Gluten is found in wheat, barley, rye, and many processed foods, sauces, and beer.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with gout is admitted with an acutely painful, red, swollen great toe. Which dietary instruction should the nurse provide to help prevent future attacks?
Answer: B. Gout results from hyperuricemia and urate crystal deposition. Clients should limit purine-rich foods such as organ meats, red meat, shellfish, and alcohol (especially beer), and increase fluid intake to promote uric acid excretion. High-purine diets worsen attacks.
Question 2 of 3
A nurse is assisting with the delivery of a client experiencing shoulder dystocia. Which maneuver should the nurse perform first?
Answer: B. The McRoberts maneuver (hyperflexing the maternal thighs sharply against the abdomen) combined with suprapubic pressure is the first-line intervention for shoulder dystocia because it flattens the sacrum and rotates the symphysis to free the impacted shoulder. Fundal pressure is contraindicated as it worsens impaction.
Question 3 of 3
A nurse is caring for a client with a third-degree perineal laceration. Which intervention is contraindicated for this client?
Answer: A. A third- or fourth-degree laceration extends into or through the anal sphincter. Rectal interventions such as enemas, rectal suppositories, and rectal temperature measurement are contraindicated because they can disrupt the suture line and the healing sphincter. Stool softeners, sitz baths, and a high-fiber diet with fluids are appropriate to promote comfort and prevent straining.
Keep the streak going with more questions like these, each with a full rationale.
What is gluten-free diet?
In celiac disease, gluten triggers an immune reaction that damages the small intestine and impairs nutrient absorption. Strict, permanent avoidance allows the intestinal villi to heal.
Key points to remember
- Gluten is found in wheat, barley, rye, and many processed foods, sauces, and beer.
- The classic memory aid is to avoid BROW: barley, rye, oats with risk of cross-contamination, and wheat.
- Naturally gluten-free foods include rice, corn, quinoa, potatoes, fruits, vegetables, meat, fish, and eggs.
- Even small amounts of gluten and cross-contamination can cause intestinal damage.
- Untreated celiac disease leads to malabsorption, anemia, and deficiencies in iron, folate, calcium, and vitamin D.
Nursing priorities
- Teach the patient to read labels for hidden gluten in additives, sauces, and processed foods.
- Educate on preventing cross-contamination with separate utensils and toasters.
- Monitor for resolution of diarrhea, bloating, and weight loss as the gut heals.
- Assess for and address nutritional deficiencies such as iron and folate.
- Reinforce that the diet is lifelong even after symptoms resolve.
Labs & values
Patient teaching
- Read every food label and watch for wheat, barley, rye, malt, and brewer's yeast.
- Avoid oats unless certified gluten-free due to cross-contamination.
- Use separate cutting boards, toasters, and utensils to avoid cross-contact.
- This diet is for life; even small slips can damage your intestine.
Red flags: report now
- Persistent diarrhea, weight loss, and steatorrhea despite the diet suggest ongoing gluten exposure or another problem.
- Never assume the diet is temporary; lifelong adherence is required for celiac disease.
- Signs of severe malabsorption or anemia should be reported and worked up.
References
Clinical references for this topic
