Real World NP

Liz Rohr
  • 4.9 (444)
  • Courses
  • Weekly

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. Make sure you subscribe and leave a review so you won’t miss an episode. Plus, you’ll find links to all the episodes, plus extra goodies over at realworldnp.com/podcast. Hosted on Acast. See acast.com/privacy for more information.

  1. 2d ago

    Head Injury Assessment in Primary Care for New Nurse Practitioners

    A patient comes in after a head injury. They're having headaches, dizziness, brain fog, or nausea—but how do you know whether this is a concussion you can manage in primary care or something more serious? Head injuries can feel especially intimidating as a newer nurse practitioner. You want to make sure you're not missing an intracranial injury, but you also need to know which patients actually need imaging and what to recommend for recovery. In this updated episode, I'm walking through how I approach concussion assessment in primary care, starting with red flags and working through the history, neurologic exam, imaging decisions, and follow-up plan. TIMESTAMPS 00:00 Introduction to concussion assessment in primary care 00:21 Concussion cheat sheet and Digital NP Binder 01:30 Red flags after a head injury 02:41 When to refer to the ER 03:32 SCAT6, SCOAT6, and concussion symptoms 04:30 Key history questions after a head injury 05:42 Neurologic exam and signs of skull fracture 07:54 When does a patient need a head CT? 08:50 Concussion management and return to activity 10:02 Persistent symptoms and when to refer 10:40 ER precautions and follow-up Want a Quick Reference for Concussion Visits?The Concussion Evaluation & Management Cheat Sheet gives you a step-by-step approach to evaluating a head injury—including red flags, the focused neurologic exam, concussion assessment tools, when to consider head CT, and return-to-activity guidance. Get your copy inside the Digital NP Binder. For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/concussion-evaluation-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. Oct 23

    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 teams Timestamps 00:00 – Introduction 01:32 – Your role in the preoperative evaluation 02:13 – Assessing surgical risk 03:04 – Reasons to pause before surgery 03:58 – Cardiovascular risk assessment: RCRI and ACS NSQIP 04:45 – Functional capacity and DASI 05:24 – Preoperative history and chronic conditions 06:56 – Pulmonary risk assessment 07:25 – Physical exam and selective testing 08:25 – Perioperative medication considerations 09:37 – Documenting the preoperative evaluation Resources 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.

  3. Oct 15

    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-diabetes Need 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/binder Want 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.

  4. Oct 8

    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 update 01:30 Confirming COPD + the patient's baseline 02:19 COPD exacerbation or something else? 04:26 Assessing severity + when to escalate care 07:20 COPD exacerbation treatment: inhalers + prednisone 08:00 When do you need antibiotics? 10:45 Follow-up + reassessing long-term COPD treatment For 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.

  5. Oct 1

    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 updates 01:03 – Approaching COPD management in primary care 01:53 – Confirming COPD with spirometry and FEV1/FVC 03:01 – Pre-COPD and PRISm 03:53 – GOLD 1–4 and the ABE assessment 05:12 – Using the mMRC and CAT scores 06:23 – What to assess at a COPD follow-up visit 07:50 – Alpha-1 antitrypsin deficiency testing 08:26 – Blood eosinophils and inhaled corticosteroids 09:37 – COPD management beyond inhalers 11:15 – Pulmonary rehabilitation and comorbidities 11:37 – SABA, SAMA, LABA, LAMA, and ICS 12:21 – Initial COPD treatment by GOLD ABE group 13:50 – Initial treatment for Groups A and B 14:35 – COPD follow-up and spirometry 15:04 – Chest imaging and lung cancer screening 15:46 – When to refer to pulmonology COPD cheat sheet + Digital NP Binder: realworldnp.com/binder For 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.

  6. Aug 28

    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 – Introduction 02:19 – Meet GI specialist Paige Sosebee, FNP 04:31 – H. pylori testing, treatment & referrals 13:20 – GERD, PPIs & when to consider endoscopy 20:06 – Alginate therapy for GERD 22:31 – Elevated liver tests & GI referrals 24:51 – Elevated alkaline phosphatase & imaging 30:00 – Celiac disease testing 41:10 – Chronic constipation 46:00 – SIBO & intestinal methanogen overgrowth (IMO) 52:50 – When to refer to a GI specialist 56:00 – Clinical resources for primary care NPs For 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.

  7. Aug 13

    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.

  8. Jul 30

    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. Timestamps 00:00 Meet Christy Cantey, NP 02:02 What Is Structural Heart Disease? 03:22 Understanding Modern Valve Procedures 06:05 Symptoms That Should Raise Concern 07:28 Two Questions That Reveal Functional Decline 08:51 Why Patients Often Don't Realize How Sick They Feel 09:47 The Challenge of Detecting Heart Murmurs 11:09 When to Order an Echocardiogram 12:07 Why Early Referral Matters 15:35 Working With Structural Heart Programs 18:15 What TAVR and Valve Procedures Are Really Like 20:56 Primary Care Follow-Up After Valve Intervention 23:19 Long-Term Monitoring and Annual Echocardiograms 26:17 How to Counsel Patients Who Are Hesitant About Treatment 32:32 Clinical Pearls and Resources for Learning More For 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.

See All (133)

4.9
out of 5
444 Ratings

About

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. Make sure you subscribe and leave a review so you won’t miss an episode. Plus, you’ll find links to all the episodes, plus extra goodies over at realworldnp.com/podcast. Hosted on Acast. See acast.com/privacy for more information.

Information

  • Creator
    Liz Rohr
  • Years Active
    2021 - 2026
  • Episodes
    133
  • Rating
    Clean
  • Copyright
    © Liz Rohr
  • Show Website
    Real World NP

You Might Also Like