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

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© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details.

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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 evaluation
• How to assess surgical risk and identify reasons to pause before surgery
• Using RCRI, ACS NSQIP, and DASI to assess cardiovascular risk and functional capacity
• What to include in the preoperative history and physical exam
• Assessing chronic conditions and pulmonary risk before surgery
• When preoperative labs, ECGs, and imaging are indicated
• Medication considerations before surgery, including anticoagulants, diabetes medications, and SGLT2 inhibitors
• What 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

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© 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.

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

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© 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.