Medical 8-Pediatric27-Wilms Tumor
Terms
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- What is Wilms tumor (nephroblastoma)?
- most common malignant renal and intraabdominal tumor of childhood (most common in AA, followed by East Asians)
- The peak age of diagnosis of Wilms is about __ years, higher frequency in boys.
- 3
- Wilms tumor favors the left?
- kidney
- Most children with Wilms tumor are brought to practitioner because of ____ ____ or an _____ ______.
-
abdominal swelling
abdominal mass - What are specific tests for Wilms?
-
radiographic studies
abdominal ultrasound
abdominal and chest
computed tomography scan
hematologic studies
biochemical studies
urinalysis - With Wilms, studies to demonstrate relationship of tumor to ______ kidney and the presence of normal functioning kidney on the contralateral side are essential.
- ipsilateral
- If a large Wilms tumor is present, an ____ _____ is necessary to demonstrate possible tumor involvement adjacent to vena cava.
- inferior venacavagram
- What might be done to rule out metastasis in a Wilms tumor patient, which is rare?
- bone marrow aspiration
-
Nursing Alert!
To reinforce need for caution, it may be necessary to post a sign on the bed that reads? - "DO NOT PALPATE ABDOMEN".
- With Wilms tumor, careful bathing and handling are important in preventing trauma to the ____ site.
- tumor
- With Wilms tumor, the child may be left with one kidney, so teach patient to avoid?
- contact sports to prevent injury to remaining organ.
- With Wilms tumor, prompt detection and treatment of any ___ signs or symptoms are mandatory.
- GU
-
The most effective agents for treating Wilms is 1.___?
Duration of therapy varies, ranging from 2.___ to ___ months. -
1. actinomycin D (dactinomycin)
vincristine
Adriamycin with addition of
cyclophosphamide
2. 6 to 15 months - Clinical manifestations of Wilms tumor are?
-
abdominal swelling of mass:
firm
nontender
confined to one side
hematuria (less than one
fourth of cases)
fatigue/malaise
hypertension (occasionally)
weight loss
fever
manifestations resulting
from compression of tumor
mass
secondary metabolic altera-
tions from tumor or
metastasis
If metastasis, symptoms of
lung involvement:
dyspnea
cough
shortness of breath
chest pain (sometimes) -
Staging of Wilms tumor?
What is Stage 1? - tumor is limited to kidney and completely resected
-
Staging of Wilms tumor?
Stage II - tumor extends beyond kidney but is completely resected
-
Staging of Wilms tumor?
Stage III - residual nonhematogenous tumor is confined to abdomen
-
Staging of Wilms tumor?
Stage IV - hematogenous metasases; deposits are beyond stage III, namely, to lung, bone, and brain
-
Staging of Wilms tumor?
Stage V - bilateral renal involvement is present at diagnosis
- Survival rate of Wilms tumor is ___
- high (90% cure)
- Relapse to ____ and ____ may occur and relapse more than ___ months after diagnosis.
-
lung
abdomen
12 - Nurse must prepare child and parents for all lab and surgical procedures within?
- 24 to 48 hours of admission...keep explanations brief, repetitive and simple
- Upon admission, nurse should especially monitor blood pressure, because hypertension from excess ___ _____ is a possibility.
- renin production
- Several special preoperative concerns, the most important of which is that?
- the tumor is not palpated unless absolutely necessary, because manipulation of mass may cause dissemination of cancer cells to adjacent and distant sites.
- Following chemo and radiation, the child should be prepared for alopecia within?
- 2 weeks after initial treatment
- Recovery for Wilms is usually ____?
- rapid
- Major nursing responsibilities concern what type of surgery and responsibilities are the same with that type of surgery?
- abdominal
-
Post-op.
Wilms tumor children are at increased risk of ____ ____ from vincristine-induced ileus, radiation-induced edema, and postsurgical adhesion formation, GI activity, such as bowel movements, bowel sounds, distention, vomiting, and pain - intestinal obstruction
-
Post-op.
Besides blood pressure, what should nurse monitor? -
urine output
signs of infection
institute pulmonary hygiene
to prevent postop
pulmonary complications - What can nurse do to help pschyological ramifications of Wilms tumor treatment?
-
play therapy with dolls or
puppets, drawing
child may feel angry because
of extent of surgery,
need for addtl therapy,
seriousness of disorder