Real World NP

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.

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.

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.

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.

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.

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.

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.

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.