Nurse Practitioner Chronicles

New ACC Guidance on Obesity and Cardiovascular Disease: What Every NP Needs to Know If you're a nurse practitioner in primary care, family practice, or cardiology, you already know that the obesity conversation has fundamentally changed. We're no longer in the era of "eat less, move more" as the sole clinical recommendation. The American College of Cardiology dropped two major guidance documents in August 2025 that every NP managing cardiovascular risk needs to have on their radar — and if you missed them, consider this your clinical catch-up. Let's break down what matters for your practice. Two Documents, One Clear Message The ACC released a Concise Clinical Guidance (CCG) on the medical management of obesity and a Scientific Statement focused specifically on treating obesity in adults with heart failure. Both documents signal a seismic shift in how we should be thinking about weight management as a core component of cardiovascular care — not a side conv...

  Fatigue Workup in Childbearing Women: Not a Fishing Trip Four tests. That’s the starting line: CBC, ferritin, TSH, pregnancy test. Not a 30-tube rainbow draw. “I'm just so tired all the time.” It's one of the most common complaints in primary care, and in women of childbearing age, the differential is simultaneously broad and predictable. The temptation is to order everything—a CMP, CBC, iron studies, B12, folate, vitamin D, cortisol, ANA, Lyme, EBV, celiac panel, ferritin, TSH, free T4, testosterone—and hope something lights up. That's not a workup. That's a fishing trip. And fishing trips catch incidental abnormalities that generate more tests, more anxiety, and no answers. This post makes the case for a disciplined, stepwise approach. The Core Four: Start Here, Every Time The First-Line Panel CBC : Anemia is the most common lab-identifiable cause of fatigue in this population. Look at hemoglobin AND MCV (microcytic = iron deficiency until proven otherwise). Ferriti...

  Vitamin D, B12, and Folate: The Most Over-Ordered and Over-Treated Labs in Primary Care When low B12 is real vs. artifactual, the vitamin D debate that won't die, and why folate deficiency is now almost nonexistent. These three labs are ordered reflexively on nearly every patient with fatigue, brain fog, or "just to check." And in most cases, the results either don't change management or lead to treatment of a "deficiency" that wasn't real. Let's bring some evidence-based clarity to the most over-ordered panel in primary care. Vitamin B12 When to Test Test B12 when there's a clinical reason: macrocytic anemia (MCV >100), peripheral neuropathy, cognitive changes, glossitis, or risk factors for deficiency (strict vegans, pernicious anemia, gastric bypass, metformin use, elderly with poor nutrition, chronic PPI use, Crohn's/celiac affecting the terminal ileum). The Serum B12 Problem Serum B12 is a notoriously unreliable test: A "low...

  Tumor Markers in Primary Care: When to Order, When to Step Away, and Why Screening Causes More Harm Than Good PSA, CA-125, CEA, AFP—the tests that cause the most unnecessary panic in your practice. Tumor markers are among the most misused tests in primary care. They get ordered for vague abdominal pain, pelvic discomfort, fatigue, or "just to be thorough"—and then a mildly elevated result triggers imaging, referrals, biopsies, and patient anxiety for a condition that doesn't exist. The core principle:  tumor markers are for monitoring known cancers, not for screening asymptomatic patients  (with limited exceptions). The Markers: What They Do and Don't Tell You Marker Primary Cancer Association Non-Cancer Causes of Elevation Role in Primary Care PSA Prostate cancer BPH, prostatitis, recent ejaculation, bike riding, UTI, age Screening (shared decision-making for men 55–69); monitoring after treatment CA-125 Ovarian cancer Endometriosis, fibroids, PID, pregnancy, menst...

  STI Testing Beyond Syphilis: HIV Algorithms, GC/CT NAAT, and the Herpes Serology Dilemma The testing rules that have changed, the test you probably shouldn't be ordering, and the window periods that still trip everyone up. The syphilis post covered one STI in depth. But the full STI panel has its own set of testing nuances, window periods, and pitfalls that new NPs need to master. HIV testing has evolved dramatically with 4th-generation assays, gonorrhea/chlamydia NAAT is site-specific, and herpes serology is the test that causes more unnecessary distress than almost any lab in primary care. HIV Testing: The Modern Algorithm 4th-Generation Ag/Ab Combo Test (The Standard) The current recommended initial screen is the  4th-generation HIV-1/2 antigen/antibody combination immunoassay . It detects both HIV antibodies AND p24 antigen, shortening the window period to approximately  2–4 weeks  after exposure (compared to 3–12 weeks for older antibody-only tests). The CDC R...