2. Celiac disease (gluten enteropathy, nontropical sprue): immune to gluten, causing impaired absorption and digestion of nutrients through the small bowel. Affects adults and children and is characterized by inability to digest and use sugars, starches, and fats.
   1. Pathophysiology: intolerance to the gliadin fraction of grains causing degeneration of the epithelial surface of the intestine, atrophy of the intestinal villi, and impaired absorption of essential nutrients.
   2. Risk factors:
      1. Possible genetic or familial factors.
      2. Hypersensitivity response.
      3. History of childhood celiac disease.
   3. Assessment:
      1. Subjective data: family history.
      2. Objective data:
         1. Loss: weight, fat deposits, musculature.
         2. Anemia.
         3. Vitamin deficiencies.
         4. Abdomen distended with flatus.
         5. Stools: diarrhea, foul smelling, bulky, fatty, float in commode.
         6. Skin condition known as dermatitis herpetiformis.
         7. History of acute attacks of fluid and electrolyte imbalances.
         8. Diagnostic tests: stool for fat; barium enema; antibody tests, including endomysial (EMA); blood studies of iron, folate, proteins, minerals, and clotting factors; small bowel biopsy.
         9. Gluten-free diet leads to remission of symptoms.
   4. Analysis/nursing diagnosis:
      1. Altered nutrition, less than body requirements, related to inability to digest and use sugars, starches, and fats.
      2. Diarrhea related to intestinal response to gluten in diet.
      3. Fluid volume deficit related to loss through excessive diarrhea.
      4. Knowledge deficit related to dietary restrictions to control symptoms.
   5. Nursing care plan/implementation:
      1. Goal: prevent weight loss.
         1. Diet: high in calories, protein, vitamins, and minerals, and gluten free.
            1. Avoid wheat, rye, oats, barley.
            2. All other foods permitted.
         2. Daily weights to monitor weight changes.
      2. Goal: health teaching.
         1. Nature of disease.
         2. Dietary restrictions and allowances.
         3. Complications of noncompliance.
   6. Evaluation/outcome criteria:
      1. No further weight loss.
      2. Normal stools.
      3. Fluid/electrolyte balance obtained and maintained.