Nurse’s Toolbox: Triaging Patients with Celiac Disease
May is celiac disease awareness month. In these final days of May, we wanted to dedicate this Nurse’s Toolbox to detailing what celiac is, what the symptoms are, how it is diagnosed, and treatment options. Triaging a patient with known Celiac Disease can be challenging. It is important for triage nurses to know the symptoms, in order to get the patient on the right path to care. On average, 1 out of every 141 people have celiac disease, many go undiagnosed.
It is always important for triage nurses to ask the patient for past medical history (PMH). Establishing that the patient has celiac disease will ensure that the nurse can reach the right disposition. The triage nurse must have at least a basic understanding of the pathophysiology of celiac disease in order to understand if the patient’s symptoms could be serious enough to warrant seeking medical attention immediately. The triage nurse must ask the right questions in order to determine what is the safest place for her patient to be at that time.
Questions to ask:
“Has your diet changed recently?”
“Have you knowingly ingested gluten?”
“Are the symptoms you are calling about tonight typical for you?”
“What symptoms are concerning you and are they different than what you typically experience with your celiac disease?”
What is it: Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye.
Who is at risk: Celiac can happen to anyone. However, it seems to be more common among those who have a family member with celiac disease or dermatitis herpetiformis, Type 1 diabetes, Down syndrome or Turner syndrome, autoimmune thyroid disease, Sjogren’s syndrome, or microscopic colitis (lymphocytic or collagenous colitis).
Cause: For patients who have celiac, eating gluten triggers an immune response in their small intestine. Over time, this damages the lining in their small intestine, resulting in malabsorption. The immune response damages the villi on the small intestinal wall floor.
Symptoms: The nurse must first understand common symptoms that patients may exhibit. These symptoms should be remembered when triaging a patient and should be considered when choosing the safest disposition for the patient. Weight loss and diarrhea are the most common symptoms, but there are many varying symptoms.
These symptoms can include:
- Anemia, usually resulting from iron deficiency
- Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Damage to dental enamel
- Headaches and fatigue
- Nervous system injury, including numbness and tingling in the feet and hands, and possible problems with balance
- Joint pain
- Reduced functioning of the spleen (hyposplenism)
- Acid reflux and heartburn
Infants can show signs that include chronic diarrhea, swollen belly, pain, or weight loss. Older children can show signs that include diarrhea, constipation, short stature, delayed puberty, neurologic symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disability, headaches, and lack of muscle coordination.
How is it diagnosed: There are three tests that are used to diagnose celiac disease.
- Blood test – looking for elevated antibodies in the blood after eating gluten
- Endoscopy – if the blood test results reveal antibodies, the doctor may want a biopsy of the small intestine
- Capsule Endoscopy – a camera, in pill form, can be swallowed to take thousands of pictures of the entire small intestine
Complications: Eventually, people who have celiac disease will find that their brain, nervous system, bones, liver, and other organs are deprived of vital nourishment. In children, malabsorption can prevent growth and development.
Treatment: A strict gluten-free diet can prevent symptoms and promote intestinal healing. If the malabsorption has been severe, their doctor may recommend vitamins, in addition to a gluten-free diet. Some patients that have severe intestinal damage may have to have steroid treatments, to reduce the inflammation of the small intestine as well.
Did you know? This disease can be triggered after severe emotional stress, pregnancy, childbirth, surgery, or a viral illness.