Clinical Manual for the Oncology Advanced Practice Nurse

September 1, 2001

This book is intended to serve as a quick reference for advanced practice nurses (APNs) caring for oncology patients, from diagnosis through treatment and rehabilitation. With the advances made over the past several years in prevention, early

This book is intended to serve as a quick reference for advancedpractice nurses (APNs) caring for oncology patients, from diagnosis throughtreatment and rehabilitation. With the advances made over the past several yearsin prevention, early detection, and treatment, oncology patients are livinglonger and developing other diseases that must be managed. In the inpatient andoutpatient oncology settings, the role of the oncology APN is becoming morefocused on primary care. This book provides a guide for managing the acute andchronic oncologic issues familiar to the oncology APN, but can also assist inmanaging general medical problems with which the APN may not be as familiar. Italso serves as an excellent reference for nurses in any of various specialtyareas (eg, medical oncology, surgical oncology, home care) who are seekingmedical information that is not necessarily related to a patient’s cancerdiagnosis or treatment.

The book’s many contributors are primarily advanced practice nurses workingin a broad range of settings. An introductory chapter provides an overview ofthe general role of the APN in patient management. It includes an extensivediscussion of the history-taking process, the components of a physicalexamination, diagnostic tests, interpretation of symptoms and history,differential diagnosis, treatment and management (both nonpharmacologic andpharmacologic), the referral process, and short and long-term follow-up.

Each subsequent chapter is presented in outline form and includes thefollowing sections for each diagnosis or symptom: definition, pathophysiology,clinical features, diagnostic tests, differential diagnosis, treatment,follow-up, and referrals. In cases where the differential diagnoses aredescribed elsewhere in the book, the reader is referred to that separatechapter. For example, if dyspnea is being evaluated, the APN can review thechapter that specifically addresses that topic, to ensure that a thoroughhistory is taken and correct diagnostic tests are performed. If the diagnosis ispleural effusion, the APN can review the pleural effusion chapter for a morecomprehensive evaluation of that diagnosis.

Following the introduction, the book is divided into sections on 11 bodysystems. Each of these sections includes descriptions of associated symptoms andmedical diagnoses. A section entitled "Miscellaneous" containschapters that review a variety of topics, including anxiety, breast tenderness,nipple discharge, swelling, lumps, fatigue, depression, phlebitis, humanimmunodeficiency virus, and the use of total parenteral nutrition.

There are 158 chapters in all, and many contain detailed tables that will bebeneficial to the APN. For example, the myocardial infarction chapter includes atable on thrombolytic therapy that serves as a quick drug reference, withmechanisms of action, the advantages and disadvantages of treatment, andguidelines for administration. The APN can use this table to identify theappropriate agent for managing a particular clinical situation in a timelymanner. References appear at the end of each chapter.

There are 18 appendices with useful oncologic and medical information,including antibiotic treatments, different drug categories (eg, antidepressantagents, antiemetic agents) with prescribing information, National CancerInstitute Common Toxicity Criteria, tumor markers, paraneoplastic syndromes,dermatomes, cranial nerve assessment, and dose equivalents for opioidanalgesics. Additional resources are referenced in this section.

The major strength of the book is its organized, easy-to-read outline format,and the multiple tables supplementing the chapters. It would be an extremelyuseful reference for the traditional oncology clinical nurse specialist movinginto an APN role with a primary care focus. The book can also serve as a"refresher course" on various medical conditions and as a quickcomprehensive resource, not only for APNs, but for all nurses involved in caringfor this patient population.