Page 922 - Saunders Comprehensive Review For NCLEX-RN

6. Positive biopsy specimen of a lymph node

(presence of Reed-Sternberg cells) and positive bone
marrow biopsy specimen
7. Computed tomography scan of the liver, spleen, and
bone marrow may be done to detect metastasis.

C. Interventions

1. For early stages without mediastinal node
involvement, the treatment of choice is extensive
external radiation of the involved lymph node
regions.
2. With more extensive disease, radiation and multidrug
chemotherapy are used.
3. Monitor for medication-induced pancytopenia and an
abnormal depression of all cellular components of the
blood, which increases the risk for infection, bleeding,
and anemia.
4. Monitor for signs of infection and bleeding.
5. Protect the child from infection.
6. Monitor for adverse effects related to chemotherapy or
radiation; the most common adverse effect of
extensive irradiation is malaise, which can be difficult
for older children and adolescents to tolerate
physically and psychologically (Table 31-1).
7. Monitor for nausea and vomiting, and administer
antiemetics as prescribed.
III. Nephroblastoma (Wilms’ Tumor)
A. Description

1. Wilms’ tumor is the most common intra-

abdominal and kidney tumor of childhood; it may
manifest unilaterally and localized or bilaterally,
sometimes with metastasis to other organs.
2. The peak incidence is 3 years of age.
3. Occurrence is associated with a genetic inheritance
and with several congenital anomalies.
4. Therapeutic management includes a combined
treatment of surgery (partial to total nephrectomy)
and chemotherapy with or without radiation,
depending on the clinical stage and the histological
pattern of the tumor.
B. Assessment

1. Swelling or mass within the abdomen (mass is

characteristically firm, nontender, confined to 1 side,
and deep within the flank)

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