Last updated on August 19th, 2022 at 07:32 am
Wilms Tumor Nursing Care Plans Diagnosis and Interventions
Wilms Tumor NCLEX Review and Nursing Care Plans
Wilms tumor, also known as nephroblastoma, is the most common cancer of the kidney. It is identified as the second most common tumor that affects children, particularly those aged 3 to 4 years of age.
It also rarely occurs in adults. When diagnosed, Wilms tumor is usually present in only one kidney, but there are rare cases when it occurs to both kidneys at the same time.
With the advances in technology and other medical breakthroughs, treating Wilms tumor has become easier, allowing for better patient prognosis and quality of life.
Signs and Symptoms of Wilms Tumor Nephroblastoma
The clinical manifestations of Wilms tumor vary from patient to patient, and may include:
- Abdominal swelling
- Abdominal pain
- Blood in urine
- Nausea and/or vomiting
- Loss of appetite
- Shortness of breath
- High blood pressure
Causes and Risk Factors of Wilms Tumor Nephroblastoma
The cause of Wilms tumor is idiopathic. However, genetics plays a major component for its development.
The WT1 gene has been identified as one of the genes observed not only in children with Wilms tumor, but also as part of patients with WAGR syndrome – characterized by Wilms tumor, Aniridia (partial or complete absence of the iris), Genito-urinary anomalies and mental Retardation.
The risk factors for Wilms tumor include:
- Race – there is a slightly more common risk in African-Americans
- Family history of Wilms tumor
Children with certain abnormalities and syndromes are also observed in having Wilms tumor as part of the disease process. Examples of which include:
- Aniridia – A condition wherein the iris partially or completely does not develop fully.
- Hemihypertrophy – condition wherein one side of the body is bigger when compared to the opposite side.
- WAGR Syndrome
- Denys-Drash Syndrome – syndrome including Wilms tumor, renal disease, and pseudohermaphroditism in males (born with testicles but exhibiting female qualities)
- Beckwith-Wiedemann syndrome – Syndrome characterized by macrosomia (appears larger than average), macroglossia (enlarged tongue), and protrusion of abdominal organs through the umbilical cord, enlarged internal organs, and ear anomalies.
Complications of Wilms Tumor Nephroblastoma
The initial complications of Wilms tumor are abdominal obstructions. As the tumor enlarges, the organs in the abdomen become displaced.
Likewise, complications of Wilms tumor may also arise from the type of treatment the patient will receive and they are:
- Renal complications. Patients post removal of the affected kidney (nephrectomy) have minimal risk of impairments unless the patient has bilateral Wilms tumor. However, radiation therapy targeted at the affected area can impair with normal kidney function. Likewise, introduction of chemotherapy in the system may lead to toxicities of the kidney.
- Hepatic problems. Administration of radiation and cytotoxic drugs, as part of the treatment protocol for Wilms tumor, may also compromise general liver health for it interferes with normal hepatic physiology.
- Congestive heart failure. Administration of chemotherapy from the anthracycline drug class will compromise cardiac health and will promote rhythm and other physiologic dysfunctions.
Diagnosis of Wilms Tumor Nephroblastoma
Diagnosing Wilms tumor involves the following:
- Complete physical exam
- Blood and urine tests – to assess for baseline kidney and general health of the patient. Sample tests are complete blood count, biochemistry profile, urinalysis, coagulation tests, and cytogenetic studies.
- Imaging studies
- Four-field chest radiography – to assess for presence of lung metastasis.
- Renal ultrasonography – to determine patency of inferior vena cava when preparing for nephrectomy.
- CT scan – to visualize the tumor, the extent of involvement, and for other metastasis.
- MRI scan –a more comprehensive imaging of the abdomen for proper visualizing of structures.
- Biopsy – to confirm the diagnosis of Wilms tumor through the histopathologic approach.
- Staging – as with any solid tumors, Wilms tumor follows a staging process of severity
- Stage 1 – The cancer is found and contained in one kidney, that can be completely resected.
- Stage 2 – The cancer has spread to other areas of the affected kidney, like the blood vessels, but can still be resected.
- Stage 3 – There is lymph node involvement and the tumor spreads to the abdomen; tumor may spread before or during resection; it can only be removed partially.
- Stage 4 – The cancer has spread and has already metastasized to the lungs, liver, bones and/or brain.
- Stage 5 – Presence of tumor to both kidneys.
Treatment for Wilms Tumor Nephroblastoma
The usual treatment plan for Wilms tumor involves the surgical removal of the kidney called nephrectomy, followed by chemotherapy and/or radiation therapy.
In relation to this, the treatment protocol for Wilms tumor will depend on the stage of the disease and the extent of the affected area.
|Stage and histology||Surgery||Chemotherapy||Radiation therapy|
|Stage 1 or 2 favorable histology without lost of heterozygosity (LOH) 1p and 16qt||Nephrectomy||Vinca Alkaloids + antitumor antibiotic||No|
|Stage 1 or 2 favorable histology with LOH 1p and 16q||Nephrectomy||Vinca Alkaloids + antitumor antibiotic + Anthracycline||No|
|Stage 3 and 4 favorable histology without LOH 1p and 16q||Nephrectomy||Vinca Alkaloids + antitumor antibiotic + Anthracycline||Yes|
|Stage 3 and 4 favorable histology with LOH 1p and 16q||Nephrectomy||Vinca Alkaloids + antitumor antibiotic + Anthracycline + Alkylating agents + Podophyllotoxin derivatives||Yes|
|Stage 5||Double Nephrectomy with preservation of renal parenchyma||Vinca Alkaloids + antitumor antibiotic + Anthracycline + Alkylating agents + Podophyllotoxin derivatives||Yes|
High risk Wilms tumor cases follow the treatment protocol described below:
- Focal anaplastic stage 1-3 and diffuse anaplastic stage 1 tumor – Nephrectomy followed by Vinca alkaloids + antitumor antibiotic + Anthracycline, with additional local radiation therapy
- Focal anaplastic stage 4 and diffuse anaplastic stage 2-3 tumor – same with number 1 treatment with additions of Alkylating agents + Podophyllotoxin derivatives + Antineoplastics to chemotherapy
- Stage 4 diffuse anaplastic – more aggressive; tis needs Nephrectomy followed by Topoisomerase 1 inhibitors + Vinka alkaloids; another regimen of Antitumor antibiotic + Anthracylines + Alkylating agents + Podophyllotoxin derivatives then radiotherapy.
Nursing Diagnosis for Wilms Tumor Nephroblastoma
Wilms Tumor Nursing Care Plan 1
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to abdominal pain and cramping secondary to Wilms tumor, as evidenced by abdominal cramping, stomach pain, weight loss, nausea and vomiting, and loss of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Wilms Tumor Nursing Interventions||Rationale|
|Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.)||To create a baseline of the patient’s nutritional status and preferences.|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake and alcohol and coffee intake.||To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed Wilms tumor.|
|Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Provide anti-emetics to resolve nausea and/or vomiting. Promote bowel emptying using laxatives as prescribed.||To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe constipation, which is a common symptom of Wilms tumor.|
Wilms Tumor Nursing Care Plan 2
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Wilms tumor as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Wilms tumor and its management.
|Wilms Tumor Nursing Interventions||Rationales|
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).||To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning.|
|Explain what Wilms tumor is and its symptoms. Avoid using medical jargons and explain in layman’s terms.||To provide information on Wilms tumor and its pathophysiology in the simplest way possible.|
|Educate the patient about his/her Wilms tumor treatment plan. If patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for surgery, explain the procedure to the patient.||To give the patient enough information on the treatment plan, so that he/she can provide or deny an informed consent.|
|Educate the patient about the diagnostic tests required while treating Wilms tumor.||To inform the patient of the rationale behind the imaging, blood tests, and other diagnostic procedures.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics and bowel medications. Explain how to properly self-administer each of the supportive medications. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and administration details.|
|Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be improved or modified while treating Wilms tumor. Teach the patient on how to get started on the recommended lifestyle changes (e.g. smoking cessation, alcohol cessation, proper diet and exercise.)||To assist the patient in identifying and managing lifestyle choices while having anti-tumor treatment.|
Other nursing diagnoses:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.