Wilms Tumor (Nephroblastoma) Nursing Care Plans

Most of the time a parent finds it first, a firm, nontender abdominal mass noticed while bathing or dressing the child. Your job on the floor is to protect that mass from any pressure, watch the remaining kidney, and carry the family through chemotherapy without letting infection or bleeding get ahead of you.

Wilms tumor (nephroblastoma) is the most common malignant renal tumor in children. Average age at diagnosis is 41.5 months for unilateral tumors and 29.5 months for bilateral tumors. It runs with congenital anomalies and chromosomal abnormalities: aniridia, hypospadias, cryptorchidism, pseudohermaphroditism, Beckwith-Wiedemann syndrome, Denys-Drash syndrome, and Perlman and Sotos syndromes.

Beyond the abdominal mass, look for abdominal pain, gross hematuria, low-grade fever, and hypertension. The tumor spreads most often to the lungs, regional lymph nodes, and liver. Histology is classified as favorable or unfavorable, with 3 cell types (blastemal, stromal, epithelial); 10% show anaplastic or unfavorable findings, including clear cell sarcoma and rhabdoid tumor of the kidney. Histology and pathologic staging, defined by the National Wilms Tumor Study Group, drive how aggressive the chemotherapy and radiation will be.

Nursing Care Plans and Management

The priorities: protect the child from injury and infection, keep the oral mucosa intact through chemotherapy, control anxiety, and watch the remaining kidney.

Nursing Problem Priorities

• Treat and manage the tumor through surgery, chemotherapy, and radiation.
• Preserve kidney function and the affected kidney when possible.
• Assess and manage metastasis to the lungs and liver.
• Monitor renal function and catch treatment-related complications early.
• Run regular followup, imaging, and labs to detect recurrence and late effects.
• Support the child and family through the emotional weight of the diagnosis.

Nursing Interventions and Actions

1. Preventing Infection and Protecting the Oral Mucosa

Chemotherapy suppresses the marrow, so these children bleed and catch infection easily, and the same drugs strip the lining of the mouth. Stay ahead of both.

Assess for bleeding from any site and febrile episodes; monitor WBC, platelet count, hematocrit, and absolute neutrophil count. This flags frank bleeding and the marrow suppression and immunosuppression that drive it.

Check the oral cavity for ulcers, lesions, gingivitis, mucositis, or stomatitis, and how they affect the child's ability to eat and drink. This tracks the chemotherapy's effect on intake.

Wash your hands before care, use a mask and gown when needed, and provide a private room when the absolute neutrophil count drops below 1,000/cu mm. A weakened immune system can't fight off transferred organisms.

Pad the side rails, apply pressure for 5 minutes after IV administration, and avoid rectal temperatures and unnecessary invasive procedures. Chemotherapy alters platelets and clotting factors, so any trauma bleeds.

Tell parents and child to avoid anyone with an upper respiratory infection, contact sports, blowing the nose hard, and straining at stool. These prevent infection and bleeding in a highly susceptible child.

Have parents report fever, behavior changes, headache, dizziness, fatigue, pallor, slow oozing of blood, or exposure to communicable disease. Any of these signals an abnormal blood profile.

Teach urine and stool testing for blood with dipstick and hematest, and have them return the demonstration. This catches GI or urinary tract bleeding at home.

Give blood transfusion as ordered for severe loss. Monitor patency and watch for chills, fever, urticaria, rash, dyspnea, diaphoresis, and headache during transfusion, and stop it if any appear. Transfuse when anemia shows (dizziness, pallor, fatigue, rising pulse and respirations) or when the Hct drops below 20% or platelets below 20,000/cu mm.

For the mouth: use a soft-sponge toothbrush, toothette, or gauze when rinsing. Avoid lemon glycerin swabs and foods that are hot, spicy, or high in ascorbic acid; these aggravate oral lesions. Avoid oral temperatures. Give oral hygiene 30 minutes before or after meals, and have the child hold off eating or drinking for 30 minutes after. Offer moist, soft, bland foods. Give local anesthetics before meals and an antiseptic mouth rinse 30 minutes before intake, as ordered. Teach parents that the mucosal damage is a temporary side effect of chemotherapy.

2. Preventing Injury

The tumor, the surgery, and the chemotherapy all threaten this child. The single most important rule is on the bed before the OR: do not palpate the mass.

Monitor blood pressure before and after surgery every 2 hours, along with pulse and respirations. Renal involvement and nephrectomy both disturb vital signs, and you are also watching for postoperative atelectasis.

Assess urine for cloudy, foul-smelling output; collect a specimen for culture and report any change in renal function (hypertension, headache, irritability, weight gain, behavior changes). Renal involvement alters renin and raises blood pressure, and immunosuppression invites infection.

Avoid any palpation of the abdominal mass and post a sign on the bed not to palpate preoperatively. Pressure can rupture the tumor and seed cancer cells.

Document frequency and description of all bowel movements and measure abdominal girth. Watch for vincristine-induced adynamic ileus and bowel obstruction.

Assess bowel activity after surgery for elimination pattern, bowel sounds, and distention. Inspect the incision for redness, swelling, drainage, and healing, and change the dressing when soiled or wet. Maintain reverse isolation if leukopenia is present or per agency policy, and limit visitors to protect the immunosuppressed child.

Teach parents to dress the child for the weather and keep them out of rough activity. Have them report any change in urinary pattern or renal function promptly so the remaining kidney gets immediate attention. Give stool softeners as ordered to prevent straining.

3. Reducing Anxiety

Diagnosis and surgery move fast here, often within days, and that pace is its own source of fear for parents and child.

Assess the source and level of anxiety. For parents it is often guilt, uncertainty about surgery and recovery, and fear of losing the child; for the child it is the procedures and the effects of treatment.

Have parents stay with the child or keep open visitation, and give them a number to call. Let them verbalize concerns about the disease, surgery, and prognosis. Explain every procedure in simple, direct, honest terms and repeat as needed, because anxiety blocks comprehension when too much information arrives at once.

Teach the disease process, the surgery, what to expect before and after, and the effects of radiation and chemotherapy (alopecia, stomatitis, nausea, vomiting, and diarrhea are possible but temporary). Explain that a kidney will be removed and walk them through the staging and the pathology report afterward.

Keep nurse assignments consistent and bring parents into care to build trust. Orient the child to the surgical and ICU units, the equipment, and the staff. Use therapeutic play, drawings, and models so the child can understand and voice their feelings. Connect parents to community agencies and support groups who have lived the same experience.