DISCHARGE PLAN

General Objective

To provide continuity of care and appropriate needs and teachings at

home in the absence of a professional healthcare provider after discharge
from the hospital.

Specific objectives

1. Client’s folks will be oriented about the Wilms’ Tumor process in order
for them to be fully aware about the client’s health status.
2. Client’s folks will observe proper aseptic technique in rendering home
care to eliminate the spread of pathogens and microbes that can
possibly infect primary and secondary infection to the client as well as
to the whole members of the family.
3. Client’s folks will employ comfort and safety measures that will include
promotion, prevention, cure and rehabilitation of the client’s health
status.
4. Provide education on client and folks about proper nutrition.
5. Client will strictly follow the therapeutic regimen indicated by the
physician on the discharge instructions to prevent complications.
6. Inform the folks of the schedule for the follow-up visit in order to
assess health status.

Health Teaching

A. Knowledge

Wilms’ tumor also called nephroblastoma is a rare type of kidney cancer that
affects mostly children. It causes a tumor on one or both kidneys. Having
certain genetic conditions or birth defects can increase the risk of developing
Wilms’ tumor. The peak time of Wilms’ tumor occurrence is around ages 3 to
4, and it occurs only rarely after age 6.

 Signs and Symptoms

• Abdominal swelling
• An abdominal mass you can feel
• Fever
• Blood in the urine
• Reduced appetite
• High blood pressure
• Constipation
 • Stomach pain
• Nausea

 Risk factor

• Sex – girls are slightly more likely to develop Wilms’ tumor than boys
• Race – black children have a slightly higher risk than Asian – American
• Family history – if someone had Wilms’ tumor in the family or presence
of any type of cancer increase the risk
• Aniridia – iris of the eye forms particularly or not at all
• Hemihypertrophy – one side of the body is noticeably larger than other
side
• Undescended testicles – one or both testicles fail to descend into the
scrotum
• Hypospadias – urinary (urethral) opening is not at the tip of the penis
but on the other side

 Stages

• Stage I – cancer is only found in the kidney

• Stage II – cancer has spread to the tissue and structures near the
kidney
• Stage III – cancer has spread beyond the kidney area to nearby lymph
nodes or other structures within the abdomen
• Stage IV – cancer has spread to distant structures such as the lungs,
liver or brain
• Stage V – cancer cells affect both kidneys

RATIONALE:

To give folks an idea regarding the disease process, signs and

symptoms, risk factors and treatment.

B. Personal Hygiene

Instruct client/folks to practice strict hand washing before and

after eating or before and after using the toilet to prevent the spread
of infection among the family members and to reduce the risk of
wound infection. Instruct client’s mother to keep client’s fingernails
clean and short to prevent from scratching that results in skin injury.
Instruct client/folks to clean thoroughly fresh fruits before eating to
avoid from ingestion of pathogens and any microorganisms. Instruct
client/folks to change clothing everyday or frequently as much as
possible to promote comfort and grooming. Instruct folks to provide a
 smoke free and dust free environment for the client to avoid nasal
irritation that might aggravate client’s condition. Instruct folks to
change bed linens thrice a week to prevent to prevent dwelling of
microbes, dust and viruses in the linens. Instruct client to avoid
touching the surgical site to reduce the risk of infection and injury.
Clean skin surface with running water and mild soap after change of
dressing to reduce skin contaminants. If client cannot take a bath, offer
him regular sponge bathing when client verbalized feeling of
discomfort to promote feeling of comfort and well-being. Instruct folks
to observe proper aseptic technique in dressing and cleaning of
surgical site to reduce the risk of contamination and infection.
Encourage good oral hygiene such as mouth rinse that can be helpful
for sores or areas that are bleeding and use of lip balm or petroleum
jelly to soothe cracked lips.

RATIONALE:

Proper personal hygiene prevents contamination and spread of

microorganisms which can lead to further complications and infections.

C. Activities of Daily Living

Encourage client to turn reposition, transfer and ambulate to promote

circulation, increase peristalsis and pain tolerance; promote maximum lung
expansion during respiration. Tell the mother to make sure that her child
avoid vigorous exercise or activities and exhaustion and always have rest
periods. Encourage client to take adequate rest and sleep to avoid stress.
Instruct patient to continue deep breathing 10x per hour to improve lung
ventilation and produces endorphins that promotes feeling of comfort.
Encourage/instruct the client or address the mother to avoid second hand
smoking and any other strong chemicals to be inhaled because these could
enter the blood stream and could affect his health condition. Encourage folks
to boil or sterilize their drinking water to prevent ingestion of pathogens such
as Entamoeba Hystolitica. Avoid doing hard activities, such as heavy lifting,
pulling, and pushing. Instruct client to limit body movements, especially
bending his back. Encourage walking soon after surgery for early return
bowel function, promotes effective breathing, mobilizes secretions, improves
circulation, prevents stiffness of joints and relieves pressure. Inspect surgical
site/size, noting characteristics and integrity to early recognize or delayed
healing/developing complication may prevent a more serious situation such
as infection. Monitor surgical dressing, placement, and bleeding to make
appropriate referrals if there are significant findings such as hypovolemic
shock.
RATIONALE:

To give on folks what activities of daily living must be practice at home to

aid prevention and recovery for the client.

D. Nutrition

Encourage client to continue to eat vitamin C rich foods such as citrus

fruits and protein such as meat products, for faster wound healing and
prevents infection by enhancing immune system/response. Instruct mother
to include fruits and vegetable in the client’s diet to replace dead cells and
tissue in the body. A well balanced diet is encouraged to promote healing
and good bowel function. Encourage client/folks to have an adequate
hydration by drinking at least 6 - 8 glasses of sterilized water to promote
circulation and maintain fluid balance in the body. Instruct mother to provide
foods to the client that is rich in iron and vitamin C to boost the immune
system. Instruct the mother to avoid foods that are oily in order not to
aggravate client’s health condition. Prepare favorite foods to gain weight for
upcoming chemotherapy because his appetite may dwindle. Instruct mother
to increase fluid intake of the child to counter the decrease in solid food
intake. Avoid legumes because it is high in purines which produce uric acid
that can deposit in the kidneys in the form of urate stones.

RATIONALE:

To take foods that promotes and aid recovery and avoidance of

restricted foods.

E. Medication

Instruct the mother to follow the medication program carefully. The

drugs prescribed to client are designed to prevent various complications and
to treat the condition.

MEDS DOSAGE and TIMING INDICATION

Paracetamol 5ml every 4 hours For mild pain

Cefuroxime 8ml every 8 hours For perioperative
prevention

Strictly instruct the mother not to give any medicines, over-the-counter

drugs, vitamins, herbs, or food supplements to her child without first talking
to physician. Tell the mother to call the physician if she thinks the medicines
are not helping or if the child is having side effects. Instruct the mother not
quit the home medications until she discuss it with the physician. Teach the
folks on how to administer the medication, its correct route, dosage, and
timing.

RATIONALE:

To subject folks for medications and special procedures to enhance

health.

F. Follow up check up

Tell the mother to return to the physician for physical exams and imaging
tests such as ultrasound and CT scans to look for the growth or return of the
tumor. Remind the mother that blood and urine tests will be done to check
how well the remaining kidney is working. Physician may schedule follow-up
check up. But if any unusual symptoms occur before the date of check up,
client should visit the physician’s clinic immediately.

February 23, 2010 first visit.

March 1, 2010 (releasing of biopsy) biopsy result should be taken at the
Department of Pathology to know the type of cancer cell of tumor.

SEEK CARE IMMEDIATELY IF: There is trouble breathing or chest pain all of
a sudden and trouble having a bowel movement or passing urine, if bandage
becomes soaked with blood, if incisions are swollen, red, have pus coming
from them, or they have come apart and there are chills or fever of 101 F or
more. Severe pain that is not relieved by pain medication.

RATIONALE:

Follow-up visit to help evaluate effective of the treatment and

interventions. It would provide support to client with regards to the
achievement of goals.