Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms Tumor - Causes, Clinical Manifestations, Diagnostic, Complication and Management

Wilms tumor or nephroblastoma is a cancer of the kidneys that typically occurs in children, rarely in adults. It is named after Dr. Max Wilms, the German surgeon (1867–1918) who first described it.

Type of renal carcinoma is the most frequently encountered arise from renal epithelium and cause more than 85% of kidney tumors. These tumors metastasize first to the lungs, bones, liver, brain, and the contralateral kidney. A quarter of patients had metastatic disease at time of diagnosis. (Brunner & Suddarth, 2014).


Causes

1. Exactly unknown
2. Genetic predisposition
3. Can be associated with congenital anomalies: which often is sporadic aniridia, genitourinary anomalies, hemihypertrophy, microcephaly and cryptorchidism. (Suriadi & Rita Yulianni, 2006).


Clinical Manifestations
1. There is a mass in the abdomen.
2. haematuria.
3. Hypertension.
4. Abdominal pain.
5. Anemia.
6. Fever.
7. Metastatic to the lungs, shortness of breath, dyspnea, cough, chest pain.
8. Pale.
9. Lethargy.
10. Anorexia.


Diagnostic
1. Physical examination.
2. Ultrasound.
3. CT scan.
4. X-rays.
5. CBC, electrolytic, BUN, creatinine and urine analysis.
6. Biopsy.


Complication
1. Metastasis.
2. Poor Prognosis
3. Complications from surgery.


Management
1. Chemotherapy with or without radiation
2. Surgery

Fluid Volume Deficit related to Dehydration

Dehydration occurs when water or fluids out of the body more than the incoming fluid, so that the body is not able to function as it should. If the fluid needs are not immediately met, then the body will become dehydrated.

The initial signs of dehydration include:

• Feeling thirsty.
• Dizziness.
• Dark yellow urine color.
• Frequency of urination less than usual.

The most obvious indicator to determine the body dehydration / less fluid is to look at the color of urine: if bright and clear, the body hydrated, and if the yellow - dark red then it is almost certainly a sign of dehydration.

Dehydration mild - moderate effect and can cause the following symptoms:

• Dry mouth and sticky.
• Tired and sleepy.
• Thirst.
• The quantity of urine is reduced.
• Dry skin.
• Constipation.
• Headache.

In children, they usually become less active than usual when dehydrated.

Severe dehydration

If left unchecked, the body that dehydration can cause dehydration worse. Severe dehydration is an emergency medical condition, and must be given treatment.

Symptoms of severe dehydration can include:

• Very thirsty.
• Mouth, skin, and mucous membranes are very dry.
• Confusion and irritability.
• Not urinating more than 8 hours.
• Urine is very dark, and few in number.
• Eyes look sunken, heavy, dry and sore.
• Rapid heartbeat.
• Low blood pressure.
• Low level of awareness to a fever.

Fluid Volume Deficit related to excessive output, less input. (Doenges, 1999)

Goal: Adequate fluid volume, so the lack of fluid volume can be resolved.

Expected outcomes:

• Maintaining fluid balance.
• Vital signs (pulse = 80-100 x / min, temperature = 36-37 ° C)
• Capillary refill less than 3 seconds.
• Acral warm.
• Urine output is 1-2 cc / kg body weight / hour.

Action Plan

1) Monitor vital signs, capillary refill, status mucous membranes, turgor.
Rationale: circulation volume adequacy indicator, the data hypotension occurs with risk of injury after the change of position.

2) Monitor the amount and type of fluid intake, urine output measure accurately.
Rational: Patients should not consume fluids at all lead to dehydration, or changing caloric intake of fluids to affect electrolyte balance.

3) Discuss strategies to stop vomiting and use of laxatives / diuretics.
Rationale: Helping patients received the feeling that as a result of vomiting and / or use of laxatives / diuretics prevent further loss.

4) Identification of a plan to improve / maintain optimal fluid balance. For example: fluid intake schedule.
Rationale: Involving the patient in a plan to correct the imbalance.

5) Assess function test results electrolyte / kidney.
Rationale: The transfer fluids / electrolytes, renal function decline may extend affect healing.

6) Provide / supervise administration of IV fluids.
Rationale: Emergency measures to correct the imbalance of fluid.

7) Additional potassium, oral or N as indicated.
Rationale: It can prevent cardiac dysrhythmias.