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).


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.

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

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

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.

Pain in Lower and Upper Right Side of the Abdomen

There are many kinds of pain that commonly occur in the stomach. Starting from the pain that is not too distracting to the sharp pain. There is also a type of stomach pain could slowly feel unbearable, then improve again. This condition needs to be examined whether the pain radiating to the specific direction, along with other symptoms that accompany.

The conditions generally can be the cause of Pain in Right Side of the Abdomen.

Ectopic pregnancy

Ectopic pregnancy is a condition in pregnancy where the egg is fertilized are not able to stick or cling to the mother's womb, but attached to another place, namely at the place known as the fallopian tubes, cervix, in the abdomen or in the ovaries. By the time the pregnancy reaches the age of 6-10 weeks, ordinary women who have an ectopic pregnancy will experience symptoms ; Pain in the pelvic area to one side and usually occur suddenly, abdominal pain that appears to be happening more and more often.


Appendicitis is a condition in which infection occurs in the appendix. In mild cases may resolve without treatment, but many cases require laparotomy with the removal of the infected appendix. Symptoms of acute appendicitis include fever, nausea, vomiting, decreased appetite, pain around the navel is then localized in the lower right abdomen, pain worse for a walk, but not everyone will show symptoms like this, it could also just be chills, or nausea-vomiting only.


Hepatitis is a disease that attacks the organs of the human heart. Here the liver inflammation that makes the function of the liver, which as a filter toxins in the blood, becomes impaired. With the disruption of liver function, then disrupted the function of other organs, thus making a person's health will be destroyed as a whole. Common symptoms of hepatitis are pain in the right abdomen, weakness, nausea, fever and diarrhea.


Gallstones are hardened bile deposits or petrified that form in the gallbladder. Bags or gallbladder is a small organ shaped like a pear that is located in the right abdomen, just below the heart. Gallstones have different sizes ranging from as small as a grain of sand to a golf ball-sized. Some people who are sick have only one gallstones, but did not rule gallstones are formed in large numbers at the same time. The main symptom of gallstones is pain in the abdomen sudden, abdominal pain usually lasts 1-5 hours (although sometimes it may last only a few minutes), known as biliary colic. The pain can be felt: In the middle of the abdomen, between the sternum and abdomen (solar plexus). Just below the rib cage to the right, the pain will spread to the side and back. The pain sometimes is triggered by eating fatty foods, but can also occur at any time of day and can awaken sufferers while sleeping at night.

Ovarian Cysts

Ovarian cysts is not a dangerous disease of the female body, the majority of cases cysts will disappear by itself in a woman's body. The existence of cysts tend not cause symptoms. But if the cyst cells rupture, large, or block blood flow to the ovaries, will show some of the symptoms. Menstrual pain and abnormal bleeding. Experiencing abdominal pain or bloating.

Pain in Right Side of the Abdomen also can be classified by the location :

Lower Right Abdominal Pain
  • Injury.
  • Disorders of the cervix.
  • Endometriosis.
  • Kidney stones.
  • Inguinal hernia.
  • Gastroenteritis caused by a virus.

Upper Right Abdominal Pain
  • Gastritis.
  • Hiatal hernia.
  • Peptic ulcers.
  • Pneumonia.
  • Kidney stones, infections or cancer of the kidneys.
  • Inflammation of the bile duct or cholangitis.
  • Inflammation or pancreatic cancer.
  • Gallbladder cancer.

Recognize Signs of Emergency

Abdominal pain should get immediate medical help or medical personnel if caused by trauma such as an injury or accident, or stomach pain along with pain or pressing on the chest.

Likewise, if the abdominal pain that occurs so severe that you can not afford to sit, or abdominal pain accompanied by bloody bowel movements, nausea and vomiting sustainable, yellow skin, or swelling in the abdomen.

Immediately consult a doctor if you experience abdominal pain right side, especially if there is prolonged to interfere with your activities. In addition, avoid all efforts to resolve this pain by taking drugs free because if it does not match the risk of making conditions more severe pain.

NCP for Psoriasis - 4 Nursing Diagnosis

Nursing Care Plan for Psoriasis

Psoriasis is a skin disease whose sufferers experience skin replacement process is too fast. The emergence of this disease sometimes for a longer period. In contrast to the normal human skin changes that usually lasts for three to four weeks, the skin changes in patients with psoriasis take place quickly is about 2-4 days, (it can even happen faster) that a lot of skin cell turnover and thickened.

Psoriasis can be found in all parts of the world with morbidity (incidence rate) is different. In terms of age, Psoriasis can be at any age, but usually more often found in adults.

Psoriasis is a skin disorder characterized by plaque, patches, scaly known papulosquamous disease. (Price, 1994).

The cause of psoriasis is unknown until now. Allegedly inherited polygenic. Although the majority of patients with psoriasis arises spontaneously, but in some patients found the existence of precipitating factors, among others:

1) Trauma
Psoriasis first arise in places that are exposed to trauma, scratching, incision, a former vaccination, and so on. The likelihood that this is a mechanism Koebner phenomenon. Typical in psoriasis arises 7-14 days after trauma.

2) Infection
In children, especially hemolytic streptococcal infections often cause guttate psoriasis. Psoriasis also arise after other bacterial infection and certain viral infections, but disappeared after infection healed.

3) Climate
Some cases tend to heal in the summer, while in the rainy season will recur.

4) Endocrine factors
The highest incidence at puberty and menopause. Psoriasis tends to improve during pregnancy and relapse and resistance to treatment after birth. Sometimes generalized pustular psoriasis arise during pregnancy and after high-dose progesterone treatment.

5) Sunlight
Although sunlight generally useful for patients with psoriasis, but in some patients the strong sunlight can stimulate the onset of psoriasis. Photochemical treatment has similar effects in some patients.

6) Metabolic
Hypocalcemia may cause psoriasis.

Patients usually complain of mild itching in places of predilection, namely the scalp, the border area with the face, extremities on the extensor, especially the elbows and knees, and the lumbosacral region. Skin disorders consisting of patches of elevated erythema (plaque) with scales on it. The scales are layered, rough, and white like mica, and transparent. In psoriasis there is the phenomenon of droplets of wax, Auspitz and Köbner.

Symptoms of psoriasis include:
Complained of mild itching.
Patches of erythema elevated, scaly thereon.
There is a phenomenon of the droplets of wax.
Cause nail abnormalities.

Nursing Diagnosis for Psoriasis

1. Impaired sense of comfort related to disease-related symptoms
characterized by: the itching, burning sensation on the skin, anxiety, clients seemed agitated, and disruption of sleep patterns.

2. Impaired skin integrity related to chemical irritation, mechanical factors, nutritional factors
characterized by: tissue damage of the skin (scaly skin, poor skin turgor, cracks, patches, itching).

3. Disturbed body image related to the biophysical, disease, and perceptual
characterized by: insecure, self-conscious, feelings of isolation, the interaction is reduced.

4. Anxiety related to changes in health status
characterized by: a client anxiety, fear, sleep disturbances, often sweating.