Wilms tumor affects approximately one child per 10,000
worldwide before the age of 15 years. Incidence rates appear to be slightly
elevated for U.S. and African Blacks in comparison to Whites, but are only half
as great among Asians. Several case-control studies have suggested that
paternal occupational or maternal hormonal exposures during pregnancy may increase
the risk of Wilms tumor, but small numbers of subjects and inconsistencies in
the patterns of exposures do not permit firm conclusions to be drawn. It is
unlikely that such environmental exposures play a major role in the etiology of
Wilms tumor. The median age-at-onset of Wilms tumor is 38 months in the U.S.
National Wilms Tumor Study series, with cases in girls occurring on average 6
months later than in boys (Breslow, 2018). Patients with bilateral tumors,
aniridia, cryptorchism/hypospadias, Beck-with-Wiedemann syndrome, or intralobar
nephrogenic rests tend to be diagnosed much younger than average (median 17-27
months). Those with familial disease or multicentric tumors have intermediate
age-at-onset distributions, while those with perilobar nephrogenic rests are
diagnosed at older ages. The epidemiologic features suggest that somatic
mosaicism, rather than a germline mutation, may be responsible for some of the
bilateral and multicentric cases, (Breslow, 2018). Wilms tumor also called
Wilms’ tumor or nephroblastoma is a type of cancer that starts in the kidneys.
It is the most common type of kidney cancer in children. It is named after Max
Wilms, a German doctor who wrote one of the first medical articles about the
disease in 1899 (Breslow, 2018). Wilms tumors are the most common cancers in
children that start in the kidneys. About 9 of 10 kidney cancers in children
are Wilms tumors. Most Wilms tumors are unilateral, which means they affect
only one kidney. Most often there is only one tumor, but 5% to 10% of children
with Wilms tumors have more than one tumor in the same kidney. About 5% of
children with Wilms tumors have bilateral disease (tumors in both kidneys).
Wilms tumors often become quite large before they are noticed. The average
newly found Wilms tumor is many times larger than the kidney in which it
started. Most Wilms tumors are found before they have spread (metastasized) to another
organ (Breslow, 2018).
The kidneys are 2
bean-shaped organs that are attached to the back wall of the abdomen. One
kidney is just to the left and the other just to the right of the backbone. The
lower rib cage protects the kidneys. Small glands called adrenal glands sit on
top of each of the kidneys. Each kidney and adrenal gland is surrounded by fat
and a thin, fibrous capsule (known as Gerota’s fascia). The main job of the
kidneys is filtering blood coming in from the renal arteries to rid the body of
excess water, salt, and waste products. These substances become urine. Urine
leaves the kidneys through long, slender tubes called ureters that connect to
the bladder. Urine flows down the ureters into the bladder, and is stored there
until the person urinates (Wilms Tumor Clinical Presentation, 2017). The
kidneys also have other jobs such as they help control blood pressure by making
a hormone called renin, they help make sure the body has enough red blood cells
by making a hormone called erythropoietin. This hormone tells the bone marrow
to make more red blood cells. Our kidneys are important, but we need less than
one complete kidney to do all its basic functions. Many people in the United
States live normal, healthy lives with just one kidney (Wilms Tumor Clinical
Presentation, 2017). The clinical presentation of Wilms tumor is an
asymptomatic abdominal mass, which occur in 80% of children. Abdominal pain or
hematuria occurs in 25%. Urinary tract infection and varicocele are less common
findings than these. Hypertension, gross hematuria, and fever are observed in
5-30% of patients. A few patients with hemorrhage into their tumor may present
with hypotension, anemia, and fever. Rare patients with advanced disease may
present with respiratory symptoms related to lung disease metastases.
As I was
researching regarding Wilms tumor, research is continuing to unravel how
changes in certain genes cause Wilms tumors and affect how aggressive tumors
are likely to be. While doctors learned how to treat Wilms tumors more
effectively, they have also begun to differentiate ways to determine which
children might have spared from more intense treatment and which children might
need more aggressive treatment to become cured. For example, recent studies
have shown that Wilms tumors with certain changes on chromosomes 1 or 16 seem
to be more likely to come back after treatment. Doctors are now studying
whether children with such tumors might benefit from more intense treatment.
Also, researchers are also studying the gene changes that seem to cause Wilms
tumor cells to grow and spread. This may lead to treatments that specifically target
these changes. However, researchers continue to study ways to improve treatment
for children with Wilms tumors. Due to favorable histology, earlier studies
found treatments that were very effective in curing Wilms tumors. Clinical
trials are currently studying ways to treat these cancers successfully, all
while reducing the side effects as much as possible. For example, studies are
looking at whether young children with very favorable outlooks need any
treatment other than surgery. In Europe, recent studies suggested that in some
cases chemo may not need to be continued if previously thought. Far as, the
outlook for children with Wilms tumors with unfavorable histology is not as
good, and doctors are looking for better treatments for these children. Newer
chemotherapy drugs such as topotecan and irinotecan are now currently being
tested. Other studies are looking at stem cell transplants, which let doctors
give higher doses of chemo than the body normally could tolerate. By doing this
approach, might help treat tumors that are not responding to standard treatments
or that would otherwise have a poor outlook. Researches have started to develop
newer drugs that specifically target changes, due to learning more about the
gene changes in Wilm’s tumor cells. Targeted drugs work differently from
standard chemotherapy drugs. They sometimes work when chemo drugs don’t and
they often have different (and less severe) side effects. Targeted therapies
have already become standard treatments for some kinds of adult cancers. Being
that Wilms tumors with favorable histology are usually cured with surgery and
chemotherapy, and because Wilms tumors with unfavorable histology are uncommon,
most research on targeted drugs so far has been done on cells growing in lab
dishes or in animals. But eventually researchers hope to test these new drugs
with children in clinical trials, so that these drugs may someday have a role
in treating unfavorable histology Wilms tumors.
It’s a necessity to know other
factors, such as religion and cultural background which influence one’s
beliefs, behaviors, and attitudes toward health and illness. Health beliefs and
practices of the Arab Muslim population is at an increased risk for several
diseases and faces many barriers to accessing the American health care system.
Some barriers, such as modesty, gender preference in healthcare providers, and
illness causation misconceptions, arise out of their cultural beliefs and
practices. Other barriers are related to
the complexity of the health care system and the lack of culturally competent
services within it. Nurses need to be aware of these religious and cultural
factors to provide culturally competent health promotion services for this
population. Nurses also need to integrate Islamic teachings into their
interventions to provide appropriate care and to motivate healthy behaviors
(Yosef, 2008). Nurses need to be aware of the implications of spiritual and
cultural values for clinical practice. They should understand the need for
privacy and modesty, the appropriate use of touch, dietary requirements and use
of medications (Rassool, 2018). Muslims, who abstain from food from dawn to
dusk during holy periods, for orthodox Christians fasting means abstaining from
animal and dairy products. Far as Christians, all people should be treated with
dignity and respect because they have been created in the image of God. This
‘divine’ dignity gives them fundamental human rights. A very sick person or a
member of his or her family may ask a priest to perform one or more of the holy
sacraments. By anointing the sick with oil in Christ’s name, the priest asks
Him to alleviate suffering and heal the person, either in this or the eternal
life. The dying person may also want to take confession and holy communion.
These rituals are important preparations for the journey to the next life. In
areas with large orthodox communities, contacting priests should not be a
problem. In areas with a small orthodox community, health care staff should
plan. Although some people will not consent to organ donation because of the
importance they place on the integrity of the body after death, the church
teaches that organ donation is an act of Christian love.
diagnosis for Wilms tumor:
Risk of infection
related to chronic disease.
outcomes (measurable goals):
The patient will
identify infection risk factors, and signs and symptoms of infection.
Perform hand hygiene
before and after providing care, and direct patient to do this before and after
meals and using bathroom, bedpan, urinals.
Avoid spread of pathogens
Instruct patient to
immediately report loose stools or diarrhea.
May indicate need to discontinue or change antibiotic
therapy or test for clostridium difficle.
Monitor and record
temperature at least every 4 hours after surgery; report elevations
May signal complications, wound infection or dehiscence,
UTI, or thrombophlebitis.
less than body requirements related to inability to digest/ingest food.
The patient will gain
1 pound per week and show no further evidence of weight loss by 01/12/2019.
weight, meal preparation, serum albumen, usual dietary pattern, weight.
fluctuation over the last 10 years, psychosocial status,
and coping behavior interventions.
Assessment of the factors will allow the nurse to choose
Refer patient to a
dietitian or nutritional support team.
For dietary management.
patient’s food preferences, attempt to obtain desired foods for the patient.
Offer food that appeal to olfactory, visual, and tactile senses.
To enhance patient’s appetite.
Impaired oral mucous
membrane related to ineffective oral hygiene.
The patient will
demonstrate oral hygiene practices by 01/12/2018.
Inspect patient’s oral
cavity every shift. Describe and document condition; report any change in
Regular assessments can anticipate or alleviate problems.
Have patient return a
demonstration of the oral care routine.
These measures increase patient’s awareness of oral hygiene
practices to reduce discomfort resulting in increased nutrition and hydration.
mouthwash/gargles, as ordered.
To increase patient comfort and maintain moisture in his/her