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TELEMETRY/STEPDOWN (HDU) SKILLS CHECKLIST DATE: Applicant’s Name: Type your name here: (First) (Middle) (Last) To IITR Professionals: The purpose of the following checklist is to assist in matching your skills and interests with available assignments, thus meeting your needs and the needs of our clients as much as possible. Your employment is not dependant upon responses given in this checklist. **Please make sure this Skills checklist is signed and dated. We will accept the form on email with your name typed in place of signature The information I have given is true and accurate to the best of my knowledge. Signature: Date To IITR: IITR has developed unique skills checklist for each nursing specialty. This checklist is not necessarily a valid indicator of clinical skills and should not be utilized as the sole measure of the ability of an individual to perform the duties of a registered nurse or therapist in your facility. It is intended to be used only as a guide in your screening procedures and in orientation to procedure within your institution. PLEASE MARK YOUR LEVEL OF EXPERIENCE X Self-Assessed Experience Rating Scale Limited Experience 1 2 3 4 Very Experienced A. Phlebotomy/IV Therapy 1 2 Draw Blood: a. Venous Stick b. Central Line IV Therapy: a. Obtain IV Access b. Calculate IV Drips c. Mix IV Medications d. Regulate IV’s e. Use IV Infusion Pumps f. Perform Central Line Dressing Changes g. Administer Chemotherapy h. Administer Blood/Blood Products i. Administer TPN/PPN j. Maintain Multi-Lumen Central Catheters k. Use Continuous Subcutaneous Infusion Pumps l. Monitor PCA Pumps (Patient Controlled Analgesia) 1 Mark One 2 3 4 10 12 Care of the patient with: a. CHF b. Angina c. Hypertension d. Cardiomyopathy e. Cardiopulmonary Arrest f. Abdominal Aortic Aneurysm h. Carotid Endarterectomy i. Femoral Popliteal Bypass j. Permanent Pacemaker k. Temporary Pacemaker l. External Pacemaker m. Pre/Post Cardiac Cath n. Pre/Post PTCA Cardiac Lab Interpretation(CPK, Iso Enzymes) Cardiac Rehab/Patient Teaching 13 Use and Administration of: 11 1 2 3 4 Cardiac Monitors Rhythm Strip Measurements Recognize and Interpret Dysrhythmias Obtain 12 Lead EKG’s a. Digoxin b. Dopamine c. Dobutamine d. Heparin e. Verapamil 5 Perform CPR f. Lopressor 6 Cardioversion/Defibrillation g. Lidocaine 7 Pulse Checks h. Nitroglycerine 8 Use of Dopplers i. Code Cart/ Emergency Drugs 9 Automatic BP Cuff B. Cardiovascular Telemetry/ Stepdown Checklist Page 1 of 3 1 Mark One 2 3 4 Applicants Name: 1 C. Mark One 2 3 4 Mark One 1 2 3 a. Tube Feedings b. ILeostomy c. Colostomy d. Pancreatitis e. Bowel Obstruction f. Abdominal Wounds/ Surgery g. Hemovac h. Gastrostomy Tube/ Jejunostomy Respiratory 1 2 3 4 5 6 7 8 9 10 11 12 D. O2 Masks/Cannulas Ambu Bags Chest PT Incentive Spirometry Instruction of Coughing/Deep Breathing Nebulizer Set-up Suctioning a. Oral b. Tracheostomy c. Endotracheal Use of Pleurevac (chest drain) Sputum Specimen Collection Pulse Oximetry Care of the Patient with: a. COPD b. Tracheostomy c. Pre/Post Thoracic Surgery d. Pneumonia e. Chest Tubes f. Asthma g. Emphysema Use and Administration of: a. Aminophylline b. Corticosteroids c. inhalers F. 3 4 G. 6 Neuro Assessment Glasgow Coma Scale Seizure Precautions Assist with Lumbar Puncture Care of the Patients with: a. Acute Head Injury b. CVA/TIA c. DT’s d. Spinal Cord Injury e. Pre/Post Neuro Surgery f. Halo Traction g. Multiple Sclerosis h. Overdose Use and Administration of: a. Decadron b. Dilantin c. Phenobarbitol d. Magnesium Sulfate e. Valium Urinary Catheter Insertion Bladder Irrigations a. Continuous b. Intermittent Electrolyte Imbalance/Replacement Care of the Patient with: a. Hemodialysis b. T.U.R.P c. Shunts and Fistulas d. Nephrectomy e. Supra-Pubic Catheter f. Nephrostomy Tube Orthopedics 1 2 3 4 5 Neurological 1 2 3 4 5 Genitourinary/Renal 1 2 H. Cast Care Tractions a. skin b. Skeletal ROM Use of Assistive devices: walkers etc Care of the Patient with: a. Total Joint Replacement b. Amputation Miscellaneous 1 2 3 4 5 6 7. List types Dressing Changes Use of Air Fluidized Beds Normal Serum Lab Values Universal Precautions-Isolation Care of Patients with: a. Pressure Sores b. Sickle Cell Anemia c. Cancer d. Alzheimer’s Disease e. HIV/AIDS f. Diabetes Discharge Planning Blood Glucose Monitor Types: 1. 2. f. Ativan E. Gastrointestinal 1 NG Tube Care and Maintenance 2 NG Tube Insertion 3 4 Bowel Preparation Enterostomal Care 5 Care of Patients with: Telemetry/ Stepdown Checklist Page 2 of 3 8 List types OSHA TB Fit Test Mask Type: 1. 2. 9 List types Computer Charting Type: 1. 2. 4 Applicants Name: Mark One 1 2 3 4 I. Age of Patients Cared For 1 2 3 4 5 6 7 8 Infants and Toddlers (ages 0-3) Young Children(ages 4-6) Older Children(ages 7-12) Adolescents (ages 13-20) Young Adults (ages 21-39) Middle Adults (ages 40-64) Older Adults (ages 65-79) Adults (ages > 80) STEPDOWN SKILLS 1 J This section to be completed by those with PCU/Stepdown experience ONLY! 1 2 3 4 5 6 7 8 1 2 3 4 Maintain Arterial Line Draw Blood from Arterial Line Administer IV Push Medications Titrate IV drip Medications Care of Patients with: a. Acute MI b. Pulmonary Edema c. ARDS d. GI Bleed e. Liver Transplant f. Peritoneal Use and Administration of: a. Atropine b. Nipride c. Thrombolytic Agents Interpret ABG’s Ventilator Management a. Assist with Intubation/Extubation b. Wean Patient of Ventilator Maintain Arterial Line Draw Blood from Arterial Line Administer IV Push Medications Titrate IV drip Medications Telemetry/ Stepdown Checklist Page 3 of 3 2 3 4