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Real World NP: Daily Summaries Delivered
by Liz Rohr
Hi, I’m Liz Rohr: family nurse practitioner, wife, parent, and founder of Real World NP, a continuing education company for new nurse practitioners in primary care. I’m on a mission to equip and guide new nurse practitioners so they can feel confident and capable through comprehensive, concise, and hyper-relevant educational resources, without the fluff. We’re also here to provide an approachable, supportive community in order to bring about a new generation of healthcare providers who know that they can make an impact & inevitably disrupt the healthcare industry. Each week you’ll hear a mix of clinical pearls and practice tips, guest interviews with specialists and allied health professionals, and guidance on navigating the role transition from RN to NP.
Latest Episodes
The most recent episodes — sign up to get AI-powered summaries of each one.
- 6 days ago11 min
Preoperative Exams in Primary Care: A Guide for Nurse Practitioners
You're seeing a patient for a preoperative evaluation before an upcoming surgery. The surgeon has requested some testing and documentation—but how do you determine what your patient actually needs before their procedure?Which patients need additional cardiovascular evaluation? When should you use RCRI or DASI? Do you need to order an ECG, chest X-ray, or routine labs? And how do you document your assessment without saying the patient is "cleared" for surgery?In this updated episode of Real World NP, we're walking through a practical approach to the preoperative evaluation for noncardiac surgery in primary care, including updated cardiovascular risk assessment recommendations and how to apply them during an actual patient visit.What You'll Learn:What your role is during a preoperative evaluationHow to assess surgical risk and identify reasons to pause before surgeryUsing RCRI, ACS NSQIP, and DASI to assess cardiovascular risk and functional capacityWhat to include in the preoperative history and physical examAssessing chronic conditions and pulmonary risk before surgeryWhen preoperative labs, ECGs, and imaging are indicatedMedication considerations before surgery, including anticoagulants, diabetes medications, and SGLT2 inhibitorsWhat to document and communicate to the surgical and anesthesia teamsTimestamps00:00 – Introduction01:32 – Your role in the preoperative evaluation02:13 – Assessing surgical risk03:04 – Reasons to pause before surgery03:58 – Cardiovascular risk assessment: RCRI and ACS NSQIP04:45 – Functional capacity and DASI05:24 – Preoperative history and chronic conditions06:56 – Pulmonary risk assessment07:25 – Physical exam and selective testing08:25 – Perioperative medication considerations09:37 – Documenting the preoperative evaluationResources Mentioned:Preoperative Evaluation Cheat Sheet: A quick-reference guide to surgical risk, cardiovascular assessment, functional capacity, testing, and documentation. Get your copy at www.realworldnp.com/binder For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/preop-exam-nurse-practitioner ______________________________© 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.
- 2 weeks ago10 min
Starting Insulin in Type 2 Diabetes (2026 Updates)
Starting insulin in type 2 diabetes can feel intimidating—especially when you're a new NP seeing a patient with an A1C of 13% or 14% and wondering: Does this patient need insulin? Can I safely manage them outpatient? And how much insulin should I actually start?In this episode, I walk through a practical approach to starting basal insulin in adults with type 2 diabetes, including updates from the 2026 ADA and AACE guidelines.We'll cover when insulin is appropriate, how to calculate a starting dose, how to titrate using fasting blood glucose, and what to do when fasting glucose is at goal but A1C remains elevated.We'll also talk about CGM, preventing hypoglycemia, and making insulin initiation manageable for patients—because you don't have to solve everything in one visit, but you do need to make sure your patient can safely manage their treatment at home.For a full transcript and conversation chapters, visit the blog: www.realworldnp.com/blog/starting-insulin-type-2-diabetesNeed a Quick Insulin Reference?The Digital NP Binder includes an updated Starting Insulin in Type 2 Diabetes cheat sheet with dosing, titration, monitoring, and treatment considerations for primary care. https://www.realworldnp.com/binderWant More Support with Diabetes Management?The Diabetes Management in Primary Care course covers medication selection, treatment adjustments, insulin therapy, diabetes monitoring, and more. https://www.realworldnp.com/diabetes______________________________© 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.
- 3 weeks ago12 min
COPD Exacerbations: A Guide for Nurse Practitioners
A patient with COPD comes in with worsening cough, sputum, and shortness of breath. Is this actually a COPD exacerbation? Can you safely treat them outpatient? And do they need antibiotics?In this episode, I walk through a practical approach to evaluating and treating COPD exacerbations in primary care, including updates from the 2025–2026 GOLD guidelines.We’ll talk through how to rule out other causes of worsening respiratory symptoms, assess exacerbation severity, decide when a patient needs a higher level of care, and choose appropriate treatment—including bronchodilators, prednisone, and antibiotics.TIMESTAMPS:00:00 COPD exacerbations: 2025–2026 update01:30 Confirming COPD + the patient's baseline02:19 COPD exacerbation or something else?04:26 Assessing severity + when to escalate care07:20 COPD exacerbation treatment: inhalers + prednisone08:00 When do you need antibiotics?10:45 Follow-up + reassessing long-term COPD treatmentFor a full transcript, resources mentioned in this episode, and conversation chapters, visit the blog: www.realworldnp.com/blog/copd-exacerbation-new-nurse-practitioner ______________________________© 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.
- 4 weeks ago16 min
COPD Management (2026 Updates)
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.
- Aug 28, 202658 min
GI Specialist Interview: H. pylori, GERD, Celiac, Constipation & When to Refer
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.
- Aug 13, 20261h 1m
Interview with a Nephrologist: CKD, Dialysis & When to Refer
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.
- Jul 30, 202631 min
Structural Heart Disease in Primary Care: When to Suspect Valve Disease & When to Refer
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.
- Jul 16, 20268 min
How to Use the PREVENT Risk Calculator
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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About Real World NP
Hi, I’m Liz Rohr: family nurse practitioner, wife, parent, and founder of Real World NP, a continuing education company for new nurse practitioners in primary care. I’m on a mission to equip and guide new nurse practitioners so they can feel confident and capable through comprehensive, concise, and hyper-relevant educational resources, without the fluff. We’re also here to provide an approachable, supportive community in order to bring about a new generation of healthcare providers who know that they can make an impact & inevitably disrupt the healthcare industry. Each week you’ll hear a mix of clinical pearls and practice tips, guest interviews with specialists and allied health professionals, and guidance on navigating the role transition from RN to NP.
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