Page 923 - Saunders Comprehensive Review For NCLEX-RN

2. Urinary retention or hematuria, or both
3. Anemia (caused by hemorrhage within the tumor)
4. Pallor, anorexia, and lethargy (resulting from anemia)
5. Hypertension (caused by secretion of excess amounts
of renin by the tumor)
6. Weight loss and fever
7. Symptoms of lung involvement, such as dyspnea,
shortness of breath, and pain in the chest, if
metastasis has occurred
C. Preoperative interventions
1. Monitor vital signs, particularly blood pressure.

2. Avoid palpation of the abdomen; place a sign

at bedside that reads, Do Not Palpate Abdomen.
3. Measure abdominal girth at least once daily.
D. Postoperative interventions
1. Monitor temperature and blood pressure closely.
2. Monitor for signs of hemorrhage and infection.
3. Monitor strict intake and urine output closely.
4. Monitor for abdominal distention; monitor bowel
sounds and other signs of gastrointestinal activity
because of the risk for intestinal obstruction.

Avoid palpation of the abdomen in a child with Wilms’ tumor

and be cautious when bathing, moving, or handling the child. It is
important to keep the encapsulated tumor intact. Rupture of the tumor
can cause the cancer cells to spread throughout the abdomen, lymph
system, and bloodstream.
IV. Neuroblastoma
A. Description
1. Neuroblastoma is a tumor that originates from the
embryonic neural crest cells that normally give rise to
the adrenal medulla and the sympathetic ganglia.
2. Most tumors develop in the adrenal gland or the
retroperitoneal sympathetic chain; other sites may be
within the head, neck, chest, or pelvis.
3. Most children present with neuroblastoma before 10
years of age.

4. Most presenting signs are caused by the tumor

compressing adjacent normal tissue and organs.
5. Diagnostic evaluation is aimed at locating the primary
site of the tumor; analyzing the breakdown products
excreted in the urine, namely vanillylmandelic acid,
homovanillic acid, dopamine, and norepinephrine,
permits detection of suspected tumor before and after

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