Service. Years of Experience: Directions for completing skills checklist:
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1 Professional Nursing Service Pediatrics Checklist Name: Date: Years of Experience: Directions for completing skills checklist: The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate your level of experience/proficiency with each area and, where applicable, the types of equipment and/or systems you are familiar with. Use the following key as a guideline: A) Theory Only/No Experience--Didactic instruction only, no hands on experience B) Limited Experience--Knows procedure/has used equipment, but has done so infrequently or not within the last six months C) Moderate Experience--Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed. D) Proficient/Competent--Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach. A. CARDIOVASCULAR A B C D a. Auscultation (rate/rhythm) b. Blood pressure/non-invasive c. Doppler d. Heart sounds/murmurs e. Perfusion a. Arterial blood gases b. Hemoglobin & hematocrit 3. Equipment/Procedures a. Basic EKG interpretation b. Non-invasive cardiac monitoring a. Bacterial endocarditis b. Cardiac arrest c. Cardiomyopathy d. Congenital heart defects/disease e. Congestive heart failure f. Myocarditis g. Pericarditis h. Post cardiac cath i. Post cardiac surgery j. Rheumatic fever
2 k. Shock 5. Medication - Digoxin (Lanoxin) B. PULMONARY a. Chest/Lungs: Inspection Palpation, Percussion, Auscultation b. Breathing Patterns/Rate/SOB Inspiration c. Cough/Secretions/Hemoptysis d. Pains - Chest e. Skin - Color a. Airway management devices/suctioning (1) Bulb syringe (2) Endotracheal tube/suctioning (3) Nasal airway/suctioning (4) Oropharyngeal/suctioning (5) Sputum specimen collection (6) Tracheostomy/suctioning b. Apnea monitor c. Chest physiotherapy d. Chest tubes e. End tidal CO2 f. Oximetry g. O2 therapy & medication delivery systems (1) Bag and mask (2) Hood (3) Inhalers (4) Nasal cannula (5) Portable O2 tank (6) Trach collar h. Water seal drainage system a. Asthma b. Bronchiolitis (RSV) c. Bronchopulmonary dysplasia (BPD) d. Cystic fibrosis e. Epiglottitis f. LTB/croup g. Pertussis h. Pneumonia i. Tonsillitis j. Tuberculosis 4. Medications a. Alupent (Meraproteranol) b. Aminophylline (Theophylline) c. Isuprel (Isoproterenol) d. Ventolin (Albuterol) C. NEUROLOGICAL/ORTHOPEDICS
3 - level of consciousness a. Application of splints b. Assist with lumbar puncture c. Cast d. ICP monitoring e. Pinned fractures f. Traction a. Battered child syndrome b. Closed head trauma c. Clubfoot d. Encephalitis e. Febrile seizures f. Meningitis g. Multiple sclerosis h. Multiple trauma i. Near drowning j. Neuromuscular disease k. Osteogenic sarcoma l. Osteomyelitis m. Spinal cord injury 4. Medications a. Clonazepam (Klonopin) b. Corticosteroids c. Dilantin (Phenytoin) d. Phenobarbital e. Tegretol (Carbamazepine) f. Valium (Diazepam) D. GASTROINTESTINAL a. Abdominal/Bowel Sounds/Inspection b. Nutrition - Diet/Fluid balance/ht/wt - Serum electrolytes 3. Equipment & procedures a. Feedings (1) Bottle (2) Breast (3) Central hyperalimentation (4) Gavage (5) Peripheral hyperalimentation b. Gastrostomy/button c. I-tubes d. Jejunal feeding e. NG and sump tubes to suction f. Penrose drains g. Placement of naso/orogastric tube h. Wound irrigation/dressing change a. Anal fissure b. Cleft lip/palate
4 c. Colostomy d. Diaphragmatic hernia e. Failure to thrive (FTT) f. Gastroenteritis/dehydration g. GE reflux h. GI bleeding i. Ileostomy j. Intestinal parasites k. Necrotizing enterocolitis (NEC) l. Pyloric stenosis m. Surgical abdomen n. Ulcerative colitis E. RENAL/GENITOURINARY - fluid balance a. BUN & creatinine b. Urinalysis 3. Equipment & procedures a. Assist with suprapubic tap b. Catheter insertion (1) Catheter care (2) Female (3) Indwelling (4) Male (5) Straight c. Collection of urine specimen a. Circumcision b. Glomerularnephritis c. Hemodialysis d. Hemolytic uremic syndrome (HUS) e. Hypospadias f. Ileal conduit ureteral g. Infantile polycystic disease h. Kidney transplant i. Nephrotic syndrome j. Peritoneal dialysis k. Renal failure l. Urinary tract infection m. Wilm's tumor F. ENDOCRINE/METABOLIC a. Blood glucose b. Thyroid studies 3. Equipment & procedures a. Blood glucose testing: type Type: a. Adrenal disorders b. Cushing's syndrome
5 c. Juvenile diabetes d. Pituitary disorders e. Thyroid malfunction 5. Medications a. Growth hormone b. Insulin c. Thyroid G. HEMATOLOGY/ONCOLOGY of nutritional status a. Blood chemistry b. Blood counts 3. Equipment & procedures - reverse isolation a. Anemia b. Bone marrow transplant c. Depressed immune system d. Disseminated intravascular coagulation (DIC) e. Hemophilia f. Hodgkin's disease g. Infectious mononucleosis h. Leukemia i. Malignant tumors j. Sickle cell anemia k. Spleen trauma/splenectomy 5. Medications a. Chemotherapy certification? yes no b. Prednisone H. MEDICATION ADMINISTRATION FOR CHILDREN 1. Calculation of pediatric doses 2. Eye/ear installations 3. Knowledge of emergency drugs 4. Knowledge of routine pediatric drugs 5. Metered dose inhaler I. PHLEBOTOMY/IV THERAPY 1. Equipment & procedures a. Administration of blood/blood products (1) Cryoprecipitate (2) Packed red blood cells (3) Whole blood b. Drawing blood from central line c. Drawing venous blood d. Starting IVs (1) Angiocath (2) Butterfly (3) Heparin lock 2. Care of the child with: a. Central line/catheter/dressing (1) Broviac (2) Groshong (3) Hickman
6 (4) Portacath (5) Quinton b. Cutdown line/dressing c. Peripheral line/dressing J. INFECTIOUS DISEASES 1. Interpretation of lab results - blood count a. Fever management b. Isolation a. AIDS b. Common childhood - communicable diseases c. Cytomegalo virus (CMV) d. Hepatitis e. Kawasaki disease f. Lyme disease K. MISCELLANEOUS a. Normal growth and development b. Normal laboratory values c. Recognize signs of abuse or neglect 2. Medication - immunization schedule a. Anorexia/bulimia b. Craniofacial reconstruction c. Depression d. ENT surgery e. Eye surgery f. Ingestion of foreign body g. Ingestion of poison or toxins h. Plastic surgery i. Suicidal threats/actions L. WOUND MANAGEMENT a. Skin for impending breakdown b. Stasis ulcers c. Surgical wound healing a. 1st degree burns (throughout body) b. 2nd degree burns c. 3rd degree burns d. Pressure sores e. Staged decubitus ulcers f. Sterile dressing changes g. Surgical wounds with drain(s) h. Traumatic wound care i. Use of air fluidized, low airloss beds j. Wound care/irrigations M. PAIN MANAGEMENT of pain level/tolerance
7 2. Care of the child with: a. Epidural anesthesia/analgesia b. IV conscious sedation c. Narcotic analgesia AGE SPECIFIC PRACTICE A.Newborn/Neonate (birth - 30 days) D.Preschooler (3-5 years) G.Young adults (18-39 years) B.Infant (30 days - 1 year) E.School age children (5-12 years) H.Middle adults (39-64 years) C.Toddler (1-3 years) F.Adolescents (12-18 years) I.Older adults (64+) EXPERIENCE WITH AGE GROUPS A B C D E G H I Able to adapt care to incorporate normal growth and development. Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level. Can ensure a safe environment reflecting specific needs of various age groups. My experience is primarily in: (Please indicate number of years) Medical year(s) Cardiothoracic year(s) Neuro year(s) Neurological year(s) Cardiovascular year(s) Burn year(s) Trauma year(s) Coronary care year(s) PACC year(s) Other (specify) year(s) The information I have given is true and accurate to the best of my knowledge. I hereby authorize Professional Nursing Service to release Pediatrics Skills Checklist to client facilities of PNS in relations to consideration of employment as a Traveler with those facilities. Signature Date Address Phone
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