Real World NP

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.

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.

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.

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.

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.