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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Risk for Injury

Nursing Diagnosis

  • Risk for Injury

May be related to

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  • Side effects of medications
  • Complications

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will not experience injury.
Nursing InterventionsRationale
Monitor for increase blood pressure pre and postoperatively every 2 hours, changes in pulse and respirations.Provides information about vital signs caused by renal function abnormality preoperatively or by nephrectomy postoperatively, postoperative atelectasis.
Assess urinary output for presence of
cloudy, foul-smelling urine; collect the specimen for culture analysis and report any change in renal function (hypertension, headache irritability, weight gain, behavior changes).
Indicates possible renal impairment and/or urinary bladder infection; renal involvement alters renin excretion which increases BP and immunosuppressive therapy leads to infection.
Avoid any palpation of abdominal mass; post sign on bed stating not to palpate preoperatively.Prevents trauma to the tumor site and possible metastasis by dissemination of cancer cells.
Assess and document frequency of bowel movements; document a description of all bowel movements; measure abdominal girth.To assess potential intestinal obstruction from vincristine-induced adynamic ileus.
Assess bowel activity postoperatively for elimination pattern, bowel sounds, bowel distention.Provides information about possible adynamic ileus from chemotherapy causing bowel obstruction.
Assess incision site for redness, swelling, drainage, intactness, and healing and change dressing when soiled or wet; assess oral and perineal area.Indicates infectious process resulting from invasive procedure or inflammation resulting from immunosuppressive therapy for stomatitis or skin breakdown or inflammation; provides oral care and anal care after elimination; provides postoperative pulmonary care.
Maintain reverse isolation if leukopenia present or according to agency dictate.Prevents transmission of infective agents to the immunosuppressed child.
Teach parents to avoid exposing the child
to infectious agents; limit visitors.
Prevents exposure to the possible microorganism in the immunosuppressed child.
Advise parents and child about all assessments and procedures and rationale for isolation precautions.Promotes understanding and cooperation.
Encourage parents to appropriately dress child based on weather conditions and to refrain from participating on rough activities or sports.Prevents respiratory infections associated with exposure or trauma to the abdominal site preoperatively and surgical site
postoperatively.
Teach parents and child about mouth care such as rinsing and swabbing with solutions, cleansing and drying after bowel elimination.Prevents or treats skin and mucous membrane damage as a result of therapy.
Instruct parents and child to report any changes in urinary pattern or
characteristics or renal function promptly.
Allows for immediate attention to any genitourinary problems in remaining kidney.
Administer stool softeners as ordered.Avoids straining during bowel movements

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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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