Pediatric Nursing Demystified

Hypertension due to tumor excretion of renin may occur on occasion.

Metastasis may reveal symptoms dependent on location.

• Dyspnea, cough, shortness of breath, and chest pain with chest
  involvement

Test Results

History (familial history of cancer) and physical examination are

important.

Diagnosis by biopsy of fully excised tumor to prevent seeding by rup-

ture of encapsulated tumor mass.

Hematologic studies (may reveal polycythemia due to excess erythropoi-

etin secretion or anemia from deficient erythropoietin secretion or from

hemorrhage).

Blood chemistry (including creatinine and BUN), urinalysis, and

glomerular filtration rate may be used to assess renal function.

Abdominal ultrasound and other radiographic studies.

CT scan, MRI, and bone scans to detect metastasis to lung.

Inferior venacavogram may reveal involvement with vena cava.

Treatments

Multimodal treatment with surgical removal of tumor and chemotherapy

Irradiation added based on stage of tumor and to shrink tumor before

surgery

Chemotherapy to shrink tumor before surgery and as follow-up:

• Chemotherapy agents of choice:
  Vincristine
  Actinomycin D
  Cyclophosphamide
  Doxorubicin
  Partial or total nephrectomy (removal of kidney) may be necessary.
  If both kidneys involved, bilateral nephrectomy (last resort if sibling
  transplant is possible)

Nursing Interventions

Interventions are similar to those with other solid tumors.

Preoperative care:

• Monitor closely for signs of renin release: Hypertension.

Nursing alert Protect abdomen from trauma; tumor must notbe palpated

unless absolutely necessary and only with gentle pressure to avoid possible

rupture and spread of cancer cells. Post sign above bed as reminder to reduce

risk of deep palpation.

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(^164) Pediatric Nursing Demystified