Clinical decisions with nadja™
Structured
thinking for better clinical decisions
A clinical reasoning platform designed for nurse practitioners, physician assistants, and advanced practice clinicians to develop clearer diagnostic thinking through real patient cases and the RISER™ framework.
RISER™ is a structured approach that guides clinicians from patient presentation to confident clinical action.
The Reality of Clinical Practice
Patients rarely arrive with a diagnosis.
They present with:
• vague symptoms
• abnormal laboratory findings
• complex medical histories
• multiple medications
• overlapping conditions
In these situations, clinicians must gather information, evaluate risk, and develop a plan of care often within limited time.
For many clinicians and trainees, the challenge is not a lack of medical knowledge.
The challenge is how to structure clinical thinking when facing diagnostic uncertainty.
Clinical reasoning should not rely on guesswork.
It should follow a clear and disciplined framework.
The RISER™ Clinical Reasoning Framework
A structured approach to clinical thinking in real patient care.
RISER™ is a structured clinical reasoning framework that helps clinicians move from patient presentation to confident clinical action.
R — Reason for Presentation
Identify the primary clinical trigger bringing the patient to care.
I — Integrated Differentials
Build a structured differential diagnosis based on the patient’s presentation.
S — Stratify Risk
Assess clinical urgency and identify potential danger.
E — Explain the Pathophysiologic Driver
Identify the biological mechanism driving the patient’s presentation.
R — Response Plan
Develop a clinical plan for evaluation, management, and follow-up.
RISER helps clinicians organize complex information and approach patient cases with clarity, structure, and confidence.
Clinical Reasoning Through Real Cases: RISER Rounds™
RISER rounds is an educational podcast exploring real primary care presentations using the RISER framework.
Each episode walks through clinical reasoning step-by-step so listeners can see how experienced clinicians approach diagnostic thinking.
Common case topics include:
• abdominal pain
• abnormal laboratory findings
• persistent fatigue
• dizziness and syncope
• chest discomfort
• medication-related symptoms
Through case-based discussion, listeners learn how structured reasoning supports safer and more confident clinical decisions.
Chest Pain in Primary — Reflux or something life-threatening?
A1C of 9% in Diabetes — When diabetes control is slipping
Globulin Gap of 6 — A subtle lab finding with serious implications
Critical Hyperkalemia— When a lab result becomes an emergency
Dizziness in a 70-Year-Old Patient — Benign vertigo… or a warning Sign?
Why RISER Was Created
Many clinicians complete their training with strong medical knowledge but limited training in structured clinical reasoning.
In real clinical encounters, patient presentations are often complex and ambiguous.
Without a framework, it can be difficult to organize clinical information and approach diagnostic decisions systematically.
RISER was created to provide a clear pathway for clinical reasoning, helping clinicians move from patient presentation to clinical action.
About Nadja
Nadja St-Surin, MSN, APRN, FNP
Nadja St-Surin is a Family Nurse Practitioner and clinical educator dedicated to helping clinicians strengthen their clinical reasoning skills.
Through the RISER™ Framework and case-based teaching, she supports nurse practitioners, physician assistants, and advanced practice students in developing clearer diagnostic thinking and more confident clinical decisions.
Clinical Decisions With Nadja™ was created to promote structured clinical thinking in everyday medical practice.
Free Clinical Resource
RISER Clinical Reasoning Guide
A practical reference clinicians can use to apply the RISER™ framework during real patient encounters.
Inside the guide:
• Overview of the RISER™ clinical reasoning method
• Structured clinical reasoning prompts
• A quick reference pathway for evaluating patient presentations
Download the RISER Guide
Enter your email to receive the RISER Clinical Reasoning Guide.
Start Thinking in RISER™
Clinical reasoning becomes clearer when thinking is structured. Explore real patient cases and strengthen your diagnostic thinking RISER Rounds™.
Stay Connected with Clinical Decisions With Nadja™
Stay connected and explore more clinical reasoning insights and case discussions.
Clinical Decisions With Nadja™
Structured thinking for better clinical decisions.
Teaching structured clinical reasoning for Nurse Practitioners, Physician Assistants, and advanced practice students through the RISER™ framework and case-based learning.
Educational Disclaimer
The information provided through Clinical Decisions With Nadja™, RISER™, and RISER Rounds™ is intended for educational purposes only.
This material does not constitute medical advice, diagnosis, or treatment and should not replace independent clinical judgment or consultation with appropriate healthcare professionals.