Report continued symptoms or weight loss despite a gluten-free diet (possible hidden gluten or refractory disease).
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse is assessing a newborn for Hirschsprung disease. Which finding in the first 48 hours of life is most suggestive of this disorder?
Answer: A. Failure to pass meconium within 24 to 48 hours of birth is a hallmark of Hirschsprung disease, caused by absence of ganglion cells in a segment of the distal colon. Frequent loose stools, projectile vomiting, and excessive meconium passage are not characteristic.
Question 2 of 3
A child is diagnosed with hand-foot-and-mouth disease. The nurse expects to find which characteristic lesions?
Answer: A. Hand-foot-and-mouth disease, caused by coxsackievirus, produces painful vesicular lesions in the mouth and on the palms and soles. It is usually self-limiting, and care focuses on hydration and comfort.
Question 3 of 3
A nurse is assessing a 78-year-old client. Which finding is a normal age-related change rather than a sign of disease?
Answer: A. Decreased skin elasticity and turgor is an expected aging change due to loss of subcutaneous tissue and collagen. Resting tachycardia, productive cough, and a new confusion onset are not normal aging and warrant evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is celiac disease?
Memory aid for forbidden grains: BROW (Barley, Rye, Oats-if contaminated, Wheat). The only treatment is a strict, lifelong gluten-free diet.
Key points to remember
- Gluten exposure flattens intestinal villi, causing malabsorption with steatorrhea (bulky, foul, fatty, floating stools), weight loss, bloating, and fatigue.
- Malabsorption leads to deficiencies of iron, folate, vitamin B12, fat-soluble vitamins (A, D, E, K), and calcium, causing anemia and osteoporosis.
- The cornerstone of treatment is a lifelong strict gluten-free diet that excludes wheat, barley, and rye.
- Safe grains include rice, corn, quinoa, and certified gluten-free oats; patients must read labels for hidden gluten.
- Diagnosis uses serology (tissue transglutaminase IgA, anti-endomysial antibodies) and small-bowel biopsy showing villous atrophy.
- In children, untreated disease causes failure to thrive; dermatitis herpetiformis is a related itchy blistering rash.
Signs & symptoms
- Steatorrhea: pale, foul, fatty
- Bloating, weight loss, anemia
- Dermatitis herpetiformis rash
Nursing priorities
- Teach and reinforce a strict lifelong gluten-free diet and meticulous label reading.
- Assess for and address nutritional deficiencies (iron, folate, B12, calcium, vitamin D) and monitor growth in children.
- Monitor hydration and electrolyte balance during active diarrhea/malabsorption.
- Refer to a dietitian and celiac support resources for sustainable adherence.
- Watch for accidental gluten exposure and reinforce avoidance of cross-contamination.
Labs & values
Patient teaching
- Strictly avoid all wheat, barley, and rye, including hidden sources in sauces, soups, processed foods, and medications.
- Choose naturally gluten-free foods (rice, corn, quinoa, potatoes, fresh meats, fruits, vegetables) and certified gluten-free products.
- Prevent cross-contamination with separate utensils, toasters, and preparation surfaces.
- Read every label every time, since ingredients change, and the diet is lifelong.
Red flags: report now
- Report continued symptoms or weight loss despite a gluten-free diet (possible hidden gluten or refractory disease).
- Report signs of severe deficiency: bone pain/fractures (osteoporosis), neuropathy (B12), or bleeding (vitamin K).
- Never reintroduce gluten 'just to test'; even small amounts cause damage.
References
Clinical references for this topic
