4 Wilms Tumor (Nephroblastoma) Nursing Care Plans

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Wilms tumor (nephroblastoma) is recognized as the most common pediatric malignant renal tumor in children. The incidence of Wilms tumor is slightly less frequent in boys than in girls. The average age at diagnosis with unilateral tumors is 41.5 months and with bilateral tumors is 29.5 months. It occurs in association with congenital anomalies and chromosomal abnormalities, such as: aniridia (congenital absence of the iris); hypospadias; cryptorchidism; pseudohermaphroditism; Beckwith-Wiedemann syndrome; Denys-Drash syndrome; Perlman and Sotos’ syndrome. The appearance of the Wilms tumor is usually referred to as the “pushing type” (or adjacent renal parenchyma, enclosed by a distinct intrarenal pseudocapsule).

The most common initial clinical presentation for most children with Wilms tumor is the presence of a firm, non-tender abdominal mass. This initial presentation is usually first noticed by a parent while bathing or dressing the child. Other assessment findings at diagnosis include abdominal pain, gross hematuria, low-grade fever, and hypertension.

The most common sites of metastases of Wilms tumor are the lungs, the regional lymph nodes, and the liver. Histology classifies the tumor into: (1) favorable or unfavorable histology; (2) 3 cell types: triphasic or biphasic; with blastemal, stromal, and epithelial elements; and (3) 10% have anaplastic or unfavorable histologic findings, including anaplastic Wilms’ tumor, clear cell sarcoma of the kidney, rhabdoid tumor of the kidney. Other histologic patterns include: nephrogenic rests, congenital mesoblastic nephroma, and renal cell carcinoma.

An unfavorable histology is associated with a poor prognosis and more extensive chemotherapy. Prognosis is determined by the pathologic staging of Wilms’ tumor, defined by the National Wilms Tumor Study Group. Both the histology classification and the pathologic staging of Wilms’ tumor determine the type and length of time for
administration of chemotherapy agents and radiation treatments.

Nursing Care Plans

The nursing care plan goals for a child with Wilms tumor include: prevention of injury, improved condition of oral mucous membranes, comprehension of the disease and its management,  and absence of complications.

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Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for Wilms tumor:

  1. Ineffective Protection
  2. Impaired Oral Mucous Membrane
  3. Anxiety
  4. Risk for Injury
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Impaired Oral Mucous Membrane

Nursing Diagnosis

May be related to

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  • Chemotherapy

Possibly evidenced by

  • Hyperemia
  • Oral pain or discomfort
  • Oral plaque
  • Oral ulcers
  • Stomatitis

Desired Outcomes

  • Child will be free of oral mucous membrane irritation.
Nursing InterventionsRationale
Assess oral cavity for pain ulcers, lesions, gingivitis, mucositis or stomatitis and
effect on the ability to ingest food and fluids.
Provides information about chemotherapy effect.
Instruct the use of a soft-sponge toothbrush or sponge toothette or gauze when rinsing the mouth.Prevents oral trauma.
Instruct to avoid the use of lemon glycerin swabs.Lemon may cause increase irritation to oral lesions.
Instruct to avoid foods which are hot, spicy, or high in ascorbic acid (vitamin C).Decreases irritation to oral ulcers; these foods may aggravate pain and irritation
to the oral mucosa.
Instruct to avoid oral temperatures.Prevents oral trauma.
Provide oral hygiene 30 minutes prior or after meals; instruct to refrain from eating or drinking for 30 minutes after completion of oral hygiene.Prevents oral mucositis.
Offer moist, soft, bland foods.Minimize irritation to oral ulcers; it may also be better tolerated by the child.
Administer local anesthetics to the oral area before meals as ordered.May be effective in temporary pain relief from oral lesions; permits eating with
decreased oral pain.
Administer an antiseptic mouth rinse 30 minutes before any food or fluid intake as ordered.Maintains integrity and promotes comfort of oral mucosa.
Provide mouth care tips to parents.Promotes effective care of oral cavity to relieve discomfort.
Instruct parents about effect of
chemotherapy on oral mucosa and management to decrease discomfort in oral cavity.
Promotes understanding of side effects that occur and temporary nature of the side effects.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for pediatric conditions and diseases:

Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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