Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Genitourinary Disorders: Wilms' Tumor


  • also called Nephroblastoma, the most common malignant tumor of the kidneys affecting children
  • a large, encapsulated tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney
  • usually unilateral, usually develops in the renal parenchyma of the left kidney
  • occurs in association with congenital anomalies such as aniridia, cryptorchidism, hypospadias, pseudohermaphoditism, cystic kidneys, hemangiomas, and talipes disorders
  • peak age of occurrence is between 1-3 years, rarely occurs in children older than 8 y.o.
Assessment Findings
  • firm, non-tender abdominal mass, usually midline near the liver--> usually discovered when a parent dresses or bathes child
  • hematuria (blood in urine)
  • low-grade fever
  • hypertension-->due to increased renin production
  • possible anemia, weight loss, malaise, anorexia, stomach pain, nausea, and vomiting
  • diagnostic tests
1. intravenous pyelogram--> will reveal a mass displacing normal kidney structure
2. chest CT Scan, chest MRI, sonogram, bone scan, and chest X-ray-->may be ordered
to determine spread beyond kidneys
3. kidney function studies (e.g. GFR and BUN)--> done prior to surgery
  • staging:
-Stage I (tumor confined to kidney and completely removed surgically)
-Stage II (tumor extending beyond the kidney but completely removed surgically)
-Stage III (tumor has spread to the nearby lymphnodes and to other areas within the
abdomen and it can't be completely removed surgically)
-Stage IV (the tumor has spread to distant structures such as the lungs, liver, or bone
-Stage V (tumor is in both kidneys)

Medical Management
  1. Postsurgical radiation--> for stages II, III, and IV; stage I may require radiation depending on histologic studies
  2. Postsurgical chemotherapy--> dactinomycin, vincristine, or doxorubicin may be used and usually given at varying intervals for as long as 15 months
Surgical Management
  • Wilms' tumor is removed by nephrectomy (surgical removal of kidney tissue). It is usually performed 24-48 hours after diagnosis as Wilms' tumor metastasizes rapidly owing to the large blood supply of the kidneys and adrenal glands.
  • Nephrectomy may be simple (entire kidney is removed), partial (removal of tumor and kidney tissue surrounding it, or radical (removal of the kidney, surrounding tissues, and neighboring lymph nodes).
Nursing Management
  1. do NOT palpate the abdomen as palpation and handling aids in metastasis
  2. instruct caregivers to bathe and dress child with care
  3. provide care for a client with a nephrectomy--> focus on urine output assessment, avoidance of pulmonary complications, signs of complications (flank pain on unoperative site, unexplained weight gain, decreased urine output)
  4. provide care for client receiving chemotherapy and radiation therapy--> avoidance of infection, promote nutrition and hydration, and care of radiation site
Prognosis

Overall five-year survival rate is 89.5%. Patients with tumors of mostly differentiated epithelial cells have a long-term survival rate of 93%. Prognosis is best for patients below 2 years old with stage I small-sized tumors.

Prevention

Wilms' tumor is not preventable


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