The nurse is admitting a 4-year-old diagnosed with Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?

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11ecbb05_caf2_c182_b433_1d126018a315_MD0009_00 Wilms tumor (nephroblastoma) is a kidney tumor that usually occurs in children age <5. Most often it involves only one kidney, and the prognosis is good if the tumor has not metastasized. Wilms tumor is usually diagnosed after caregivers observe an unusual contour in the child's abdomen. Once the diagnosis is suspected or confirmed, the abdomen should not be palpated, as this can disrupt the encapsulated tumor. It is important to post the sign "DO NOT PALPATE ABDOMEN" at the bedside. It is also essential that the child be handled carefully during bathing. (Option A) Assessment of a child's development level and emotional maturity will help determine the appropriate approach to use during the many painful procedures that the child will undergo in rapid succession. However, this assessment is not a priority. (Option B) If the tumor has metastasized, adventitious sounds may be present. Auscultating for them is not a priority. (Option D) Some clients may have hypertension due to excess production of renin, and this will require monitoring. However, it is not as important as ensuring that the abdomen is not palpated. Educational objective: Wilms tumor is discovered when caregivers note an unusual bulging/swelling on one side of a child's abdomen. The abdomen should not be palpated until after the diagnosis is suspected or confirmed as this can disrupt the tumor and cause dissemination of tumor cells.

The Nurse Is Admitting a 4-Year-Old Diagnosed with Wilms Tumor