Walking into an examination room and seeing a patient hunched over with labored breathing, audible wheezing, and an oxygen tank can be intimidating for any nurse practitioner.

And if you’re a nurse practitioner in primary care, it is essential to understand the management of COPD exacerbations to provide the best care you can to patients.

COPD exacerbation can look scary, but the management is fairly straightforward. So is the choice of whether or not to prescribe antibiotics (and which ones!)

This week, we’re sharing a case study about the management of COPD exacerbation in primary care. We’ll cover:

• How to know who should go to the ER
• When to give antibiotics (and which one, for how long)
• The general management you should be doing in primary care as a PCP for someone with COPD

PLUS! You can also download the COPD Management Cheat Sheet that you can keep at your desk to help you in your clinical practice! 

Read the full blog post here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

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Some people feel really uncomfortable talking about anything that has to do with reproductive health. Some of these people are patients, and some of them are healthcare professionals. Are you one of them?

If you thought that you might be off the hook because you work in primary care - you’re not. It’s a part of taking care of the entire patient. When you know and understand your patients’ goals for family planning a lot of other pieces of the clinical picture can become more clear.

Having a plan for the conversation is a good way to get more comfortable. If you get stuck just trying to think of where to start, there are tips in this week’s video that will help with the conversation. Imagine having just three questions to ask that not only guide the whole conversation, but that make the whole thing easier and less awkward for both you and the patient.  

In this video, we will cover easy-to-use strategies for contraceptive counseling in primary care. Including:

• How to actually talk with primary care patients about contraceptives
• Questions to ask the patient about contraceptive methods
• How to match contraceptive options with the patient’s preferences
• How having this conversation actually empowers patients

You don’t have to know the perfect thing to say when it comes to contraceptive counseling. But having a roadmap for the conversation will make a big difference for you and your patients. 

💫 A presentation I reference in the video is here: http://www.ctcfp.org/wp-content/uploads/APPROVED_Cason_Patient-Centered-Reproductive-Goals-and-Contraceptive-Counseling-pc-edits.pdf 

💫 And here are two other websites to help with patient reference: 

Reproductive access project: https://www.reproductiveaccess.org/resource/bc-fact-sheet/ 

💫 Bedsider.org: https://www.bedsider.org/

If you liked this post, also check out:

• Pap Screening In Primary Care
• Discussing Sexual Health With Your Patients - An Interview With A Sexual Health Educator 
• Your Urology Questions - Answered!

Read the full blog post here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

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It’s easy to think the worst when your patient mentions abnormal bleeding. It can mean so many things! Context is everything for the patient with abnormal uterine bleeding. Their age, their history, when it started, how long it lasted, their other diagnoses, even their other medications. These are all factors to consider in the patient with abnormal uterine bleeding, and will point you in a starting direction for your assessment and help you to build your differential.

Abnormal uterine bleeding often doesn’t mean the same thing for a young person in their twenties compared to someone who is past menopause. Do you know when people tend to start having periods (menarche)? Do you know when people tend to stop having periods (menopause)? Are you solid on what stopping having periods even means? Once you are solid on what is normal, you will get up to speed with abnormal things much faster. 

This week, we will cover the history questions to ask, the labs to order, and the imaging to order - and we will go even deeper. We’ll also talk about: 

• Normal versus abnormal uterine bleeding
• The anatomical factors that are key to your assessment
• Potential causes of abnormal uterine bleeding
• Other conditions that could cause or contribute to abnormal uterine bleeding
• Pearls related to imaging (what to order, and how)

Like so many other concerns in healthcare, abnormal uterine bleeding can be scary, for patients as well as providers. Increasing your knowledge level will increase your comfort level. This will help you to build a strong differential, guide your patients, and address their concerns effectively. 

If you liked this post, also check out:

• Discussing Sexual Health With Your Patients - An Interview With A Sexual Health Educator 
• Pap Screening In Primary Care 
• Pelvic Floor Dysfunction for New Nurse Practitioners 

Read the full blog post here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.

Burnout is a hot topic in all aspects of healthcare. You might be thinking that it’s something that affects other people. You might think it’s something that impacts Nurse Practitioners who are more established in their careers. You might think it’s one of the last things that you need to think about as a new grad Nurse Practitioner. Until you start to experience symptoms of burnout. 

This week, we are talking with Diana from Catalyst for Self Care. She’s a well-seasoned Nurse Practitioner and a self-care strategist. What makes her an expert? Because she also has experienced burnout as a Nurse Practitioner. In this interview, we will cover:

• Recognizing the signs and symptoms of burnout
• The benefits of addressing burnout
• Resources for preventing, assessing, and/or managing your burnout
• The importance of regular reflection as a part of your practice as a Nurse Practitioner
• Self-care and why it is so important

Learning about burnout sometimes happens the hard way, but it doesn’t have to. Watch this interview and get tips that you can start using right away. Understand what boundaries are, how to define yours, and why they are so vital to preventing and treating burnout. Self-care can mean a lot of things and is very unique to each of us. One thing is universal: we need to identify what works for us in a constructive way and make a plan to implement it for ourselves. When we care for ourselves, we can take the best care of our patients.  

If you know a colleague who is being stretched really thin, suggest this interview. 

If you liked this post, also check out:

• How To Know When To Change Jobs As A Nurse Practitioner
• When You Want To Give Up As A Nurse Practitioner
• Does It Get Better As A Nurse Practitioner

Read the full blog here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

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Have you ever wondered how best to manage your patients with pulmonary diagnoses? How much steroid use is too much for these patients? What happens after you refer your patients to pulmonology? How do we bridge the gap between primary care and pulmonology?

You gave us all the questions that you have for pulmonology – and we have answers. In this high yield interview, we will go over the answers to all of your questions and a lot more. We talk in depth with pulmonologist Dr. Daniel Seifer about your questions and more. From what to be thinking about when referring your patient to pulmonology to patient teaching techniques, we cover a lot in this interview. We talk about:

• What your patient’s steroid use can tell you about the status of their chronic condition
• Which tests to order for your patients, and what they mean for your patient
• The right way to use inhalers, and common mistakes many patients make
• Inhalers versus nebulizers – which is right for my patient?
• What to be thinking about when you refer your patient to pulmonology

This interview is like a crash course in next-level care for your patients with a pulmonary diagnosis. If you have felt pulmonology is a growth area for you, this interview should help. If you want to have better strategies for patient teaching, this interview should help. Grab a notebook and get ready to learn a lot in a little time – and improve the care that you give to your pulmonology patients in primary care.

If you liked this post, also check out:

• Interview With A Pharmacist 
• Ask A Cardiology Nurse Practitioner   
• Your Urology Questions - Answered

Read the full blog here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.

Have you had to give a patient bad news? Did you feel prepared or scared? It is a necessary part of being a Nurse Practitioner, and it’s always going to be challenging, but it is better if you are prepared.

Not all bad news is created the same. In some cases, bad news is life changing information, but in other cases, it might be life limiting information. What we might consider serious news, like a new diagnosis of diabetes, might be catastrophic to the patient. Doing our best to understand and anticipate the patient’s perspective will benefit us both.

This week, we have a video that covers so much of the ins and outs of delivering bad news to your patient. We will talk about all of the things to consider when you have these conversations with your patient. We’ll cover:

• How to prepare yourself
• How to prepare the setting
• How to have the actual conversation with the patient
• The difference that trauma-informed care can make in having these difficult conversations with patients
• A framework to guide the experience for you and the patient
• Some specific language to use in these conversations

Getting and giving bad news is always tough; having a plan for the visit will make a big difference. Develop a plan for follow up and next steps with the patient before you give them the news will also make a big difference. Using as much empathy as you can, keep the patient at the center of the conversation and give space for any emotions that might show up.

If you liked this post, also check out:

• How To Make A Plan of Care For New Nurse Practitioner
• Chronic Care Conversations 
• Medical Decision Making and Referral for New Nurse Practitioners 

Read the full blog here.

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Timestamps:

00:00 - Introduction

01:06 - Establish Framework (SPIKES)

02:12 - Setting Up

04:41 - Perception

05:56 - Invitation

07:48 - Knowledge

13:12 - Emotions and Empathy

13:41 - Strategy/Summary

15:32 - PEARL of Practice

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.

Diabetes might be one of the most challenging chronic conditions to manage. It definitely requires a lot of partnership between provider and patient; you may find yourself spending more time with your diabetic patient than any other group of patients in your practice.

We talked with Nurse Practitioner and Registered Dietitian, Meghan Kavanaugh, about her work with diabetic patients. The interview was such a hit that we brought her back again to answer all of your questions about the nutritional aspects of helping your patients with diabetes. This week, we get answers to your questions, and more, including:

• Where to start with nutritional counseling for diabetic patients
• How motivational interviewing can help with nutrition counseling
• Realistic strategies that patients can start using as soon as they leave your visit
• The importance of understanding the patient’s lifestyle in order to optimize their diabetes management

Diabetes can be a tough condition to manage; nutrition is at the foundation of good management, but not all patients have the same experience when it comes to food. Patients that travel, patients that have limited access to certain foods, patients who have religious reasons for eating or not eating certain foods, patients who simply have preferences for certain foods over others – all of these things must be kept in mind as we create strategies to help our patients manage their diet and their diabetes.

If you liked this post, also check out:

👉 Ask A Diabetic Educator Nurse Practitioner

👉 Diabetes Case Study in Mentorship for Nurse Practitioners

👉 Chronic Care Conversations

Read the full blog here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.

As a nurse practitioner in primary care, there are SO many things I’ve wanted to ask a cardiology nurse practitioner. This week, I had the lovely pleasure of interviewing Scott Pasquale, FNP and cardiology nurse practitioner, with questions from the RWNP community. 

In this episode, we covered:

• What cardiologists wish primary care providers knew
• A breakdown of common cardiovascular tests, how to explain them to patients, and how to choose between each one!
• Review of how to order holter monitors the right way!
• Common cardiovascular topics like atrial fibrillation, anticoagulation, and heart failure
• Resources for nurse practitioners interested into going into cardiovascular medicine

If you liked this post, also check out:

• Heart Failure in Primary Care
• Approach to Resistant Hypertension Part 1
• Approach to Resistant Hypertension Part 2

Read the full blog post here

Timestamps:

00:00 - Introduction

03:13 - How Scott Pasquale choose Cardiology

04:14 - What NP Cardiologist Wish That Primary Care Providers Knew

06:51 - Ordering a Stress Test

11:57 - Other Names for Nuclear Scans

12:54 - Example Situation

18:57 - Type of Monitor to Use 

24:45 - EKG Learning Resources

29:14 - A-Fibrillation

31:14 - Anticoagulation

33:56 - Cold Calling

35:20 - Coronary Calcium Score/Scan

36:54 - Hypertension Management and Their Side Effects

39:55 - Resources/Recommendations for New Nurse Practitioners Getting into Cardiology

41:32 - Heart Failure

44:24 - Diuresis Management

48:20 - Time in Specialty Practice vs Primary Care

Download the FREE Ultimate Resource Guide for NP

© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.

Feeling comfortable with treating type 2 diabetes can be overwhelming as a new grad Nurse Practitioner – and even as a seasoned Nurse Practitioner, especially if you don’t have a lot of diabetic patients in your practice. Some patients will be able to improve their diabetes and get their A1C down with lifestyle changes alone; others will need to add oral medication; others will need to add insulin to get optimal control of their diabetes.

When the time comes to have a conversation with your patient about starting insulin, they are likely to have lots of questions. If you want to be sure that you have answers, you have come to the right place. This week, we will walk through what you need to know when you have a patient who will be starting insulin for diabetes management. We’ll talk about:

✅ The other options for treating type 2 diabetes before you start insulin

✅ How much improvement you can expect with various approaches to diabetes treatment

✅ A framework for when to start insulin, and how to adjust the dose

✅ Managing hypoglycemia after starting insulin

✅ Why in-person visits are so beneficial for managing diabetes

Diabetes is a complex diagnosis for providers and patients. When you feel confused and overloaded with information, imagine how your patient feels. Being prepared for these conversations and clinical scenarios will help you to feel more confident, which will help you to be an even better resource for your patients.

✨ If you'd like support learning about how to manage Diabetes, including medication management, most recent guidelines, when to refer and examples of real-life patient cases, join us for the Managing Diabetes, Hypertension & CKD Review Course. Comes with 10.35 hours of continuing education, including 2.8 pharmacology hours, downloadable cheat sheets and lifetime access! Click here

Read the blog post here.

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Don't forget to grab your free Ultimate Resource Guide for the New NP

More Resources:

Lab Interpretation Crash Course

Digital NP Binder

Diabetes Medication Workshop

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What does it mean to “clear” a patient for surgery? Every patient needs to have a visit with a healthcare provider before their surgery in order to assess their health and verify that it is relatively safe to proceed with surgery. When they end up on your schedule, it’s up to you whether or not they will get the go ahead (no pressure). If you are wondering how, as someone who has not been trained to perform surgeries, you are supposed to understand a patient’s ability to tolerate a surgery or procedure, this video should help.

Patients and surgeries each have varying levels of risk (low, medium, high), and the preop visit is the place to get an understanding of how the pairing of the patient and the surgery is most likely to pan out. Many times, your judgment will be adequate and you can determine whether or not the patient should proceed with surgery; other times, more information will be needed, and it may be wise to send them to a specialist for the final word.

In this week’s video, we will talk about the particulars of the preop patient and the preop exam.

• The elements of a preop exam in primary care
• Relative risk levels of surgeries, and how to understand them for the purpose of a preop exam
• How to factor in the comorbidities when considering the patient’s safety for surgery
• The role of preop testing and imaging
• How to get feedback from a collaborating physician for tricky cases

Not all preop examinations are created equal, and so much of it depends on the surgery the patient is planning. Try not to get overwhelmed by the prospect; improving your understanding of the patient and assessing them for surgery, and when you should send them somewhere else, gets better with time and practice.

Read the full blog post here.

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© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details.

Hosted on Acast. See acast.com/privacy for more information.