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Medical 8-Pediatric27-Wilms Tumor


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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.
Wilms tumor favors the left?
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
With Wilms, studies to demonstrate relationship of tumor to ______ kidney and the presence of normal functioning kidney on the contralateral side are essential.
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?
With Wilms tumor, careful bathing and handling are important in preventing trauma to the ____ site.
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.
The most effective agents for treating Wilms is 1.___?
Duration of therapy varies, ranging from 2.___ to ___ months.
1. actinomycin D (dactinomycin)
Adriamycin with addition of
2. 6 to 15 months
Clinical manifestations of Wilms tumor are?
abdominal swelling of mass:
confined to one side
hematuria (less than one
fourth of cases)
hypertension (occasionally)
weight loss
manifestations resulting
from compression of tumor
secondary metabolic altera-
tions from tumor or
If metastasis, symptoms of
lung involvement:
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.
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 ____?
Major nursing responsibilities concern what type of surgery and responsibilities are the same with that type of surgery?
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
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

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