Planning the Nursing Care
- Provide preoperative and post operative nursing care to child
- Assist in therapeutic management of child.
- Provide comfort.
Surgical Intervention
Provide preoperative and post operative nursing care: When the decision for surgery has been made the nurse's responsibility is to prepare the child and the parents for surgical procedure both physically and psychologically. Parents should be advised to avoid putting any pressure on the abdomen of the child since this can lead to the rupture of the tumour.
Postoperative care include monitoring the renal status by observing weight changes, intake and output and signs of circulatory overload. Child should be watched for infection and signs of intestinal obstruciton which may be due to postoperative adhesions. This include assessing the bowel sounds, abdominal pain and distension, and observation for emesis.
Assisting in Therapies - Chemotherapy, Radiation Therapy
Radiation Therapy
Radiation therapy is indicated preoperatively only if the mass is massive and/or bilateral in order to shrink the primary tumour so that surgery can be performed. In stage I, II, III and IV of the disease, radiotherapy is given postoperatively to eradicate any microscopic residual disease. The nurse needs to watch for any signs of side effect of the therapy which include nausea;vomiting, anorexia and general malaise. There may be ulceration of mouth, hair loss and peeling of skin.You as a nurse must provide skin care to the area and teach the parents and the child regarding the importance of skin care.
Chemotherapy
This is given to treat any metastatic lesion that may exist and to distroy the tumour cells if any from blood stream. The most common drugs used are actinomycin-D 0.6-0.12 mg IV in the dose cf .025 -.05 mg arid vincristine for stage IV, and a third drug usually Adriamycin in the doses 1.25-1.9 m@g IV (every three weeks) a combination of 3 drugs over a period of 15 months