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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Anxiety

Nursing Diagnosis

May be related to

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  • Change in health status
  • Threat of death
  • Threat to self-concept

Possibly evidenced by

  • Increased apprehension and fear of diagnosis
  • Expressed concern and worry about preoperative procedures
    and preparation postoperative care and effects of therapy, possible metastasis of the disease

Desired Outcomes

  • Clients will experience decreased anxiety.
Nursing InterventionsRationale
Assess source and level of anxiety and need for information and support that will relieve it.Provides information about the extent of anxiety and need for interventions and support; sources for parents may be guilt and uncertainty about surgery, treatments and recovery, possible loss of child; sources for the child may be the number of procedures of diagnosis and surgery and the effects of postoperative treatments.
Have the parents to stay with the child or encourage open visitation, provide a telephone number to call for information.Promotes care and support of the child by parents.
Allow verbalization of concerns and questions regarding disease and possible consequences of surgery and prognosis.Provides an opportunity to express feelings, gather information needed to decrease anxiety.
Explain all procedures and care in simple, direct, honest terms and repeat as often as necessary; reinforce physician information if needed and provide specific information as needed.Prevents overloading with information in small amount of time as diagnosis and procedures usually carried out within a short period of time and anxiety will prevent ability to grasp.
Teach parents and child about the disease process, surgical procedure, what to expect with procedures done preoperatively, and what will be experienced postoperatively including radiation and chemotherapy and its benefits and effects (alopecia, stomatitis,
nausea, vomiting, diarrhea are possible but temporary).
Promotes knowledge and understanding of pre and postoperative treatments and effect on disease and self-image.
Teach parents and child the extent of  surgery with the removal of a kidney and the staging process; discuss their understanding of the pathology report postoperatively and clarify information as needed.Minimizes anxiety when information and support is handed and child and parents will not feel misguided by insufficient preparation of procedures and treatments.
Provide consistent nurse assignment with the same personnel; encourage parents to participate in care.Promotes trust and ease and familiarity with staff giving care.
Orient child to the surgical and ICU
unit, equipment, noises, and staff.
Decreases anxiety caused by fear of unknown.
Use therapeutic play, drawings,
models for an instruction of child.
Assist the child to learn and understand what will be experienced and to verbalize their feelings.
Provide parents and child with information about community agencies and support groups.Provides emotional support by those who have shared the same experiences with the disease.
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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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