TELEMETRY SKILLS CHECKLIST

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TELEMETRY SKILLS CHECKLIST 1111 North 3rd Street Instructions: Please complete this checklist to enable us to match your skills and interests with available assignments. Place an "X" in the appropriate column that best describes your experience level with each skill. LEVELS OF PROFICIENCY: 1. Experienced - performs well and independently (at least 1 year experience) 2. Limited experience - some assistance or practice needed (6 months to 1 year experience) 3. Little experience - need more experience, assistance required (less than 6 months experience) 4. No experience SKILLS 1 2 3 4 A. CARDIOVASCULAR Auscultation (rate, rhythm) Doppler Heart sounds/murmurs Pulses/Circulation checks 2. Interpretation of Lab Results Cardiac Enzymes/Isoenzymes Coagulation studies 3. Equipment & Procedures Monitotring/Telemetry Arrhythmia interpretation Basic 12 lead interpretation Lead placement: 5 electrode telemetry Lead placement: I, III, V-leads Lead placement: Lead II and MCL1 Pacemaker Permanent Temporary epocardial wires Temporary external placement Temporary transvenous Assist With Arterial line insertion Central line insertion Hemodynamic Monitoring A-line (radial) CVP monitoring Femoral artery sheath removal Swan-Ganz Perform Controlled cardioversion Emergency defibrillation Cardiopulmonary resuscitation (CPR) 4. Care of the Patient With: Abdominal aortic bypass Aneurysm Angina Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 1 of 7

Cardiac arrest Cardiomyopathy Carotid endarterectomy Congestive heart failure (CHF) Femoral-popliteal bypass Post acute MI (24-48 hours) Post angioplasty Post arthrectomy (DCA) Post CABG (24 hours) Post cardiac catheterization Post stent placement Cardiogenic shock 5. Medications Atropine Diuretics Digoxin Andrenergics Beta blockers Ca+ channel blockers Lidocaine Vasopressors Nitrates Antiarhythmics Preparation of emergency medications Oral, IV and subcutaneous anticoagulants Thrombolytic agents B. PULMONARY Breath sounds Breathing patterns 2. Interpretation of Lab Results Arterial blood gases Blood chemistry 3. Equipment and Procedures Assist with intubation Assist with thoracentesis Care of airway management devices/suctioning Endotracheal tube/suctioning Nasal airway/suctioning Oropharyngeal/suctioning Oximetry Sputum specimen collection Tracheostomy/suctioning Care of patient on ventilator Extubation Weaning modes Care of patient with chest tube: Assist with set-up & insertion Mediastinal tube removal Pleural tube removal Use of Pleurevac or Thoraclex Use of water seal drainage system Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 2 of 7

Chest physiotherapy Establishing an airway Incentive spirometry Oxygen therapy & medication delivery systems Ambu bag and mask ET tube External CPAP Face masks Inhalers Nasal cannula Portable oxygen tanks Tracheostomy Transtracheal cannulation Oral airway insertion Restraints 4. Care of the patient with: ARDS Bronchoscopy COPD Fresh trachostomy Lobectomy Pneumonectomy Pneumonia Pulmonary edema Pulmonary embolism Status asthmaticus Thoracotomy Tuberculosis 5. Medications Aminophylline Corticosteroids Atrovent Antibiotics Albuterol C. NEUROLOGICAL Cerebellar function Cranial nerves Glasgow coma scale Level of consciousness Pathologic reflexes 2. Equipment and procedures Assist with lumbar puncture Halo traction Nerve stimulator Rotation bed Seizure precautions Use of hyper/hypothermia blanket Bed alarms 3. Care of the patient with: Aneurysm precautions Basal skull fracture Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 3 of 7

Closed head injury Coma TIA/CVA DT's Encephalitis Externalized VP shunts Meningitis Multiple sclerosis Neuromuscular disease Post Craniotomy Seizures Spinal cord injury 4. Medications Dilantin Phenobarbitol Versed Lasix/Mannitol Valium Morphine sulfate Oral analgesics/narcotics D. GASTROINTESTINAL Abdominal/bowel sounds Fluid Balance Nutritional 2. Interpretation of Blood Chemistry 3. Equipment and procedures Administration of Tube Feeding Feeding pump Gravity feeding Flexible feeding tube (Corpak, Dobhoff, etc.) Placement of nasogastric tube Salem sump to suction Saline lavage 4. Management of: Gastronomy tube Jejunostomy tube PPN (peripheral parenteral nutrition) TPN and lipids administration T-tube 5. Care of the patient with: Bowel obstruction Colostomy ERCP Esophageal bleeding GI bleeding GI surgery Hepatitis Ileostomy Inflammatory bowel disease Liver failure Liver transplant Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 4 of 7

Pancreatitis Paralytic ileus Whipple procedure Pre/post open abdominal surgery E. RENAL/GENITOURINARY A-V fistula/shunt Fluid & elctrolyte imbalance 2. Interpretation of BUN & Cretinine 3. Equipment and Procedures Foley catheter insertion Female Male Supra-pubic Bladder irrigation Continuous Intermittent Specimen collection Routine 24 hour Nephrostomy tube care Manual CAPD administration Peritoneal dialysis via automatic cycler 4. Care of the patient with: Hemodialysis Nephrectomy Peritoneal dialysis Renal failure Renal transplant TURP F. GYNECOLOGY Assist with gynecological exam/pap Breast care/self-examination education 2. Interpretation of Lab Results 3. Care of the Patient With: Gynecological surgery Gynecological malignancy Mastectomy Hyserectomy G. METABOLIC S/S diabetic ketoacidosis S/S insulin shock 2. Interpretation of Lab Results Blood glucose Thyroid levels 3. Equipment and procedures Blood glucose monitoring Blood glucose measuring device Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 5 of 7

Insulin administration-iv drip Visual blood glucose strips 4. Care of the Patient With: Cushing's syndrome Diabetes insipidus Diabetes mellitus Diabetic ketoacidosis Disorders of adrenal gland (Addison's disease) Drug overdose Hyperthyroidism Hypothyroidism Pheochromocytoma Post adrenalectomy Post hypophysectomy Post thyroidectomy 5. Medications Hydrocortisone IM Vasopressin (Pitressin) Insulin Prednisone Radioactive iodine H. WOUND MANAGEMENT Skin for impending breakdown Stasis ulcers Surgical wound healing 2. Equipment and procedures Air fluidized, low airloss beds Sterile dressing changes Wound care/irrigations Perform cast care Maintain traction (skin/skeletal) 3. Care of the Patient With: Burns Pressure sores Staged decubitus ulcers Surgical wounds with drain(s) Traumatic wounds I. PHLEBOTOMY/IV THERAPY 1. Equipment and Procedures Drawing blood from central line Drawing venous blood Starting IVs Angiocath Butterfly Heparin lock Administration of blood/blood products Albumin/plasma Cryoprecipitate Packed red blood cells Whole blood Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 6 of 7

2. Care of the Patient With: Peripheral line/dressing Central line/catheter/dressing Broviac Groshong Hickman Portacath Quinton J. PAIN MANAGEMENT 2. Care of the Patient With: Anesthesia/analgesia IV conscious sedation Narcotic Analgesia Patient controlled analgesia K. MISCELLANEOUS 1. Infectious diseases (HIV/AIDS) 2. Antiobiotic Resistance Infections 3. Chemotherapy 4. Patient education 5. Informed Consent 6. Computerized charting 7. Automated medication dispensing systems 8. AMA procedures 9. Suicide precautions Age Specific Experience Circle each of the following age groups you have experience providing age specific care to: Neonatal Infant-Children(0-11) Adolescent (12-18) Adult Geriatric Employee Signature Date Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 7 of 7