An adult diagnosed with celiac disease 3 weeks ago was placed on a gluten-free diet. The client returns for ambulatory care follow-up, reports continuation of symptoms, and does not seem to be responding to therapy. Which is the best response by the nurse?

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This client with celiac disease continues to have symptoms. An assessment of the client's food intake must be obtained to determine if it includes foods that contain gluten, a protein in barley, rye, oats, and wheat (mnemonic: BROW). The most common reason for non-responsiveness to a gluten-free diet in clients with celiac disease is that gluten has not been entirely eliminated from their food intake. (Option A) Referral to a dietitian is an appropriate intervention. However, the nurse must first explore why the client is not responding to therapy. This is not the first or best response by the nurse. (Option B) Most people experience dramatic relief of gastrointestinal symptoms within a few days of eliminating gluten from their diet. (Option D) This is a non-therapeutic response that "blames" the client for symptoms. In addition, this conclusion cannot be made without an assessment of the client's intake. Educational objective: When a client with celiac disease does not experience symptom relief after being on a gluten-free diet, it is most important for the nurse to assess the underlying cause. The most common reason for refractory symptoms is failure to follow the strict gluten-free diet.

An Adult Diagnosed with Celiac Disease 3 Weeks Ago Was