Skill Checklists

Medical Surgical

This checklist was electronically signed on (Today’s date)

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

  • 1 = No Experience

  • 2 = Need Training

  • 3 = Able to perform with supervision

  • 4 = Able to perform independently

General

Patient Preparation for surgery and / or procedures ( pre-op checklists, OSA Screeings, anti microbial Bath , consents etc)

Patient Admission

Use two patient identifiers

Patient Discharge

Patient Transfer

Post Mortem Care

Formulation of Patient Specific Goals

Electronic Documentation

Cardiovascular - General

Core measures related to CHF , Stroke, AMI etc

Cardiovascular -Assessment

Auscultation (rate, rhythm)

Normal Heart tones (ie S1, S2)

Abnormal Heart tones (ie murmur, gallop, friction rub)

Basic arrhythmai interpretation

Blood Pressure (non- invasive)

Doppler

Pulse/ circulaion checks

S/S DVT

Cardiovascular - Provision of care for

Abdiminal aortic bypass

Angina

Cardiac arrest

Cardiac carthetenzation

Cardiomyopthy

Carotid endartectomy

Congestive heart failure (CHF)

Femoral popiteal bypass

MI

Mycarditis

Post angioplasty

Post Cardiac Surgery

Thrombophlebritis

Cardiovascular - Equipment / Procedures

Application of anti embolic hose

Application of SCD pump

Assist with Chest Tube insertion

Assist with Chest Tube removal

Assist with Emergency Tracheostomy

Assist with Central line Insertion

Discontinue Central Line

Phlebotomy / IV Therapy - Provision of Care

Broviac

Hickman

Portacath

Quinton

Peripheral Line

PICC Line

Phlebotomy / IV Therapy - Equipment & procedures

Perform IV Site Care

Blood / Blood administration

Management of Blood Transfusion reaction

Obtain lab speciments from Central Line

Perform Venipunture

Insertion of peripheral IV line using angiocath with saline look

Perform central line dressing change

Pain Management - Assessment of

Pain Level/ Scale

Therapeutic response

Pain Management - Provision of care

Epidural anesthsia/ Analgesia

Narcotic analgesia

Non -pharmacologic comfort measures

Patient controlled analgesia (PCA pump)

LABS - Interpretation of

ABG's

Complete Blood Count (CBC)

Blood Chemistry

BUN & creatinine

Coagulation Studies

Coagulation Studies

Thyroid Panel

Pulmonary - Assessment

Capillary Refill

Auscultate breathe sounds

Identify adventitious lung sounds

Respiratory Patterns (normal/ abnormal)

Pulmonary - Provision of Care

Bronchoscopy

Chest trauma

Chest Tube

COPD

Fresh Tracheostomy

Lobectomy

Pleural Effusion

Pnemonectomy

Pulmonary Embolism

Pneumonia

Status Asthmaticus

Thoracotomy

Tuberculosis

Pulmonary - Equipment & procedures

Application of CPAP

Aspiration precautions

Identification of chest tube air leak

Monitor & Record chest tube output

Perform Chest tube Setup

Perform nasopharyngeal suctioning

Perform orophayngeal suctioning

Perform tracheostomy suctioning

Assist with intubation

Assist with troracentensis

Chest physiotheraphy

Incentive spirometry

O2 therapy using nasal cannula and mask

Pulse Oximeter (application & interpretation)

Sputum collection

Gastrointestinal - Assessment

Abdomen

Bowel Sounds

Fluid balance

Nutritional Status

Proper N/G Tube placement

Gastrointestinal - Equipment & Procedures

Administration of tube feeding

Feeding Pump

Gravity Feeding

Hemoccult

Placement of N/G Tube

N/G tube to Suction

Removal of N/G tube

Flexible fedding tube (ie Dobhoff)

Management of Gastrostomy tube

Management of Jenuostomy tube

Management of T-tube

PPN (peripheral parenteral nutrition)

Stool Specimen collection

TPN and Lipids administration

Gastrointestinal - Provision of Care

Bowel obstruction

Colostomy

ERCP

Esophageal Bleed

GI Bleed

GI Surgery

Hemicolectomy

Hepatitis

Illeostomy

Inflammatory bowel disease

Liver transplant

Pancreathtis

Paralytic ileus

Small Bowel resection

Endrocrine/ Metabolic - Assessment

S-S Hypeglycema

S/S Hypoglycema

S/S Insulin reaction

Endrocrine/ Metabolic - Provision of Care

Addision's Disease

Cushinng's Syndrome

Diabetes Inspidus

Diabetic ketoacidosis

Diabetes mellitus

Hyoerthyroidism (Grave's Disease)

Hypothyroidism

Insulin Shock

Thyriodectomy

Endocrine - Equipment & procedures

Blood glucose monitoring

Implementation of Sliding Scale

Use of Insulin Pen

Use of Lancet

Neurological - Equipment & Procedure

Assist with Lumbar puncture

Use hyper/ hypothermia blanket

Seizure precautions

Spinal Precautions

Stryker Frame

Neurological - Assessment

Glasgow coma scale

Level of consciousness

Visual / Communication Deficits

Neurological - Provisional of Care

Aneuysm precautions

Basal Skull fracture

Closed head injury

Coma

CVA

DTs

Encephalits

Laminectomy

Externalized VP Shunts

Meningitis

Neuromusclar Disease

Post Craniotomy

Seizures Disorder

Spinal cord injury

TIA

Renal/ Genitourinary - Assessment

arterio venous (A-V) fistula / Shunt

Fluid balance

Renal/ Genitourinary - Provision of Care

Acute Renal Failure

Chronic Renal Failure

Fluid Restrictions

Hemodialysis

Nephrectomy

Peritoneal Dialysis

Renal Transplant

Renal Rejection Syndrome

TURP

Urinary diversions (ie : iteal conduit, nephrostomy)

Urinary Tract Infection

Renal/ Genitourinary - Equipment & procedures

Bladder irrigation (Intermittent)

Continous Bladder irrigation (CBI)

Insertion & maintenance of Male Foley catheter

Insertion & Maintenance of Female Foley Catheter

3 way Foley

Suprapubic Catheter

Specimen Collection

Integumentary - Assessment

Skin for impending breakdown

Stasis ulcers

Surgical Wound

S/S Wound Infection

Integumentary - Provision of Care

Pressure sores

Stage Decubitus ulcers

Surgical Wounds with drain (s)

Traumatic Wounds

Integumentary - Equipment & procedures

Air Fludized , low airloss beds

Sterile dressing changes

Wound Care/ Irrigations

Orthopedics - Assessment

Circulation Checks

Gait

Range of Motion

Orthopedics - Provision of care

Amputation

Arthroscopic Surgery

Cast

Osteoporosis

Pinned fractures

Rheumatc/ arthritic disease

Total Trip Replacement

Total Knee Replacement

Orthopedics - Equipment & Procedures

Continous passive motion devices

Cane

Cervical Collar

Gait Belt

Prosthetic Device

Sling

Transfer Boards

Walker

Wheelchair

Traction

Infectious Diseases - Provision of Care

AIDS

Hepatitis

Lyme disease

Infectious Diseases - Equipment & procedures

Fever Management

Isolation Precaution

Med/ Surg Pharmacology - Medications

Aminodarone (Codarone)

Atropine

AquaMephyton (Vitamin K)

Apresoline

Corticosteroids

Coumadin

Decadron (Dexamethasone)

Dilantin (Phenytoin)

Ditiazem(cardizem)

Dobutamine (Dobutrex)

Epinephrine (Adrenalin)

Heparin Drip

Inderal (Propanolol)

Inocor (Amrinone)

Insulin

Kayexelate

Lactulose (Cephulac)

Lasix (Furosemide)

Low Molecular Weight Heparin (ie Lovenox)

Metoprolol (Lopressor)

Nitroglycerin (Sublingual)

Nitroglycerin (Topical)

Phenobarbital

Procainamicle (Pronestyl)

Sodium Bicarbonate

Valium (Diazepam)

Verapamil (Calan, Isoptin, Verelan)

Ventolin (Albuterol)

Management of Epidural Administation

Med/ Surg Pharmacology - Provision of Care

Perform & manage IV dosage drip Calculations

Verfication of Accurate IV Pump Delivery

Patient Advocacy - General

Provide care for end of life decisions

Demostrate Spiritual & Cultural Considerations

Provide for the integration of comfort care and death with dignity

Patient Education - General

Diesese Process

Turn, Cough and Deep Breathe

Splinting tecnique post op

Use of incentive spirometer

Importance of increasing mobility post-op when applicable

Advance Directives

Oncology - Provision of Care

Reverse Isolation

Bone marrow transplant

Fresh Oncologic surgery

Impatient chemotherphy

Inpatient hospice

Leukemia

Radiation Implant

Oncology - Assesement

Nutritional Status

Pain Control

Age Specific

Infant (Birth to 1 year)

Toddler (1-3 years)

Pre-school (3-6 years)

School Age (6-12 years)

Adolescent (12-18 years)

Young Adult (18-30 years)

Mature Adult (30-60 years)

Elderly (>60 years)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.