Name: Date: RN - SKILLS CHECKLIST Experience is Primarily in: (Please indicate number of years in blank) Medical Neurology OB/GYN Oncology Orthopedics Pediatrics Psychiatry Rehabilitation Surgical Telemetry Other (type): SKILLS: If YES, please indicate your level of experience by: 1 - Theory, no practice 3 - One - Two years experience 2 - Intermittent experience 4 - Two plus years experience Cardiovascular Assessment Auscultation (rate, rhythm) Blood Pressure/non-invasive Doppler Heart sounds/murmurs Pulses/circulation check Equipment & Procedures Telemetry Pacemaker YES NO YES NO Basic 12 Lead Interpretation Basic Arrhythmia Interpretation Lead Placement Permanent Temporary Care of the patient with: Abdominal Aortic Bypass Aneurysm Angina Congestive Heart Failure Post Cardiac Cath Post Cardiac Surgery Post Cardiac Transplant Post Vascular Surgery Thrombophlebitis Endocrine/Metabolic Assessment S/S Diabetic Coma S/S Insulin Reaction Equipment & Procedures Blood Glucose Monitoring Indwelling Insulin Pump Care of the patient with: Diabetes Mellitus Disorders of Adrenal Gland Disorders of Pituitary Gland Hyperthyroidism Hypothyroidism Thyroidectomy Medications (Administration and Teaching) Insulin Oral Hypoglycemics Steroids Thyroid Electronic Measuring Device Performing Finger Stick Visual Blood Glucose Strips (Addison's Disease) (Diabetes Insipidus) Gastrointestinal Assessment Abdominal/Bowel Sounds Fluid Balance Nutritional Interpretation of Lab Results Blood Chemistry Equipment & Procedures Administration of Tube Feeding YES NO Infectious Diseases Interpretation of Lab Results Blood Count Equipment & Procedures Fever Management Isolation Care of the patient with: AIDS Hepatitis Lyme Disease YES NO Neurological Assessment YES NO Flexible Feeding Tube Management of Feeding Pump Gravity Feeding Saline Lavage Gastrostomy Tube Jejunostomy Tube T-Tube Placement of Nasogastric Tube Salem Sump to Suction Care of the patient with: Bowel Obstruction Colostomy/Ileostomy GI Bleeding GI Surgery Hepatitis Inflammatory Bowel Disease Invasive Diagnostic Testing Liver Failure Paralytic Ileus Post Liver Transplant Post Pancreas Transplant Glasgow Coma Scale Level of Consciousness Equipment & Procedures Assist with Lumbar Puncture Use of Hyper/Hypothermia Blanket Care of the patient with: Aneurysm precautions Basak skull fracture Close head injury Coma CVA DTs Encephalitis Externalized VP Shunts Meningitis Neuromuscular Disease Post Craniotomy Seizures Spinal Cord Injury Oncology Assessment YES NO YES NO Pain Management Assessment Assessment of Pain Levels/Tolerance Care of the patient with: Epidural Anesthesia/Analgesia YES NO Phlebotomy / IV Therapy Equipment & Procedures Administration of Blood/Blood Products YES NO Nutritional Status Pain Control Interpretation of Lab Results Blood Chemistry Blood Counts Equipment & Procedures Reverse Isolation Care of the patient with: Bone Marrow Transplant Fresh Oncologic Surgery Impatient Chemotherapy Inpatient Hospice Leukemia Radiation Implant Medications (Administration and Teaching) Certification Orthopedics Assessment Circulation Checks Gait Range of Motion Skin Equipment & Procedures Continuous Passive Motion Devices Support Devices Care Cervical Collar Gait Belt Prosthetic Sling Transfer Boards Walker Wheelchair Traction Care of the patient with: Amputation Arthroscopic Surgery Cast Osteoporosis Pinned Fractures Rheumatic/Arthritic Disease Total Hip Replacement Total Knee Replacement Drawing Blood from Central Line Drawing Venous Blood Starting IVs Care of the patient with: Central Line/Catheter/Dressing Peripheral Line/Dressing Albumin Cryoprecipitate Packed Red Blood Cells Plasma Whole Blood Angiocath Butterfly Heparin Lock Broviac Groshong Hickman Portacath Quinton Pulmonary Assessment Breath Sounds Rate and work of Breathing Interpretation of Lab Results Blood Chemistry Blood Gases Equipment & Procedures Airway management devices/suctioning Assist with intubation Assist with thoracentesis Care of the patient on a ventilator Care of the patient with a chest tube Chest Physiotherapy Incentive Spirometry O2 Therapy & Medication Delivery System YES NO YES NO Endotracheal tube/suctioning Nasal airway/suctioning Oropharyngeal/suctioning Sputum specimen collection Tracheostomy/suctioning Assist with set-up & insertion Measuring and emptying Removal Bag & Mask External CPAP Face Masks Inhalers Nasal Cannula Portable O2 Tank Trach Collar Oximetry Care of the patient with: Bronchoscopy COPD Fresh Tracheostomy Lobectomy Pneumonectomy Pneumonia Pulmonary Embolism Thoractomy Tuberculosis Renal/Genitourinary Assessment Arterio Venous Fistula/Shunt Fluid Balance Interpretation of Lab Results BUN & Creatinine Electrolytes Equipment & Procedures Insertion & Care of Straight and Foley Catheter Catheter Care Bladder Irrigations Specimen Collection Care of the patient with: Hemodialysis Nephrectomy Peritoneal Dialysis Renal Failure TURP Urinary Diversion/Ileal Conduit Nephrostomy Urinary Tract Infection Female Male 3-way Foley Supra-pubic Continuous Intermittent Routine 24 Hour Wound Management Assessment Skin for Impending Breakdown Stasis Ulcers Surgical Wound Healing Equipment & Procedures Air Fluidized, Low Airloss Beds Sterile Dressing Changes Wound Care/Irrigations Care of the patient with: Burns Pressure Sores Staged Decubitus Ulcers Surgical Wounds with Drains Traumatic Wounds Certifications YES YES NO If YES, Expiration Date NO YES NO ACLS BLS PALS Other: Other: Age Specific Practice Criteria Newborn/Neonate (birth-30 days) Infant (30 days - 1 year) Toddler (1-3 years) Preschooler (3-5 years) School Age (5-12 years)