The Nurse Practitioner Mentor Blog 

The influenza vaccine is one of the most common — and most debated — vaccines you’ll recommend in primary care. As a new nurse practitioner, it’s essential to know who needs it, which type to use, and how to counsel hesitant patients.

Who Should Get the Flu Vaccine?

• Everyone ≥6 months old (u...

Perimenopause basics
 

Perimenopause is the transition period—the months to years before menopause—when ovarian hormones fluctuate and cycles become irregular. During this time, many patients ask their primary care nurse practitioner (NP) about hormone therapy (HRT). For the right candidates, HRT is...

Perimenopause is getting the attention it deserves. Many patients want to talk hormone therapy (HRT)—and for the right candidates, it’s safe and very effective for symptom relief.

What Is Perimenopause?

The months–years before menopause (final menstrual period), when ovarian estrogen and progest...

What is CAC?

A noninvasive, low-dose, non-contrast CT that measures calcified plaque in the coronary arteries and reports a calcium score.

• Higher scores = higher future risk of MI and stroke.

• It doesn’t see soft (non-calcified) plaque, so a low score doesn’t fully exclude CAD—but CAC re

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A thyroid nodule is a rounded growth within the thyroid gland. Most adult nodules are benign, but evaluation matters because a small percentage are malignant.

Who Gets Them (and why that matters)

• Children: Nodules are less common but more likely malignant → early endocrine/surgical referral.

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Quick reminder: confirm the patient wasn’t taking biotin at the time of the lab draw—biotin can cause false labs that mimic hyperthyroidism (TSH artifactually low, T4/T3 high). Ask patients to hold biotin 48 hours before repeat testing.

Typical Lab Pattern

• TSH: low/suppressed

• Free T4 an...

Typical lab pattern

• TSH: high

• Free T4: low

• T3: normal or low (often not necessary to diagnose)

Treatment goals

1. Reverse hypothyroid symptoms

2. Normalize TSH (and FT4)

3. Reduce goiter size (if present)

First-Line: Levothyroxine (T4)

Why: Physiologic, stable ha...

Thyroid complaints are common—and vague. Here’s a practical, clinic-friendly way to triage symptoms, choose the right tests, and interpret results quickly.

Common Symptoms Patients Report

• Feeling of fullness in the throat, painless enlargement

• Voice changes

• Energy changes (fatigu

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A quick refresher on the thyroid axis and the most common causes of hypo- and hyperthyroidism you’ll see in clinic.

The Thyroid Axis (TRH → TSH → T4/T3)

• Hypothalamus releases TRH → stimulates the pituitary.

• Pituitary releases TSH → stimulates the thyroid to produce T4 (thyroxine) and

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Quitting is hard. Your plan doesn’t have to be. Here’s a simple, evidence-based approach that pairs combination NRT(patch + short-acting) with varenicline or bupropion when appropriate—plus dosing, side effects, and follow-up you can copy/paste into your EMR.

Why Combination NRT?

Preferred for...