Professional Medical/Surgical Nursing Checklist Medical .

ProfessionalNursingServiceMedical/Surgical SkillsName:Medical/SurgicalChecklistDate:Years of Experience:Directions for completing skills checklist:The following is a list of equipment and/or procedures performed in renderingcare to patients. Please indicate your level of expereince/proficiency with eacharea and, where applicable, the types of equipment and/or systems you are familiarwith. Use the following key as a guideline:A)B)C)D)Theory Only/No Experience--Didactic instruction only, no hands on experienceLimited Experience--Knows procedure/has used equipment, but has done soinfrequently or not within the last six monthsModerate Experience--Able to demonstrate equipment/procedure, performs thetask/skill independently with only resource assistance needed.Proficient/Competent--Able to demonstrate/perform the task/skill proficientlywithout any assistance and can instruct/teach.A. CARDIOVASCULAR1. Assessmenta. Auscultation (rate, rhythm)b. Dopplerc. Heart sounds/murmurs2. Equipment & proceduresa. Assist with insertion and set up(1) Arterial line(2) Central venous line(3) PA catheter/Swan-Ganz(4) Pacemakerb. Cardioversionc. Interpretation of waveforms & values(1) A-line(2) CVPd. Monitoring(1) Basic 12 lead interpretation(2) Basic arrhythmia interpretation3. Care of the patient with:a. Acute MIb. Aneurysmc. Anginad. Cardiac arreste. Congestive heart failure (CHF)f. Myocarditis4. MedicationsABCD

a. ACLS drugs(1) Atropine(2) Bretylium (Bretylol)(3) Epinephrine (Adrenalin)(4) Lidocaine (Xylocaine)(5) Procainamide (Pronestyl)(6) Sodium bicarbonateb. Other(1) Adenosine (Adenocard)(2) Amiodarone (Cordarone)(3) Digoxin (Lanoxin)(4) Diltiazem (Cardizem)(5) Dobutamine (Dobutex)(6) Dopamine (Intropin)(7) Esmolol (Brevibloc)(8) Lasix (Furosemide)(9) Nitroglycerin (Tridil)(10) Nitroprusside (Nipride)(11) Thrombolytic therapy B. PULMONARY1. Assessmenta. Breath soundsb. Rate and work of breathing2. Interpretation of lab resultsa. Arterial blood gases3. Equipment & proceduresa. Airway management devices/suctioning(1) Endotracheal tube/suctioning(2) Nasal airway/suctioning(3) Oropharyngeal/suctioning(4) Sputum specimen collection(5) Tracheostomy/suctioningb. Assist with extubationc. Assist with intubationd. Assist with thoracentesise. Care of the patient on a ventilatorf. Care of the patient with a chest tube(1) Assist with set-up & insertion(2) Measuring(3) Removalg. Measure peak flowh. Obtaining arterial blood gases(1) Arterial line(2) Femoral artery(3) Radial arteryi. O2 therapy & medication delivery systems(1) Bag and mask(2) ET tube(3) External CPAP(4) Face masks

(5) Inhalers(6) Nasal cannula(7) Nebulizer(8) Portable O2 tank(9) T-piece(10) Trach collarj. Pulse oximetryk. Trouble shooting high pressure alarmsl. Trouble shooting low pressure alarms4. Care of the patient with:a. Aspirationb. COPDc. Hemopneumothoraxd. Laryngospasme. Pneumoniaf. Pneumothoraxg. Pulmonary edemah. Pulmonary embolismi. Tension pneumothoraxj. Tuberculosis5. Medicationsa. Aminophylline (Theophylline)b. Bronkosol (Isoetharine hydrochloride)c. Epinephrine (Adrenalin)d. Isuprel (Isoproterenol hydrochloride)e. Steroidsf. Terbutaline C. NEUROLOGICAL1. Assessmenta. Advanced neuro assessment(1) Glasgow coma scale(2) Reflex/motor deficits(3) Visual or communications deficitsb. Level of consciousness2. Equipment & proceduresa. Assist with lumbar punctureb. Increased ICP management(1) Medications(2) Positioning(3) Regulation of ICP(4) Temperature control(5) Ventilationc. Intracranial pressure monitoring3. Care of the patient with:a. Basal skull fractureb. Closed head injuryc. CVAd. DTse. Encephalitisf. Externalized VP shunts

g. Meningitish. Neuromuscular diseasei. Overdosej. Seizuresk. Spinal cord injury4. Medicationsa. Decadron (Dexamethasone)b. Dilantin (Phenytoin)c. Mannitol (Osmitrol)d. Phenobarbitale.Solu-Medrol (Methylprednisolone sodium succinate) D. ORTHOPEDICS1. Assessmenta. Circulation checksb. Gaitc. Range of motiond. Skin2. Equipment & proceduresa. Assist with placement of castb. Support devices(1) Cane/crutch(2) Cervical collar(3) Sling(4) Transfer boards3. Care of the patient with:a. Ankle braceb. Ankle splintc. Castd. Knee immobilizere. Pinned fracturesf. Wrist splintE. GASTROINTESTINAL1. Assessmenta. Abdominal/bowel soundsb. Fluid balancec. Nutritional status2. Interpretation of blood chemistry3. Equipment & proceduresa. Placement of nasogastric tubeb. Salem sump to suctionc. Saline lavage4. Care of the patient with:a. Abdominal traumab. Bowel obstructionc. GI bleedingd. Hepatitise. Liver failure5. Medications

a. Antiemeticsb. Antispasmodicc. Charcoald. IpecacF. RENAL/GENITOURINARY1. Assessment - Fluid balance2. Interpretation of lab resultsa. BUN & creatinineb. Electrolytes3. Equipment & proceduresa. Insertion & care of straight and Foley catheter(1) Female(2) Maleb. Urine specimen collection4. Care of the patient with:a. Acute renal failureb. Peritoneal lavagec. Renal traumad. Urinary tract infection G. ENDOCRINE/METABOLIC1. Assessmenta. S/S diabetic comab. S/S insulin reaction2. Equipment & proceduresa. Blood glucose monitoring(1) Electronic measuring device:(2) Performing finger stick3. Care of the patient with:a. Diabetic ketoacidosis4. Medicationsa. Insulinb. Oral hypoglycemicsType :H. WOUND MANAGEMENT/SURGICAL1. Equipment & proceduresa. Application of Steristripsb. Assist with staplesc. Assist with suturesd. Culdocentesis traye. Set up suture trayf. Staple removalg. Suture removalI. EENT1. Assessmenta. Set up fluorescent/Woods lamp exam

b. Visual acuity2. Equipment & proceduresa. Application of eye patchb. Ear irrigationc. Eye irrigationd. Morgan lens irrigatione. Nasal packingf. Removal of contact lens J. TRAUMA/SHOCK1. Assessmenta. Champion trauma scoreb. Poison indexc. Triage2. Equipment & proceduresa. Air transport of trauma patientb. Application of mast suitc. Ground transport3. Care of the patient with:a. Bites, animalb. Bites, humanc. Bites, venomous snaked. Bites, venomous spidere. Burns(1) Rule of nines(2) First degree(3) Second degree(4) Third degreef. Dehydrationg. Electrocutionh. Gunshot/stab woundi. Hazardous material exposurej. Heat exhaustion/strokek. Hypothermial. Major traumam. Minor trauman. Radiation exposureo. Shock(1) Anaphylactic(2) Cardiogenic(3) Hypovolemic(4) Neurogenic(5) Septicp. Traumatic amputationK. INFECTIOUS DISEASES1. Interpretation of lab values - CBC, SMA 72. Equipment & proceduresa. Fever managementb. Isolation

3. Care of the patient with AIDS L. PHLEBOTOMY/IV THERAPY/INVASIVE PROCEDURES1. Equipment & proceduresa. Administration of blood/blood products(1) Autotransfusion(2) Cryoprecipitate(3) Packed red blood cells(4) Plasma/albumin(5) Whole bloodb. Assist with cutdownc. Drawing venous bloodd. Starting IVs(1) Angiocath(2) Butterfly(3) Heparin lock2. Care of the patient with:a. Angiographyb. Central line/catheter/dressing(1) Broviac/Hickman(2) Groshong(3) PICC(4) Portacathc. PericardiocentesisM. PAIN MANAGEMENT1. Assessment of pain level/tolerance2. Care of the patient with:a. Epidural anesthesia/analgesiab. IV conscious sedationN. PEDIATRICS1. Equipment & proceduresa. Child abuse/recognition/reportingb. Obtaining consent to treatc. Pediatric arrest2. Care of the patient with:a. Epiglottitisb. Near drowningc. Overdose/poison ingestiond. Status asthmaticuse. Status epilepticusO. WOMEN'S HEALTH1. Assessment - Assist with pelvic exam2. Equipment & proceduresa. Pelvic trayb. Rape kitc. Reporting acts of violence

3. Care of the patient with: a. Abruptio placentab. DICc. Hemorrhaged. Placenta previae. Precipitous deliveryf. Preeclampsia/eclampsiag. Spontaneous abortionP. MISCELLANEOUS1. AMA proceduresyes2. Suicide precautionsyes nono AGE SPECIFIC PRACTICEA.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 GROUPSAAble to adapt care to incorporate normal growthBCDEGHI and development.Able to adapt method and terminology of patient instructions totheir age, comprehension and maturity level.Can ensure a safe environment reflecting specific needs ofvarious age groups.My experience is primarily in: (Please indicate number of years)MedicalCardiothoracicyear(s) Neurological Trauma Other (specify)year(s)year(s) Cardiovascular Coronary careyear(s)year(s)year(s)year(s) Neuro Burn PACCThe information I have given is true and accurate to the best of my knowledge. I hereby authorizeProfessional Nursing Service to release Medical/Surgical Skills Checklist to client facilities of PNS inrelations to consideration of employment as a Traveler with those year(s)

Medical/Surgical Skills Professional Medical/Surgical 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 expere