TRAVELER SKILLS CHECKLIST NICU. 0 = No Knowledge / 1 = Limited Knowledge / 2 = Proficient. Last Name First Name Social Security Number Discipline
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1 Medication Administration PO Sub q Rectal Topical Drops (i.e. eye, nose, ear) Eye prophylaxis - Vitamin K IM Z track IV Push IV Drip Calculation of dosages Emergency drug actions and reactions Hyperalimentation Lipids Neonatal drug actions and reactions IV Therapy Start peripheral IV - angio cath Start peripheral IV - butterfly Rate calculation Mixing IV's Umbilical arterial line Umbilical venous line Percutaneous arterial line Percutaneous venous line Central Lines PICC lines Broviac lines Portacath Groshong Hickman Quinton IVAC pumps IMED pumps Syringe pumps Drawing blood from central line Drawing venous blood Cardiovascular Page 1 of 9
2 Assessment Auscultation (rate, rhythm, volume) Blood pressure/invasive (arterial line) Blood pressure/noninvasive Perfusion Heart sounds/murmurs Central venous pressure Defibrillation/cardioversion EKG interpretation Invasive hemodynamic monitoring 12 lead EKG interpretation Swan-Ganz Cardiovascular - Patient Care Cardiac arrest Cardiac transplant Cardiomyopathy Congenital heart disease/defects Hemodynamic instability Hypovolemic shock Post cardiac surgery Post interventional cardiac cath Cardiovascular - Medications Dobutamine (Dobutrex) Dopamine (Intropin) Epinephrine (Adrenalin) Nipride (Nitroprusside) Sodium bicarbonate Respiratory Chest exam and auscultation Inspiratory/expiratory evaluation Respiratory - Patient Care Assist with intubation Page 2 of 9
3 Extubation Bronchopulmonary Dysplasia Cardiogenic/hypovolemic shock Diaphragmatic hernia Fresh tracheostomy Meconium aspiration Persistent pulmonary hypertension (PPHN) Pneumothorax RDS Respiratory failure Thoracentesis Use of artificial surfactant Chest tubes - insertion/setup Chest tubes - removal Collection of sputum specimen Suction - bulb syringe Suction - endotracheal Suction-nasopharyngeal Suction-oropharyngeal Suction-tracheostomy Tracheostomy care Respiratory - Ventilator care CPAP/PEEP High frequency jet ventilator Home ventilators IMV Oscillating Pressure ventilator Volume ventilator Weaning Respiratory - Oxygen Therapy Apnea monitor Nasal cannula Face mask Nebulizer Oxyhood Tent Trach collar Non-rebreather mask Page 3 of 9
4 Ambu bag and mask ECMO (extracorporeal membrane oxygenation) Respiratory - Blood Gases Obtaining from arterial line Arterial Heelstick Peripherial Umbilical line Interpretation of gases Pulse oximetry Respiratory - Respiratory Medications Aminophylline(Theophylline) Prostaglandin Neurological Assessment - Neurological Status Assist with Lumbar puncture Intracranial pressure monitoring Neurological - Patient Care Brain death/organ procurement Increased intracranial pressure Externalized VP shunt/reservoirs Meningitis Seizures Neurological - Medications Administration of anti-convulsants Gastrointestinal Assessment-abdominal Assessment - Abdominal girth Assessment - bowel sounds Assessment - palate Page 4 of 9
5 Assessment - suck/swallow Placement of gastrostomy/button tubes Gastrointestinal - Feedings Assist with breast feeding bottle breast milk handling/storage Electric breast pump Gavage Placement of nasogastric/orogastric tubes Placement of jejunal gastro tubes Test for occult blood Gastrointestinal - Patient Care Cleft palate Gastroenteritis Colostomy/ileostomy Gastroschisis/omphalocele GI bleeding Inguinal hernia Necrotizing enterocolitis (NEC) Post abdominal surgery Reflux precautions Tracheoesophageal fistula (TEF) Renal/Genitourinary Assessment of fluid balance Interpretation of lab results Specific gravity Collection of urine specimens Insertion and care of foley catheter Insertion and care of supra-pubic catheter Assist with supra pubic tap Renal/Genitourinary - Patient Care Acute renal failure Malformations of the GU tract/kidney Peritoneal dialysis Page 5 of 9
6 Metabolic/Endocrine Assessment of electrolyte balance Interpretation of lab results - bilirubin Interpretation of lab results - glucose Interpretation of lab results - occult blood Interpretation of lab results - ph Interpretation of lab results - specific gravity Metabolic/Endocrine - Patient Care Hyperbilirubinemia Acid base imbalance Phototherapy for jaundice Disorders of internal/external organs Drug addiction/withdrawal Hypo/hyperkalemia Hypo/hypernatremia Infant of diabetic mother Oncology/Hemotology Assessment Interpretation of blood chemistry and counts Interpretation of culture reports Interpretation of maternal lab results Oncology/Hemotology - Patient Care Hepatitis surface antigen+ mother HIV positive mother DIC Oncology/Hemotology -Immunizations HBIG HBV Polio DPT RespiGam/synergis prophylaxis Oncology/Hemotology - Administration of blood products Page 6 of 9
7 RBC Platelets Cryoprecipitate FFP Albumin/Plasma Whole blood Wound and Skin Management Assessment of skin Neonatal skin care Cord care Positioning devices Wound and Skin Management - Thermoregulation Isolette with humidity Radiant warmer Temperature (axillary, skin) Weaning to open crib/bassinet Isolation Standard Contact Enteric Respiratory MRSA VRE Pain Management Assessment of pain level Care of the neonate with sedation Miscellaneous Normal growth and development adaptations Bereavement/postmortem care Preparation for transport/transfer Page 7 of 9
8 Gestational Age Ballard Dubowitz Other Screen for hearing loss Maternal history Consents Immunization Procedural Treatment Able to assure a safe environment for the specific needs of various age groups A.Newborn/Neonate (birth - 30 days) B.Infant (30 days - 1 year) C.Toddler (1-3 years) D.Preschooler (3-5 years) E.School age children (5-12 years) F.Adolescents (12-18 years) G.Young adults (18-39 years) H.Middle adults (39-64 years) I.Older adults (64+) Able to communicate and/or instruct patients according to their age, maturity, comprehension A.Newborn/Neonate (birth - 30 days) B.Infant (30 days - 1 year) C.Toddler (1-3 years) D.Preschooler (3-5 years) E.School age children (5-12 years) F.Adolescents (12-18 years) G.Young adults (18-39 years) H.Middle adults (39-64 years) I.Older adults (64+) Evaluate age-appropriate behavior, motor skills and physiological norms A.Newborn/Neonate (birth - 30 days) Page 8 of 9
9 B.Infant (30 days - 1 year) C.Toddler (1-3 years) D.Preschooler (3-5 years) E.School age children (5-12 years) F.Adolescents (12-18 years) G.Young adults (18-39 years) H.Middle adults (39-64 years) I.Older adults (64+) Page 9 of 9
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