Real World NP

Epizódy

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  COPD Management (2026 Updates) 01.10.2026 16min

  COPD guidelines have changed—and if you’re managing COPD in primary care, there are a few updates worth knowing.In this episode, I walk through how to approach a patient with COPD at a routine visit, especially when you’re seeing them for the first time or inheriting their care from another provider.We’ll cover how to confirm the diagnosis with spirometry, how to think about GOLD 1–4 alongside the ABE assessment, and how the mMRC and CAT scores fit into your assessment. We’ll also talk about alpha-1 antitrypsin deficiency testing, blood eosinophils and inhaled corticosteroids, initial inhaler therapy, and what to monitor at follow-up.I also walk through the pieces of COPD management beyond medications—including smoking cessation, vaccinations, exercise and nutrition, pulmonary rehabilitation, and management of comorbidities.In this episode:00:00 – Introduction + COPD guideline updates01:03 – Approaching COPD management in primary care01:53 – Confirming COPD with spirometry and FEV1/FVC03:01 – Pre-COPD and PRISm03:53 – GOLD 1–4 and the ABE assessment05:12 – Using the mMRC and CAT scores06:23 – What to assess at a COPD follow-up visit07:50 – Alpha-1 antitrypsin deficiency testing08:26 – Blood eosinophils and inhaled corticosteroids09:37 – COPD management beyond inhalers11:15 – Pulmonary rehabilitation and comorbidities11:37 – SABA, SAMA, LABA, LAMA, and ICS12:21 – Initial COPD treatment by GOLD ABE group13:50 – Initial treatment for Groups A and B14:35 – COPD follow-up and spirometry15:04 – Chest imaging and lung cancer screening15:46 – When to refer to pulmonologyCOPD cheat sheet + Digital NP Binder: realworldnp.com/binderFor a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/copd-management ______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  GI Specialist Interview: H. pylori, GERD, Celiac, Constipation & When to Refer 28.08.2026 58min

  What does a GI specialist wish primary care providers knew before sending a referral?In this episode, I’m joined by family nurse practitioner Paige Sosebee, who has worked in gastroenterology since 2019 at a large academic medical center. We talk through some of the most common GI concerns we see in primary care—and what happens on the other side of the referral.Paige shares practical pearls on H. pylori testing and treatment, GERD and PPI trials, evaluating abnormal liver tests, celiac testing, chronic constipation, SIBO and intestinal methanogen overgrowth (IMO), and how primary care can make GI referrals more useful for both the specialist and the patient.We also talk about something that comes up constantly for newer NPs: How much of this am I actually supposed to manage myself, and when is it time to ask a specialist for help?In this episode, we cover:H. pylori testing, treatment, and common pitfallsGERD management and when to consider EGDElevated liver enzymes and what to do before referringCeliac testing and the importance of testing before going gluten-freeChronic constipation, red flags, and initial managementSIBO and intestinal methanogen overgrowth (IMO)How to make GI referrals more useful—and when they’re truly urgentTimestamps:00:00 – Introduction02:19 – Meet GI specialist Paige Sosebee, FNP04:31 – H. pylori testing, treatment & referrals13:20 – GERD, PPIs & when to consider endoscopy20:06 – Alginate therapy for GERD22:31 – Elevated liver tests & GI referrals24:51 – Elevated alkaline phosphatase & imaging30:00 – Celiac disease testing41:10 – Chronic constipation46:00 – SIBO & intestinal methanogen overgrowth (IMO)52:50 – When to refer to a GI specialist56:00 – Clinical resources for primary care NPsFor a full transcript and conversation chapters, visit the blog: http://www.realworldnp.com/blog/gi-specialist ______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Interview with a Nephrologist: CKD, Dialysis & When to Refer 13.08.2026 1h 1min

  When should you refer a patient with CKD to nephrology—and what should you do before they get there?In this episode, I’m joined by nephrologist and medical educator Dr. Rachel Hilburg to talk through the questions that come up all the time in primary care: interpreting proteinuria and hematuria, deciding when a nephrology referral is urgent, what labs and imaging to order before referral, and what we can actually do to slow CKD progression.We also talk about the Kidney Failure Risk Equation, cystatin C, kidney-protective medications, preparing patients for dialysis and transplant, caring for patients already on dialysis, and a practical approach to hyponatremia.Want to feel more confident managing CKD in primary care?The Chronic Kidney Disease Management Course walks you through CKD diagnosis, monitoring, treatment, slowing disease progression, and when to refer to nephrology.CKD Management Course: https://www.realworldnp.com/ckd Or get the CKD course as part of the Chronic Care Bundle, which also includes diabetes, hypertension, and kidney lab interpretation.Chronic Care Bundle: https://www.realworldnp.com/chronic-care-series-bundle For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/nephrologist______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Structural Heart Disease in Primary Care: When to Suspect Valve Disease & When to Refer 30.07.2026 31min

  Valvular heart disease often presents gradually— often slowly becoming more fatigued, less active, or more short of breath over time— making it easy for symptoms to be attributed to aging or deconditioning. In this episode, Liz Rohr sits down with structural heart nurse practitioner Christy Cantey, FNP, to discuss how primary care clinicians can recognize subtle symptoms of valve disease, know when an echocardiogram is appropriate, and understand what happens after a patient is referred to a structural heart program.They also discuss modern transcatheter valve procedures—including TAVR and TEER—and how these minimally invasive treatments have changed outcomes for patients with aortic stenosis and other valvular diseases.Timestamps00:00 Meet Christy Cantey, NP02:02 What Is Structural Heart Disease?03:22 Understanding Modern Valve Procedures06:05 Symptoms That Should Raise Concern07:28 Two Questions That Reveal Functional Decline08:51 Why Patients Often Don't Realize How Sick They Feel09:47 The Challenge of Detecting Heart Murmurs11:09 When to Order an Echocardiogram12:07 Why Early Referral Matters15:35 Working With Structural Heart Programs18:15 What TAVR and Valve Procedures Are Really Like20:56 Primary Care Follow-Up After Valve Intervention23:19 Long-Term Monitoring and Annual Echocardiograms26:17 How to Counsel Patients Who Are Hesitant About Treatment32:32 Clinical Pearls and Resources for Learning MoreFor a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/valve-disease-primary-care______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  How to Use the PREVENT Risk Calculator 16.07.2026 8min

  The PREVENT Risk Calculator is a newer cardiovascular risk assessment tool developed by the American College of Cardiology (ACC) and American Heart Association (AHA). Designed to replace older pooled cohort equations, it provides a more comprehensive estimate of cardiovascular risk, including both atherosclerotic cardiovascular disease (ASCVD) and heart failure risk.In this episode, Liz Rohr breaks down what the PREVENT calculator is, how to use it in clinical practice, and why it's becoming an increasingly important part of cardiovascular risk assessment in primary care.Timestamps:00:00 - Overview of the Prevent Risk Calculator and its significance in cardiovascular risk assessment00:26 - How the calculator improves risk estimation over previous tools01:16 - Key inputs needed for the calculator and optional risk-enhancing factors01:41 - Incorporating additional data like zip code, A1C, and urine albumin02:07 - Interpreting 10- and 30-year risk results for ASCVD and heart failure03:02 - Thresholds for hypertension (≥7.5%) and hyperlipidemia risk categories03:38 - Practical tips for clinicians on using and interpreting the tool04:06 - Importance of risk-enhancing factors and patient-specific decision-making04:55 - Limitations of population-based risks and underestimation in young adults05:52 - Avoiding over-reliance on the calculator and considering the full clinical picture06:46 - Summary: integrating the Prevent calculator into patient conversations and management pathways For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/prevent-calculator-aha______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  New Hypertension Guidelines: Practical Updates with Dr. Jordy Cohen 02.07.2026 56min

  Hypertension Guidelines Updates: Practical Pearls for Primary Care with Dr. Jordy CohenWhat actually changed in the newest hypertension guidelines—and what should nurse practitioners be doing differently in clinic?In this episode, Liz Rohr, MSN, FNP-BC, sits down with Dr. Jordy Cohen, nephrologist, hypertension specialist, researcher, and member of the hypertension guideline writing committee, to break down the updates that matter most for primary care.Rather than reviewing every recommendation, this conversation focuses on the clinical decisions that can make the biggest difference in practice. Dr. Cohen shares practical guidance on medication selection, single-pill combination therapy, resistant hypertension, screening for primary aldosteronism, and evaluating younger patients with elevated blood pressure. The discussion also covers the PREVENT risk calculator, home blood pressure monitoring, white coat hypertension, and common treatment mistakes that can be avoided in everyday clinical practice.Whether you're learning hypertension management for the first time or updating your approach based on the latest evidence, this episode offers practical strategies you can apply immediately in primary care.Timestamps00:00 – Meet Dr. Jordy Cohen and the new hypertension guidelines02:27 – Biggest changes in the updated guidelines04:00 – The PREVENT risk calculator explained07:30 – Managing hypertension in younger adults11:40 – Secondary hypertension workup and screening pearls15:20 – Resistant hypertension: What specialists wish primary care would do first19:20 – When to start one medication vs. combination therapy22:10 – Choosing first-line antihypertensive medications25:40 – Hydrochlorothiazide vs. chlorthalidone vs. indapamide29:45 – Primary aldosteronism: Who should be screened?36:00 – Why PRN clonidine should be avoided in severe asymptomatic hypertension41:10 – Home blood pressure monitoring, white coat hypertension, and validated cuffs49:40 – Microalbuminuria and practical pearls for primary careIf you found this episode helpful, be sure to subscribe to the Real World NP Podcast and share it with a colleague.Real World NP provides practical, evidence-based continuing education designed specifically for nurse practitioners to bridge the gap between graduate education and real-world practice.For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/HTN-updates-2026. ______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Microalbuminuria (2026 Updates): Lab Interpretation for Nurse Practitioners 30.06.2026 12min

  Urine microalbumin is one of the earliest indicators of kidney damage, but the terminology—and the recommendations—have changed over the past several years.In this episode, Liz reviews the 2026 updates to urine microalbumin interpretation, including the transition to albuminuria and the urine albumin-to-creatinine ratio (UACR), new hypertension screening recommendations, and practical pearls that every primary care nurse practitioner should know.Whether you're a new graduate or an experienced NP looking for a refresher, this episode will help you better understand what the test measures, when to order it, and how to avoid some of the most common interpretation pitfalls.Chapters:00:00 Introduction to Microalbuminuria01:38 Understanding Urine Microalbumin Testing06:44 Clinical Significance of Microalbumin Levels10:38 Conclusion and Course Invitation11:40 Introduction to Real WorldNP Podcast11:40 Exploring Resources for New NPsThe Renal Lab Interpretation course takes a deeper, case-based approach to urine albumin, creatinine, eGFR, electrolyte abnormalities, and common kidney disorders seen in primary care.We’re doing a LIVE round of the Lab Interpretation Series (which includes the Renal Lab Interpretation Course) starting in August with Live Q&As, learn more https://www.realworldnp.com/liveFor a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/microalbuminuria-2026-updates ______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Navigating IBS with Dr. Zach Spiritos 18.06.2026 49min

  Irritable bowel syndrome (IBS) is one of the most common—and often frustrating—conditions seen in primary care. Patients may come in with chronic abdominal pain, diarrhea, constipation, bloating, or a mix of symptoms, and many have already been told that their testing is “normal.” So how do you confidently evaluate IBS, rule out more serious conditions, and help patients move forward?In this episode, Liz talks with neurogastroenterologist Dr. Zach Spiritos about the real-world approach to IBS, including the underlying pathophysiology, common diagnostic pitfalls, practical workup strategies, and treatment options that go far beyond medication alone.Whether you're a new NP or an experienced clinician, this episode offers practical strategies to help you approach IBS with greater confidence and compassion.Timestamps:00:00 - Introduction to Dr. Zach Spiritos and episode overview02:16 - Pathway into neuro gastroenterology and training background05:06 - What is IBS? Symptoms, diagnosis, and underlying mechanisms07:36 - Factors contributing to IBS: trauma, antibiotics, triggers09:21 - Differential diagnosis: celiac, SIBO, bile acid malabsorption11:54 - When to consider endoscopy and testing strategies14:35 - History-taking tips for primary care clinicians17:54 - Managing expectations in chronic GI conditions20:12 - Overuse of endoscopy and its limited findings22:08 - Understanding what endoscopy can actually reveal24:23 - Communicating with patients who have “all tests normal”27:40 - The multitude of IBS treatment approaches: diet, psychological, medication32:12 - Role of diet and FODMAP in symptom management35:10 - Pharmacological options for IBSC and IBSD39:06 - Medications overview: Linzess, Amitiza, Viberzi, and others44:04 - The role and limitations of probiotics and fiber45:08 - Tips on managing patient expectations and chronicity46:54 - Setting goals and tracking progress with patients48:16 - Final advice: empower patients with knowledge, manage expectations, and tailor treatmentsFor a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/ibs______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Podcast Hiatus, Accreditation & We’re Hiring! 13.02.2025 7min

  Hey! We’re taking a hiatus from the podcast while the team focuses on becoming an accredited organization for continuing education. We’re developing new courses to bridge the gap between graduate education and real-world practice.In the meantime, we’re inviting clinicians to contribute to paid blog posts and articles— we want to build a community dedicated to quality education and patient care.Stay informed of upcoming content by subscribing to our email list at www.realworldnp.com/guide.Apply to become a blog post writer here!For a full transcript and conversation chapters, visit the blog http://www.realworldnp.com/blog/podcast-break Hosted on Acast. See acast.com/privacy for more information.
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  Navigating Confrontation at Work as an NP 28.11.2024 14min

  This episode focuses on leadership and role transition questions, specifically addressing a scenario where a new nurse practitioner is struggling with confrontational conversations with nursing staff. The host provides advice on how to navigate these situations using a framework called nonviolent communication. The framework involves expressing observations, feelings, needs, and requests in a clear and non-confrontational manner. The host also emphasizes the importance of building rapport and facilitating open communication within the team. Additional resources and episodes on leadership are recommended.Key Takeaways:-Leadership is a challenging skill to navigate, especially in the healthcare field where there is often a lack of training.-Using the nonviolent communication framework can help facilitate difficult conversations by expressing observations, feelings, needs, and requests.-Building rapport and open communication within the team is crucial for effective collaboration and patient care.-Seeking support and additional resources on leadership can further enhance leadership skills and strategies.For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/confrontation© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Path to Overcoming Disillusionment in Healthcare with Rebecca Arnold 14.11.2024 57min

  Rebecca Arnold, a holistic leadership coach, discusses the challenges of disillusionment and burnout in mission-driven professions like nursing and medicine. She emphasizes the importance of addressing emotions and processing them in a safe and titrated manner. Rebecca highlights the concept of the window of tolerance and suggests practices like meditation and mindfulness to expand it. She also emphasizes the value of emotions as sources of information and intuition. The path from disillusionment to fulfillment involves sitting with emotions, seeking support from professionals, and making small changes within the system. In this conversation, Rebecca and Liz discuss the path to overcoming disillusionment in the medical field. They explore the importance of addressing emotions, internal mechanisms, and finding opportunities for wins. They also discuss the role of grief and the need for self-compassion. Rebecca shares examples of clients who have transformed their experiences and found fulfillment in their work. They also discuss Rebecca's book, 'The Rooted Renegade,' which offers practical tools and strategies for navigating disillusionment and finding alignment in life and work.TakeawaysAddressing and processing emotions is crucial in combating disillusionment and burnout.Expanding the window of tolerance through practices like meditation and mindfulness can help handle emotions.Emotions provide valuable information and intuition that should not be ignored.Seeking support from professionals is important, especially when dealing with trauma or intense emotions.Making small changes within the system can contribute to a sense of fulfillment and well-being. Addressing emotions and internal mechanisms is crucial in overcoming disillusionment in the medical field.Finding opportunities for wins and recognizing moments of success can help combat feelings of disillusionment.Grief is a common experience in the medical field, and it's important to acknowledge and process it.Self-compassion and self-care are essential in navigating disillusionment and finding fulfillment.Rebecca's book, 'The Rooted Renegade,' offers practical tools and strategies for overcoming disillusionment and finding alignment in life and work.For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/burnout-in-nursing. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  How to Negotiate a Raise for Nurse Practitioners with Amanda Guarniere 24.10.2024 53min

  In this conversation, Liz Rohr and Amanda Guarniere discuss negotiating a raise as a nurse practitioner. They emphasize the importance of collecting data about your job performance and your value to the organization. They also highlight the need to consider the employer's perspective and understand what matters to them. The conversation covers productivity metrics, RVUs (Relative Value Units), and the importance of building a case for a raise. They also discuss the different factors to consider in a compensation package and how to approach the conversation with your employer. In this conversation, Liz Rohr and Amanda Guarniere discuss negotiation strategies for healthcare professionals seeking salary increases. They emphasize the importance of preparation, including researching market rates and determining one's value. They also discuss the dynamics of negotiation and the need to disarm the other person and maintain a positive, collegial tone. They provide tips for requesting a meeting, presenting a case, and handling non-committal answers. They also address the challenges of negotiating within a group or tier system and offer advice for advocating for oneself while maintaining a collaborative approach. They discuss the importance of follow-up and provide strategies for handling requests for additional data or delaying decisions. They also mention the NP Salary Report, a resource for healthcare professionals to anonymously submit and access salary data.Takeaways- Collect data about your job performance and the value you bring to the organization when asking for a raise.- Consider the employer's perspective and understand what matters to them.- Build a case for a raise by highlighting your productivity metrics, such as patient volume and revenue generated.- Take into account the different factors in a compensation package, including salary, bonuses, benefits, and work schedule.- Approach the conversation with a partnership mindset, focusing on achieving mutual goals. Research market rates and determine your value before negotiating a salary increase.- Disarm the other person and maintain a positive, collegial tone during the negotiation.- Request a meeting without disclosing the purpose, and present your case in a positive and data-driven manner.- Be prepared for non-committal answers and follow up to close the loop.- Advocate for yourself within a group or tier system by discussing the issue individually with the lead NP and going through the proper chain of command.- Be open to alternative forms of compensation or recognition if a salary increase is not immediately possible.- Use the NP Salary Report to access salary data and support your negotiation efforts.For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/how-to-negotiate-a-raise/. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Unexpected Mentorship Questions from New NPs - Interview with Kara Pesola, NP 10.10.2024 44min

  In this conversation, Liz Rohr and Kara Pesola discuss the challenges and common experiences of new nurse practitioners (NPs). They highlight the importance of support and mentorship for new grads and address the imposter syndrome many NPs experience. They also discuss the common questions and concerns that new NPs have, such as managing complex conditions and navigating controlled substances. The conversation emphasizes the need for new NPs to trust their judgment, seek guidance when needed, and prioritize patient safety. In this conversation, Liz Rohr and Kara Pesola discuss the challenges and considerations in primary care practice. They touch on topics such as bias in medication management, the importance of safety assessments, and the need for patient-centered care. They also highlight the significance of long-term patient-provider relationships and the stages of change in healthcare decision-making. The conversation emphasizes the importance of meeting patients where they are and supporting their well-being.Takeaways- New nurse practitioners often experience imposter syndrome and may feel unprepared for the challenges of practice.- Support and mentorship are crucial for new grads to navigate the transition to practice.- Common questions and concerns for new NPs include managing complex conditions and navigating controlled substances.- It is crucial for new NPs to trust their judgment, seek guidance when needed, and prioritize patient safety. Bias exists in medication management, and it is essential to address it in primary care practice.- Safety assessments and goals of care conversations are crucial in patient-centered care.- Long-term patient-provider relationships are valuable in managing chronic conditions.- Understanding the stages of change can help guide healthcare decision-making.- Meeting patients where they are and supporting their well-being is essential in primary care.For a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/mentorship-questions ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Advice for Creating New NP Mentorship Programs 26.09.2024 18min

  In this episode, I share my experiences and insights on starting a mentorship program, drawing from my own journey as a nurse practitioner and founder of Real World NP. I discussed the context of mentorship, the structure of one-on-one and group mentorship programs, the frequency and duration of mentorship meetings, and the topics to cover. Additionally, I covered the importance of creating a safe psychological space for mentees and the value of peer support in mentorship programs.Takeaways- The importance of creating a safe psychological space for mentees in a mentorship program- The value of peer support and not feeling alone in a mentorship program- Considerations for mentorship frequency, duration, and topics to cover in a mentorship programFor a full transcript and conversation chapters, visit the blog www.realworldnp.com/blog/mentorship-programs______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Advice for New Grads Interested in Urgent Care with Michelle Lew, NP 12.09.2024 40min

  Michelle, a board-certified family nurse practitioner with experience in urgent care, shares her journey and insights into the field. She discusses the differences between urgent care and primary care, the challenges of not having access to medical records in urgent care, and the importance of collaboration between the two. Michelle also provides advice for those interested in working in urgent care and recommends resources for further learning.Takeaways- Urgent care is a bridge between primary care and the emergency room, providing care for acute conditions that can't wait for a primary care appointment.- There is a disconnect between urgent care and primary care, with urgent care often lacking access to patients' medical records.- It is important for urgent care and primary care to have a better partnership to ensure continuity of care for patients.- New grads interested in urgent care should work with another provider and have a ramp-up program to ensure success.- Being able to determine if a patient is sick or stable is a crucial skill in urgent care.- Resources for learning about urgent care include Hippo Education's Urgent Care Bootcamp, EKG resources by Jen at Cardiology Made Easy, and Michelle's own Instagram account for urgent care resources.For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/urgent-care-nurse-practitioner______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Assessing Chest Pain: New Red Flags & Risk Factors - Interview with Jennifer Carlquist, PA 22.08.2024 1h 6min

  In this conversation, Liz Rohr interviews Jennifer Carlquist, a physician assistant with extensive experience in cardiology, who discusses the assessment and management of chest pain.They covered: - Assessing cardiac versus noncardiac chest pain- Assessing risk for MI and when to send patients to the ED or not- What EKG findings to watch out for, and how to learn more to build your ekg reading confidence (and what’s new!)- What we can do for patients to assess and manage heart disease risk, including labs and tests to check in primary care (including the coronary calcium score, LPa, and homocysteine)- How to communicate and collaborate effectively with ER providers- Further resources to learn if you’re in cardiology or interested in making the switch from primary careTakeaways- Consider both cardiac and non-cardiac causes of chest pain, especially in female patients with atypical symptoms.- Take a detailed history, including risk factors and family history, and be aware of red flags that may indicate a more serious condition.- Recognize the limitations of certain diagnostic tests, such as EKGs and troponin levels, and consider a CTA with FFR for outpatient testing.- Collaboration between primary care providers and the ER is crucial, and concise reporting of findings is key to effective communication.- Differentiating between hyperkalemia T-waves and hyperacute T-waves can be challenging, but hyperkalemia T-waves are pointy and hyperacute T-waves are more blunted and broad-based.- Inverted T-waves in leads other than AVR and V1, especially if they are symmetric, can indicate the need for urgent evaluation.- Q-waves can form within an hour of an infarction, and a small Q-wave in lead III without other abnormalities may be a normal finding.- When learning EKG interpretation, it is important to start with understanding what a normal EKG should look like and then focus on high-risk findings.- Inflammation is a significant risk factor for heart disease, and non-traditional risk factors such as psoriasis and early menses should be considered.- Lab tests such as the coronary calcium score, LPa, and homocysteine can provide valuable information in assessing heart disease risk.- Magnesium supplementation can be beneficial for patients with palpitations and hypertension, but the specific type and dose should be tailored to the individual.- Primary care providers play a crucial role in assessing heart disease risk and can collaborate with cardiologists to order appropriate tests and make informed decisions.- The three-day EKG challenge and the Cardiology Fundamentals Mentorship program are valuable resources for learning and advancing in cardiology.- The importance of fostering a supportive and collaborative environment in healthcare to provide the best care for patients.For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/assessing-chest-pain______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Treating Substance Use Disorder: Stimulants & How to get Addiction Histories - Interview with Shelby Pope 08.08.2024 52min

  In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches.They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use disorder, and the next steps for primary care providers in managing patients with stimulant use disorder. They also explore the use of psychosocial interventions and off-label pharmacologic treatments for stimulant use disorder.TakeawaysOpen and non-judgmental conversations are essential when discussing substance use with patients.Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/treating-substance-use-disorder ______________________________© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Treating Opiate Use Disorder in Primary Care - Interview with Shelby Pope, NP 25.07.2024 1h 11min

  In this episode, Liz Rohr interviews Shelby Pope, DNP, APRN, FNP-BC, they discuss the stigma around addiction, the importance of supporting patients with opiate use disorder while exploring Shelby’s journey into addiction medicine and impacts of this field. This episode includes discussion of various treatment options for opiate use disorder, including naltrexone and buprenorphine, including the importance of medication-assisted treatment (MAT) for opioid use disorder, while emphasizing the effectiveness of methadone and buprenorphine in reducing the risk of overdose and mortality. Liz and Shelby explore the process of induction and the importance of assessing withdrawal symptoms, ongoing monitoring and support for patients on MAT, including addressing cravings and harm reduction strategies. Key takeaways: Exploring the stigma around addiction, and the importance of supporting patients with opiate use disorder.Addiction medicine is a beautiful and impactful field that can be accessible in primary care.Naltrexone and buprenorphine are two treatment options for opiate use disorder.Open conversations with patients and providing support and resources are crucial in primary care.Methadone may be necessary for some patients with extreme cases of opiate use disorder. Medication-assisted treatment (MAT) with methadone and buprenorphine is highly effective in reducing the risk of overdose and mortality in individuals with opioid use disorder.Assessing withdrawal symptoms is crucial before starting buprenorphine to avoid precipitated withdrawal.Ongoing monitoring and support are essential for patients on MAT, including addressing cravings and providing harm reduction strategies.Tapering off medication should be done slowly and on an individualized basis, considering the patient's stability and goals.Individualized care and empathetic communication are key in building trust and supporting patients on their recovery journey.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/opiate-use-disorder. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Bridging the Gap: Primary Care and Specialty Care Courses for Nurse Practitioners - Need Your Input! 11.07.2024 11min

  We’re expanding our course catalog at Real World NP! This time, we’re collaborating with specialists, making courses tailored for primary care providers. Our goal is to provide comprehensive and practical courses for nurse practitioners and PAs, and to bridge the gap between primary care and specialty care. We want NPs to have the knowledge and resources to provide the best care within their scope of practice.Share your input about what courses you want to see first! Head over to realworldnp.com/blog/courses-nurse-practitioner to share your thoughtsFor a full transcript, check out the blog.Timestamps:00:00 Introduction and Background02:12 Expanding the Course Catalog03:34 Addressing the Gap: Primary Care and Specialty Care05:45 Creating Comprehensive and Practical Courses08:06 Community Input and Feedback-----------------------Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guideSign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binder------------------------Come follow along for even more tips and inspiration:Instagram: https://instagram.com/realworldnpFacebook: https://facebook.com/realworldnp______________________________Please note: This episode is intended only for medical providers and students learning to be medical providers. While anyone is welcome to view and listen, for legal and safety reasons, we are unable to diagnose, treat, or answer medical questions for individuals through this channel. We always refer individuals back to their primary care providers for medical care.If you’re a medical provider or student and have specific patient cases you have questions about, I cannot answer those here but would love to help you inside our mentorship program! Join the waitlist at https://www.realworldnp.com/mentoring. _______________________________© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.
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  Real World NP: Redefining Continuing Education for Nurse Practitioners 27.06.2024 55min

  Welcome back to Season 3 of the Real World NP Podcast!This episode is an interview with yours truly - I want to share a bit of a “reset” with what’s going on with Real World NP, where we started, where we’re going, and how you can be involved. I also want to share a bit that has changed behind the scenes, and how we’re incorporating more of a social justice and equity lens— not just inside the clinical teaching, but overall practices inside the company. One of the core reasons behind the company is not just to make the transition to practice for nurse practitioners easier, but also make an impact on the healthcare and education industries. We want to do continuing education for nurse practitioners differently than the status quo.Some real talk: I feel like I repeat myself a lot, and part of me is like “they know this already.” They know that it’s important to be a whole human, and that they get to do that in their personal and work lives. That they’re not just a machine in the cog of healthcare, and things are starting to change. That they deserve to be supported and held in safe spaces while they learn this extremely important and difficult field of medicine. It’s old news.But I’m reminded of the number of times I’ve counseled patients on their medications - at LENGTH and REPEATEDLY - and they still need to hear it again.Like the time my patient with new-onset afib needing anticoagulation still ended up in the ER for overdosing his meds. Or after three visits for my patient with diabetes, they still did not understand their diagnosis and what it meant.I truly, truly believe that even when things feel daunting and overwhelming, whether it’s the clinic day ahead, the severity of illness of the patient in front of you, or the state of the healthcare industry, individual actions make a big difference.I’d love for you to be a part of the movement of change to make healthcare and education better — listen in to this episode to get a sense of where we’re going and what you can expect from us going forward. It’s also a helpful introduction to the backstory behind the company if you’re new here!More from Louiza “Weeze” Doran:https://www.instagram.com/accordingtoweeze/?hl=enhttps://louizadoran.com/https://louizadoran.com/podcast-----------------------Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guideSign up for the Lab Interpretation Crash Course: https://www.realworldnp.com/labs Grab your copy of the Digital NP Binder: https://www.realworldnp.com/binderFor the full transcript, and for this conversation’s topic chapters, see the blog. Hosted on Acast. See acast.com/privacy for more information.