# Situation: A nurse works in the pediatric emergency room and the pediatric oncology ward of a government hospital. A 3-year-old is admitted with a smooth, firm mass on one side of the abdomen that his mother felt while bathing him. Wilms tumor is suspected. Which action should the nurse include in his preoperative care?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the pediatric emergency room and the pediatric oncology ward of a government hospital.

A 3-year-old is admitted with a smooth, firm mass on one side of the abdomen that his mother felt while bathing him. Wilms tumor is suspected. Which action should the nurse include in his preoperative care?

## 보기

1. Post a sign at the bedside warning staff not to palpate **✔ 정답**
2. Palpate the mass each shift to monitor changes in its size
3. Collect a 24-hour urine specimen for catecholamine levels
4. Give a cleansing enema to empty the bowel before surgery

**정답: 1**

## 해설

Palpating a Wilms tumor can rupture its capsule and spread tumor cells, so once the mass is known, abdominal palpation is avoided and a sign is posted. Bathing and handling are gentle, and blood pressure is monitored because the tumor can cause hypertension.

## 심화 해설

Clinical Situation

A 3-year-old is admitted with a smooth, firm abdominal mass and Wilms tumor is suspected. The priority preoperative nursing action is to post a sign at the bedside warning staff not to palpate the abdomen. Wilms tumor, also called nephroblastoma, is a solid malignant renal mass that can grow large enough to extend beyond the kidney and invade adjacent structures [1]. Because the tumor is encapsulated, any unnecessary handling of the abdomen can rupture the capsule and release malignant cells into the peritoneal cavity, which worsens the stage of disease and complicates subsequent treatment [1][2].

Watch out! Palpation is not a monitoring tool in Wilms tumor. Repeated palpation each shift is contraindicated because it increases the risk of capsular rupture and tumor spillage. Once the mass is identified, the abdomen is handled gently during bathing, turning, and positioning, and all healthcare providers are alerted through a bedside sign.

Why Blood Pressure Matters

Hypertension is a well-recognized clinical manifestation of Wilms tumor. In a retrospective review of 17 consecutive patients, 10 had hypertension, with a mean blood pressure of 150/103 mmHg and systolic readings ranging from 130 to 220 mmHg [3]. The elevated pressure results from tumor-related pathophysiological events, including renin secretion or compression of renal vasculature [1][3]. Preoperative blood pressure monitoring is therefore essential, and hypertension should be treated to reduce peri-operative morbidity [3].

Why the Other Options Are Incorrect

| Option | Rationale for Exclusion |
| --- | --- |
| 2. Palpate the mass each shift | Directly contraindicated. Palpation can rupture the tumor capsule and spread malignant cells [1][2]. |
| 3. Collect 24-hour urine for catecholamines | This test is used for neuroblastoma, not Wilms tumor. Wilms tumor is a renal parenchymal mass and does not require catecholamine measurement. |
| 4. Give a cleansing enema before surgery | Not indicated for Wilms tumor resection. Bowel preparation is not a standard preoperative requirement, and unnecessary abdominal manipulation should be avoided. |

Preoperative Nursing Priorities

The nursing focus before radical nephrectomy includes gentle handling of the abdomen, strict avoidance of palpation, blood pressure monitoring and management, and preparation for surgery without delay. Delayed surgery is associated with tumor complications and more complex subsequent treatment, so timely preoperative preparation is part of safe care [2]. Postoperative care for pediatric oncology patients also requires vigilance for infection and bleeding because these children are often immunocompromised from chemotherapy or the underlying disease process .

Key point! The single most important preoperative safety measure for a suspected Wilms tumor is preventing abdominal palpation. A bedside sign is a simple but critical intervention that protects the tumor capsule and reduces the risk of tumor spillage.References (research sources)

- [1]Anesthetic management of an infant undergoing radical nephrectomy for Wilms tumor: a case report.Case reportGoodrich M, Keatley V, Norwood B (2008)

- [2]Prevalence and factors associated with delayed surgery among children with Wilms tumor at Mulago Hospital: a mixed-method study.Research articleLule D, Nabidda S, Muhwezi A, Naitala R, Akullo A, Kagoya EK, Namazzi R, Kakembo N, Kalyango J. (2026) · DOI: 10.1186/s12885-026-15732-w

- [3]Wilms' tumour and hypertension: incidence and outcome.Research articleSteinbrecher HA, Malone PS (1995) · DOI: 10.1111/j.1464-410x.1995.tb07683.x

## 임상 시나리오

Wilms Tumor Preoperative SafetyProtect the capsule, prevent tumor spillage
Once Wilms tumor is suspected, abdominal palpation is contraindicated because it can rupture the encapsulated mass and spread malignant cells. Post a bedside sign warning all staff not to palpate the abdomen.

Handle the child gently during bathing, turning, and positioning. Monitor blood pressure closely because hypertension is common, with systolic readings potentially reaching 130–220 mmHg.

CautionDo not use palpation as a monitoring tool. Repeated abdominal examination each shift increases the risk of capsular rupture and tumor spillage, which can upstage the disease and complicate treatment.

## 핵심 개념

- **Wilms tumor** — Nephroblastoma; a malignant renal tumor in children that is encapsulated and at risk for rupture with abdominal palpation.
- **Tumor spillage** — Release of malignant cells from a ruptured tumor capsule, which can upstage disease and worsen prognosis.
- **No palpation precaution** — Avoiding abdominal palpation of a known Wilms tumor to prevent capsular rupture; communicated via bedside sign.
- **Hypertension in Wilms tumor** — Elevated blood pressure caused by renin secretion or renal vascular compression by the tumor.
- **Neuroblastoma** — Another pediatric abdominal tumor diagnosed in part by elevated catecholamine levels in urine.

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