow-ups and monitoring for any new symptoms. They reminded her to report any changes in her health promptly, ensuring early intervention if needed. The patient left the clinic feeling supported and more confident in her ability to manage her health, setting a positive trajectory for her ongoing care journey.