Patients coming into primary care with a chief complaint of hair loss can be so stressful as a new nurse practitioner.

First, let?s normalize this. It?s a broad differential and can be tricky to parse out. It can also feel really stressful and emotional for your patient presenting for care, which adds even more pressure.

In this week?s episode, I?m covering how to approach hair loss in primary care, the differential diagnoses, history, physical exam and testing highlights for new nurse practitioners in primary care.

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So many new grads are most worried about building their clinical knowledge base-- for good reason!

But it?s one thing to prepare for clinical topics-- researching algorithms, choosing the best practice based on the evidence-- but an entirely different experience trying to apply them to the ?real world.?

Through Real World NP, I have the awesome privilege to work with new grad nurse practitioners on-on-one in mentorship calls.

Some of mentorship is reassuring new grad NPs about their clinical judgment decisions, and it also involves discussing the most up to date guidelines.

But there?s another level to mentorship and ?real world? practice that you just can?t get in school.

This week, I want to share with you some of the ?behind the scenes? of what our mentoring conversations are like. I?m covering an example patient case with complex diabetes and medical conditions that I reviewed with a real-life new grad nurse practitioner during a mentoring conversation.

Full disclosure: I hope to someday record a call with a new grad NP (with consent and voice-masking, of course), but for now, it?s just me talking, reviewing what we talked about and the variety of ways we approached the situation.

Hopefully this helps you apply these lines of thinking to your own patient cases!

Also, speaking of mentorship, we?re expanding our offerings OH. SO. SOON. Jump on the waitlist here to learn more and get first dibs.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

Sign 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

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This has been on my heart this week - between working 1 on 1 with mentees and seeing the landscape online of new grad nurse practitioners, I see this ALL the time.

Feeling like you're the only one feeling this way. Feeling behind, not knowing enough, and then beating yourself up for it.

If this sounds like you, take a listen-- sometimes just naming and acknowledging what's ACTUALLY going on makes a difference in how you're feeling about it.

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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How did your entire visit get eaten up by getting the HPI? What are you supposed to do in a visit with the complicated patients with 17 chronic conditions?

I learned many time-management lessons the hard way in my first year of practice, and they're the same patterns I see in my NP students and new grads I've worked with.

In this video you'll learn time-saving tips to help before, during and after your visits so you can be more timely with your patients (and do less charting at home and on the weekends!).

PLUS, below this video download another cheat sheet for patient visit "quick text" templates and a sample complicated patient note. Check it out here: https://www.realworldnp.com/011-opt-in

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

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Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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Keeping your head on straight while juggling so many moving pieces in a typical day as a nurse practitioner is TOUGH.

I heavily rely on structure and routines to make sure I keep it all straight ? and I don't miss anything!

In this video, I go over my routines with new patients, annual physicals, follow-up visits and sick visits, so you can stay on track and make sure you've got all the info you need.

PLUS: my cheat-sheet I give all my students (and I used for the first year+ ... literally bringing it into my visits and checking things off as we covered them).

Download it here: https://www.realworldnp.com/011-opt-in

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Don't forget to grab your free Ultimate Resource Guide for the New NP at https://www.realworldnp.com/guide

More Resources:

Lab Interpretation Crash Course: https://www.realworldnp.com/labs

Digital NP Binder: https://www.realworldnp.com/binder

Diabetes Medication Workshop: https://www.realworldnp.com/diabetes

------------------------

Come follow along for even more tips and inspiration:

Instagram: https://instagram.com/realworldnp

Facebook: https://facebook.com/realworldnp

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I love caring for patients with chronic conditions now, but it wasn?t always the case. Like so many new grads, I struggled with caring for patients managing chronic conditions -- where to start, how to proceed, feeling like we weren?t making any progress towards ?control? of those conditions (diabetes, chronic kidney disease, hypertension, etc).

When I was a new nurse practitioner, I was incredibly focused on the diagnostic algorithms and medication management. Which, of course, is crucial to know, but isn?t truly what moves the needle in chronic conditions.

In this episode, I cover:

What moves the needle in chronic conditionsNormalize what and why this is so hardWhat my dog has taught me about caring for patients (and can help you too)A practical framework for navigating the management of these conditions

**PS our brand new course Managing DIabetes, Hypertension and CKD in Primary Care opens for enrollment next week. The only way to join is by email, so join the waitlist at realworldnp.com/courses.**

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Chronic care conditions are a big part of working in primary care, but they?re also complex, time-consuming, and stressful to treat, especially for new nurse practitioners. 

So this week, we?re going to do a walkthrough of how you can conduct these visits, but in a way that that feels timely, organized, and safe!

In this video, I touch on the 4 most important steps to take in each chronic care visit:

? Reconciling medications

? Assessing the status of their condition

? Identifying the red flags for the most common chronic care conditions in primary care

? Determining the extent of specialist care

Still feeling overwhelmed by chronic care visits? I've got you covered. We're launching a new chronic care course this fall that helps you get oriented with the most common chronic conditions you see in primary care: diabetes, hypertension, and chronic kidney disease (CKD). Join the waitlist at https://www.realworldnp.com/courses.

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When I was a new grad, I thought I?d never master CKD. It was so stressful because, as you probably know very well, unmanaged CKD can lead to kidney failure. 

But the more I?ve learned and practiced medicine, the easier it gets. And now? I?m obsessed with CKD ? it?s one of my favorite clinical topics to explore these days. 

So hopefully in this week?s video, I can share some shortcuts to understanding CKD and making patient assessment and care easier. 

? The basics of staging CKD

? When should you think about referring to nephrology?

? Assessment parameters for renal problems that you absolutely need to know

And, of course, more pearls of practice!

Looking for more guidance on CKD? Get on the waitlist for our upcoming chronic care course at https://www.realworldnp.com/courses ? registration opens this fall! 

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In Part 2 of our Resistant Hypertension videos, I?m looking at hyperaldosteronism, or high aldosterone levels, as a cause for treatment-resistant hypertension ? and an underrecognized one at that. 

So what is high aldosterone? Where does it come from? When do you check for it? What causes it? If a patient has high aldosterone, what do you do next? 

Let?s dig in!

Note that assessing for this may be out of your practice comfort zone ? and that?s totally fine! But it?s still important to know what hyperaldosteronism means for your patients. 

In this video, I touch on:

? What distinguishes primary and secondary aldosteronism - and why it matters

? Symptoms to keep an eye on when looking at the different ideologies for high aldosterone

? And how to navigate that always-tricky dance of testing and referral as a nurse practitioner

Looking for more guidance on CKD? Get on the waitlist for our upcoming chronic care course at https://www.realworldnp.com/courses ? registration opens this fall!

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Both pharmacists and nurse practitioners play a critical role in medication management for patients. 

But we don?t always understand what we can do for one another, which can lead to confusion, frustration, and missed opportunities. Finding ways to collaborate and build professional bridges, however, can improve outcomes for everyone. 

In this week?s video, I talk with Miriam Ahmed, a pharmacist based in Canada who also runs the educational Instagram platform, @rxnotes. We dive into important topics like:

? Ways nurse practitioners can increase their comfort level prescribing medications

? Tips on mitigating common errors when dealing with medication management

? How to navigate medical guidelines for prescription medications

? And tons of questions from the audience

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Stressed about labs? Watch our free Top Three Mistakes New NPs Make Interpreting Labs training at realworldnp.com/training

Grab your free Ultimate Resource Guide for the New NP at realworldnp.com/guide

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Resistant hypertension is a common chief complaint in primary care clinics. But for new nurse practitioners, there?s a lot to sort through. 

In this video, I walk through the thought processes and approaches to managing resistant hypertension in primary care. 

? How to talk about medication adherence with patients

? The role of ongoing blood pressure checks ? both in clinic and at home

? Considerations for current medications and dosing

? How to investigate the secondary causes of hypertension

Stressed about labs? Watch our free Top Three Mistakes Even Smart NPs Make Interpreting Labs training at https://realworldnp.com/training

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Dizziness alone accounts for about 5% of all primary care office visits in the US. 

5%! That's a huge number. 

But as a chief complaint, dizziness is somewhat nebulous. The causes of dizziness can run the gamut from annoying-but-benign to yikes-let's-get-you-to-the-ER. So how do you sift through all the possibilities and uncover what?s really going on with your patient? 

In Diagnostic Approach to Dizziness, we walk NPs through the basics of assessing patients who are experiencing dizziness. We talk about:

? The four buckets of ideologies that your patient?s dizziness might fall into 

? The critical patient history questions. (And why it's important to drill down on what patients mean when they say they're CONSTANTLY dizzy.) 

? The diagnostic steps and key physical tests to run (and how to do them in a not-scary way for your patients!)

?And the red flags you absolutely need to watch out for 

Stressed about labs? Watch our free Top Three Mistakes New NPs Make Interpreting Labs training at realworldnp.com/training

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Back pain ? it?s truly one of the most common issues you come across in primary care. That?s why you need to have your diagnostic approach to it down pat as a nurse practitioner. 

And the sooner you get comfortable diagnosing back pain in primary care, the sooner you?ll feel confident helping your patients on their road to recovery. 

In this week?s episode, we talk about why you should really take a triage-based approach to back pain ? among other chief complaints ? plus other hot takes on assessing back pain such as:

? Red flags that are critical ? if sometimes tricky ? to uncover when taking a patient history 

? Key tests to consider when you're doing a physical exam 

? Should you order imaging or further testing?  

? And how to advise patients and set expectations for recovery

Stressed about labs? Watch our free training: 3 Mistakes New NPs Make Interpreting Labs for what to avoid and do instead at realworldnp.com/training

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It?s super common for new NPs ? and experienced ones ? to get anxious when encountering orthopedic complaints. 

It?s a conundrum ? on one hand, it seems like it should be simple. After all, you can feel all the musculoskeletal body structures right there. 

But at the same time, there are so many (SO MANY!) nuances to each body part. And there?s a lot of ortho lingo to wrap your head around. 

That?s why it?s helpful to understand exactly what an orthopedic nurse practitioner does ? and what that means for working in primary care.

So sit back and enjoy ? this week, orthopedic nurse practitioner, Yessica Salazar, has stopped by to talk ortho with us...and left behind so many great clinical pearls that I just know will help you in your daily practice: 

? How to order knee X-rays the right way

? Her approach to medications for orthopedic complaints

? Non-invasive treatment options for patients 

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Do you ever find yourself spending an ENTIRE 20-minute visit just getting a history?

And even with all that time, do you still leave the room feeling like you didn't even get the info you needed?

In this episode, I'm sharing my top tips for not only a FASTER history, but also a more accurate one ? so you can take great care of your patients while saving time and, quite honestly, health care dollars.

You'll learn:

My top tip to keep your patient visits movingPitfalls of where you could be missing info (and how to ask questions to get the answers you're looking for)The most important question to ask to save you TONS of time in each visit

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Seeing "lower leg swelling" as the chief complaint for patients as a new nurse practitioner was incredibly stressful. What?s the best course of action? Should you give diuretics for symptom control? Is this something serious...or something totally ordinary?

I had a super interesting case the other week and knew immediately that I had to share it with you ? and it was one that I actually got a double-check from my colleague on!

In this episode, you'll learn:

The top DDXs - most common and red flagsWhat important history questions to askTwo clinical pearls of patient historiesDifferential diagnosesHow to manage patients in this common scenario - re: testing & treatment

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Urine microalbumin: you need to check it once a year for patients with diabetes. But interpreting the results ? and knowing what to do with them! ? can be tricky. 

In this episode, you?ll learn:

When to order urine microalbumin labsHow to interpret the results and what to do with themHow to treat abnormal levels4 steps to elevated microalbumin management

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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I saw a meme recently that compared hyponatremia to folding a fitted sheet? you can watch a million videos on how to do it, but in the end you'll probably just crumple it up and hope you never have to deal with it again. ?

Luckily in primary care low sodium is easier to deal with outpatient, and doesn't have to be super complicated. In this episode, I talk about low sodium, which is one of the top abnormal labs in primary care.

Hyponatremia involves understanding kidney function, but I've broken it down into the simplest, clearest, most digestible way to give you the most helpful insight to take into your practice. I'll bring you through the step-by-step process to implement for the vast majority of patients you'll see, and if you need to go down the rabbit hole of workup further, you'll have the tools to do so!

You'll learn:

How to know when your patient needs to go to the ER, and when you can work them up outpatientThe simplest way to remember low sodiumThe #1 lab you should always think of when you see low sodiumHow to know if your patient needs IV fluid (or if that'd be the worst possible thing to do for them)

Want more lab goodies? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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Feeling uncertain about referring a patient? That?s super common. You might wonder things like:  

Are there other tests you could do first?

Should you wait it out?

At what point can you be sure?

In this episode I will answer ALL of these questions. I will also walk you through my 3-step process, the pitfalls and mistakes to avoid (that I learned from experience!). Plus, I?ll give you my NUMBER ONE resource to help you:

Feel more confident with your referralsDeepen and broaden your knowledge baseTake excellent care of your patients

Need more support? Check out the Lab Interpretation Crash Course for Nurse Practitioners

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You've seen high WBC counts as a nurse, but what about leukocytosis that's only 13 or 15? And it's chronic? And what about peripheral smears? How do you know if it's urgent?

In this episode we are going to talk about this super interesting case study to give you the step by step approach to interpreting these labs, and teach you how to manage a high WBC count safely and confidently.

Together, we will cover:

Knowing when to order what labsThree main components of working up a high WBCThe differential and the peripheral smear Absolute lymphocyte count The Flow Cytometry Test

Check out the Lab Interpretation Crash Course for Nurse Practitioners

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There are many facets when it comes to interpreting Elevated Liver Enzymes (LFTs). In this episode we will be going through the most common presentation and primary care so that you will feel confident in knowing what steps to take when you come across these abnormal labs, and as a result, put your mind at ease and keep you from freaking out!

Together, we will cover:

Key anchors of LFTs that you need to rememberTwo main factors to know what labs to order and when Three points to start with during your initial approach to LFTsFour main questions to ask with every labSymptoms, causes, evaluation, and algorithm specifically for mild AST and ALT

Check out the Lab Interpretation Crash Course for Nurse Practitioners

Download FREE Ultimate Resource Guide for the New NP

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It happens to all of us. Those questions and self doubts we get in the back of our minds, ?What did I get myself into? Do I even know what I?m doing? Should I even be in this field?? 

The list goes on. If you are struggling with these fears, then you need to know a few things. First, you are not alone! And second, you are in the right place, because I?m giving you the strategies I use to deal with imposter syndrome. 

Imposter syndrome is especially common among New Grad NPs, but in all honesty imposter syndrome is something that many of us experience whenever we move to take that next step in our career or any time we explore something new. (Yes, even I still experience this!) So even if you are not a New Grad NP, you?ll still want to check out this episode because these tips are beneficial to everyone.

Download FREE Ultimate Resource Guide for the New NP

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When you?re a new nurse practitioner, there can be a lot of overwhelming, high-stress situations that you may find yourself in. 

A big contributing factor are lab interpretation resources ? they?re scattered, hard-to-use, and don?t cover enough information. I used to DREAD opening up my lab results, but over time I went from avoiding my inbox to being obsessed with labs. 

How did I get there? I found the right tools and techniques to use. In this episode, I?m going to help eliminate the overwhelm as we walk step by step through a case study of a patient with high TSH levels. Together, we?ll:

Go over the three main steps of hypothyroidism assessment and managementReview components of holistic careTalk about medications that can affect thyroid levelsAnd share pearls of practice

Get out your pen and paper because this episode is jam packed with information, and I know you will walk away feeling more confident and prepared for your next high TSH level patient! 

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Welcome to the first episode of the Real World NP Podcast! Let?s dive right into the good stuff. 

I?m giving you my top three survival tips to help you get through your first year as a Nurse Practitioner. 

As a student, you?re always looking to your preceptor for approval and feedback. You have someone to tell you, ?Yes, that was right,? and ?No, that was wrong.? This relationship sure makes things easier, but we don?t remain students forever! 

There comes a time when we have to take that leap and make the transition from student to professional. 

I know that leap can be a scary one filled with anxiety, self doubt, and a lot of questions. That?s why I?m giving you these three tips that I learned from personal experience. I can?t stress enough how important it is to get the adequate support you need from the very beginning so that you can avoid burnout and stay in this career for years to come.

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Hi, I?m Liz Rohr: family nurse practitioner, wife, mama and founder of Real World NP, a medical education company for new nurse practitioners in primary care. 

I?m on a mission to guide and support new nurse practitioners so they can feel confident and capable through comprehensive, concise, and hyper-relevant educational resources, without the fluff. 

Real World NP is 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 and 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.

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