NCLEX Review Book: NCLEX-PN Secrets Study Guide: Complete Review, Practice Tests, Video Tutorials for the NCLEX-PN Examination by NCLEX Exam Secrets Test Prep Team

Author:NCLEX Exam Secrets Test Prep Team [NCLEX Exam Secrets Test Prep Team]
Language: eng
Format: epub
Publisher: Mometrix Media LLC
Published: 2017-04-04T16:00:00+00:00

Visit mometrix.com/academy and enter code: 328778

Wilms’ Tumor

Wilms’ tumor is traditionally a malignant tumor of the kidney characteristically diagnosed in childhood prior to the fifth year of life, and has traits of an inherited autosomal dominant disorder. Those with a family history of Wilms’, of African-American descent, and born with other abnormalities such as hypospadius, anridia, and undescended testicles have an increased risk of Wilms’ tumor. While it is rare, it often has a very good prognosis. Signs and symptoms are as follows:

· Often asymptomatic

· Palpable abdominal mass, fever, anemia, blood in urine, abdominal ascites, well-defined abdominal wall veins, and metastases to the gonadal area

Diagnosis is based on blood work, CT/MRI, and physical exam. Treatment includes:

· Surgery to remove tumor and possibly kidney, followed by chemotherapy and radiation depending on staging of disease.

· Teaching: ensure family has adequate support, use language understandable to child and parents, frequent rest during chemo.

· NEVER palpate the stomach of a child with diagnosed/suspected Wilms’ tumor—it could cause metastasis!

Childhood Cancers

Childhood cancers usually originate in non-epithelial or embryonic cells, especially in preadolescent cancers. These cancers tend to be fast growing with the child rapidly deteriorating over a period of weeks or months. Childhood cancers may result from:

· Congenital genetic abnormalities (such as retinoblastoma and Wilms tumor)

· Impaired immune system, such as from AIDS or immunosuppression (increased risk of non-Hodgkin lymphoma, Hodgkin disease, leiomyosarcoma, Kaposi sarcoma)

· Chromosomal abnormalities, such as Down syndrome (trisomy 21) (markedly higher risk of leukemia)

· External/Environmental carcinogens resulting in genetic mutations (diethylstilbestrol, anabolic androgens, immunosuppressants, radiation exposure, and toxic chemicals) (may result in primary or secondary cancers)

While signs and symptoms vary according to the type of cancer, common findings include pain, palpable mass, cachexia, bruising, recurrent infections, anemia, and neurological impairment. Diagnostic tests include bone marrow biopsy, CBC, LP, and ANC, as well as CT, MRI, and ultrasound and surgical biopsy. Incidence of childhood cancers varies according to the age of the child:

· Infancy to younger than 5 years: Acute leukemia is most common, followed by brain and CNS tumors, sympathetic nervous system tumors, and kidney tumors. Less common are soft tissue, eye, and other tumors, as well as lymphomas.

· Ages 5 to 9 years: Acute leukemia remains most common followed by brain and CNS tumors, lymphoma, and soft tissue cancers. Less common are bone, kidney, eye, and other tumors, as well as sympathetic nervous system tumors.

· Ages 10 to 14 years: Incidence of acute leukemia, lymphoma, and brain and nervous system tumors are relatively equal followed by bone cancer, carcinoma, soft tissue cancer, germ cell cancer, and others.

· Ages 15 to 19 years: Incidence shifts with lymphoma as the most common cancer, followed by carcinoma, germ cell cancer, and then acute leukemia. Less common cancers include sarcoma, bone cancer, and other.

Neurological Disorders

Anatomy of the Brain

The brain comprises three primary areas: cerebrum, cerebellum, and brain stem. The cerebrum is divided into two hemispheres (joined by the corpus callosum), thalamus, hypothalamus, and basal ganglia. The outer layer of the hemispheres is called the cerebral cortex

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