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30 Cards in this Set
- Front
- Back
What is Wilms tumor (nephroblastoma)?
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most common malignant renal and intraabdominal tumor of childhood (most common in AA, followed by East Asians)
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The peak age of diagnosis of Wilms is about __ years, higher frequency in boys.
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3
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Wilms tumor favors the left?
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kidney
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Most children with Wilms tumor are brought to practitioner because of ____ ____ or an _____ ______.
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abdominal swelling
abdominal mass |
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What are specific tests for Wilms?
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radiographic studies
abdominal ultrasound abdominal and chest computed tomography scan hematologic studies biochemical studies urinalysis |
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With Wilms, studies to demonstrate relationship of tumor to ______ kidney and the presence of normal functioning kidney on the contralateral side are essential.
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ipsilateral
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If a large Wilms tumor is present, an ____ _____ is necessary to demonstrate possible tumor involvement adjacent to vena cava.
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inferior venacavagram
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What might be done to rule out metastasis in a Wilms tumor patient, which is rare?
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bone marrow aspiration
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Nursing Alert!
To reinforce need for caution, it may be necessary to post a sign on the bed that reads? |
"DO NOT PALPATE ABDOMEN".
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With Wilms tumor, careful bathing and handling are important in preventing trauma to the ____ site.
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tumor
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With Wilms tumor, the child may be left with one kidney, so teach patient to avoid?
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contact sports to prevent injury to remaining organ.
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With Wilms tumor, prompt detection and treatment of any ___ signs or symptoms are mandatory.
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GU
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The most effective agents for treating Wilms is 1.___?
Duration of therapy varies, ranging from 2.___ to ___ months. |
1. actinomycin D (dactinomycin)
vincristine Adriamycin with addition of cyclophosphamide 2. 6 to 15 months |
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Clinical manifestations of Wilms tumor are?
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abdominal swelling of mass:
firm nontender confined to one side hematuria (less than one fourth of cases) fatigue/malaise hypertension (occasionally) weight loss fever manifestations resulting from compression of tumor mass secondary metabolic altera- tions from tumor or metastasis If metastasis, symptoms of lung involvement: dyspnea cough shortness of breath chest pain (sometimes) |
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Staging of Wilms tumor?
What is Stage 1? |
tumor is limited to kidney and completely resected
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Staging of Wilms tumor?
Stage II |
tumor extends beyond kidney but is completely resected
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Staging of Wilms tumor?
Stage III |
residual nonhematogenous tumor is confined to abdomen
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Staging of Wilms tumor?
Stage IV |
hematogenous metasases; deposits are beyond stage III, namely, to lung, bone, and brain
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Staging of Wilms tumor?
Stage V |
bilateral renal involvement is present at diagnosis
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Survival rate of Wilms tumor is ___
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high (90% cure)
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Relapse to ____ and ____ may occur and relapse more than ___ months after diagnosis.
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lung
abdomen 12 |
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Nurse must prepare child and parents for all lab and surgical procedures within?
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24 to 48 hours of admission...keep explanations brief, repetitive and simple
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Upon admission, nurse should especially monitor blood pressure, because hypertension from excess ___ _____ is a possibility.
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renin production
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Several special preoperative concerns, the most important of which is that?
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the tumor is not palpated unless absolutely necessary, because manipulation of mass may cause dissemination of cancer cells to adjacent and distant sites.
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Following chemo and radiation, the child should be prepared for alopecia within?
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2 weeks after initial treatment
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Recovery for Wilms is usually ____?
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rapid
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Major nursing responsibilities concern what type of surgery and responsibilities are the same with that type of surgery?
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abdominal
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Post-op.
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
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Post-op.
Besides blood pressure, what should nurse monitor? |
urine output
signs of infection institute pulmonary hygiene to prevent postop pulmonary complications |
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What can nurse do to help pschyological ramifications of Wilms tumor treatment?
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play therapy with dolls or
puppets, drawing child may feel angry because of extent of surgery, need for addtl therapy, seriousness of disorder |