211 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Treatment The foundation of treatment is a strict, lifelong adherence to a gluten-free diet (Mayo Clinic, 2020a). Patients and fami - lies must be educated about what foods, besides wheat, contain gluten. These in- clude the following (Mayo Clinic, 2020a; Meadows-Oliver, 2019):
● Possible decreases in hemoglobin and hematocrit levels, white blood cell (WBC) counts, and platelet counts. ● Immunologic assay screen is positive for celiac disease. ● Serology testing looks for the presence of specific antibodies that indicate an immune reaction to gluten. ● Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA_DQ8) can be used to rule out celiac disease. ● High fat content in stool specimens. | NURSING CONSIDERATION It is important that patients be test- ed for celiac disease BEFORE trying a gluten-free diet. If gluten is eliminated from the diet before testing, the re- sults may appear falsely normal (Mayo Clinic, 2020a). If any of the preceding tests indicate the presence of celiac disease, it is most like- ly that the healthcare provider will order one of the following tests (Mayo Clinic, 2020a): ● Endoscopy : Conducted to enable a view of the small intestine and take a biopsy for analysis. ● Capsule endoscopy : The patient swallows a capsule that contains a minute wireless camera that takes pictures of the small intestine. As the capsule moves through the digestive tract thousands of pictures are taken. The pictures are transmitted to a recorder.
● Barley. ● Bulgur. ● Durum. ● Farina. ● Graham flour. ● Malt. ● Rye. ● Semolina. ● Spelt (a form of wheat). ● Triticale.
| NURSING CONSIDERATION
A referral to a nutritionist is important. The nutritionist can help patients and families make informed choices and plan a suitable diet (Meadows-Oli - ver, 2019). A gluten-free diet helps to heal the villous atrophy and promotes symptom resolution. Following a glu- ten-free diet helps to prevent compli- cations in the future, including malig- nancy development (Celiac Disease Foundation, 2021). The recommended diet is a high-pro- tein, low-fat, high calorie diet that includes corn and rice products, soy and potato flour, and fresh fruits. Additionally, infants may have breast milk or soy-based formu- la (Celiac Disease Foundation, 2021). If the patient is anemic or severe nutri- tional deficiencies are present, healthcare providers might recommend that supple- ments be taken, including the following (Mayo Clinic, 2020a): ● Copper.
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