|
Professional Pediatrics
Nursing Checklist
Service
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
1. Assessment
a. Auscultation (rate/rhythm) ○ ○ ○ ○
b. Blood pressure/non-invasive ○ ○ ○ ○
c. Doppler ○ ○ ○ ○
d. Heart sounds/murmurs ○ ○ ○ ○
e. Perfusion ○ ○ ○ ○
2. Interpretation of lab results
a. Arterial blood gases ○ ○ ○ ○
b. Hemoglobin & hematocrit ○ ○ ○ ○
3. Equipment/Procedures
a. Basic EKG interpretation ○ ○ ○ ○
b. Non-invasive cardiac monitoring ○ ○ ○ ○
4. Care of the child with:
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 ○ ○ ○ ○
k. Shock ○ ○ ○ ○
5. Medication - Digoxin (Lanoxin) ○ ○ ○ ○
B. PULMONARY
1. Assessment
a. Chest/Lungs: Inspection ○ ○ ○ ○
Palpation, Percussion, Auscultation
b. Breathing Patterns/Rate/SOB ○ ○ ○ ○
Inspiration
c. Cough/Secretions/Hemoptysis ○ ○ ○ ○
d. Pains - Chest ○ ○ ○ ○
e. Skin - Color ○ ○ ○ ○
2. Equipment & procedures
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 ○ ○ ○ ○
3. Care of the child with:
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
1. Assessment - level of consciousness ○ ○ ○ ○
2. Equipment & procedures
a. Application of splints ○ ○ ○ ○
b. Assist with lumbar puncture ○ ○ ○ ○
c. Cast ○ ○ ○ ○
d. ICP monitoring ○ ○ ○ ○
e. Pinned fractures ○ ○ ○ ○
f. Traction ○ ○ ○ ○
3. Care of the child with:
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
1. Assessment
a. Abdominal/Bowel Sounds/Inspection ○ ○ ○ ○
b. Nutrition - Diet/Fluid balance/Ht/Wt ○ ○ ○ ○
2. Interpretation of lab results - 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 ○ ○ ○ ○
4. Care of the child with:
a. Anal fissure ○ ○ ○ ○
b. Cleft lip/palate ○ ○ ○ ○
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
1. Assessment - fluid balance ○ ○ ○ ○
2. Interpretation of lab results
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 ○ ○ ○ ○
4. Care of the child with:
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
1. Assessment ○ ○ ○ ○
2. Interpretation of lab results
a. Blood glucose ○ ○ ○ ○
b. Thyroid studies ○ ○ ○ ○
3. Equipment & procedures
a. Blood glucose testing: type Type:
4. Care of the child with:
a. Adrenal disorders ○ ○ ○ ○
b. Cushing's syndrome ○ ○ ○ ○
c. Juvenile diabetes ○ ○ ○ ○
d. Pituitary disorders ○ ○ ○ ○
e. Thyroid malfunction ○ ○ ○ ○
5. Medications
a. Growth hormone ○ ○ ○ ○
b. Insulin ○ ○ ○ ○
c. Thyroid ○ ○ ○ ○
G. HEMATOLOGY/ONCOLOGY
1. Assessment of nutritional status ○ ○ ○ ○
2. Interpretation of lab results
a. Blood chemistry ○ ○ ○ ○
b. Blood counts ○ ○ ○ ○
3. Equipment & procedures - reverse isolation ○ ○ ○ ○
4. Care of the child with:
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 ○ ○ ○ ○
(4) Portacath ○ ○ ○ ○
(5) Quinton ○ ○ ○ ○
b. Cutdown line/dressing ○ ○ ○ ○
c. Peripheral line/dressing ○ ○ ○ ○
J. INFECTIOUS DISEASES
1. Interpretation of lab results - blood count ○ ○ ○ ○
2. Equipment & procedures
a. Fever management ○ ○ ○ ○
b. Isolation ○ ○ ○ ○
3. Care of the child with:
a. AIDS ○ ○ ○ ○
b. Common childhood - communicable diseases ○ ○ ○ ○
c. Cytomegalo virus (CMV) ○ ○ ○ ○
d. Hepatitis ○ ○ ○ ○
e. Kawasaki disease ○ ○ ○ ○
f. Lyme disease ○ ○ ○ ○
K. MISCELLANEOUS
1. Assessment
a. Normal growth and development ○ ○ ○ ○
b. Normal laboratory values ○ ○ ○ ○
c. Recognize signs of abuse or neglect ○ ○ ○ ○
2. Medication - immunization schedule ○ ○ ○ ○
3. Care of the child with:
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
1. Assessment
a. Skin for impending breakdown ○ ○ ○ ○
b. Stasis ulcers ○ ○ ○ ○
c. Surgical wound healing ○ ○ ○ ○
2. Equipment & procedures
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
1. Assessment of pain level/tolerance ○ ○ ○ ○
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:
|
|
