24 Hour Staffing Solutions
24
Hour Solutions Inc.
Nursing
Agency
415-648-6091
Last Name: ____________________ First Name:
_______________ Middle Initial: _____
Classification: __________________ Total Years of Experience: ___________
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Clinical Skill Competency: |
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Indicate clinical skill competency and level of proficiency for all procedures/equipment in the last 12 months. |
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SKILL LEVELS: |
0 = No experience. Theory only. |
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1 = Limited competence/proficiency. Supervision required. |
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2 = Acceptable competence/proficiency. |
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3 =
Competent/proficient. Have performed frequently |
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AGE SPECIFIC COMPETENCY: |
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Neonates/Newborns (birth - 30 days) |
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Adolescents (12 - 18 years) |
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Infants (30 days - 1 year) |
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Toddler (1 - 3 years) |
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Preschooler (3 - 5 years) |
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Older Children (5 - 12 years) |
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Young Adults (18 - 39 years) |
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Middle Adults (39 - 64 years) |
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Older Adults/Geriatrics (64+ years) |
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EXPERIENCE: |
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Admission To PACU |
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Physical Assessment of Body Systems |
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Pulmonary/Abnormal Breathing |
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Perform Suctioning |
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02 Administration |
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Care of Patient with Chest Tube |
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Post-operative Patient Care |
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Care of Patient with Tubes/Drains |
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Cardiovascular |
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Operate & Monitor Unit Equipment |
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Anesthesia Equipment |
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CHARTING: |
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Computer |
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DARE |
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APIE |
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SOAPIE |
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FOCUS |
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Discharge Planning |
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Utilization Review |
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Chart Review/Audit |
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TYPE OF UNIT: SIZE OF UNIT: |
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ADMISSION TO PACU: |
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Initial assessment |
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Airway management |
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Proper positioning |
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Vital signs |
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Skin color, temp, turgor |
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Neurological status |
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PHYSICAL ASSESSMENT OF BODY SYSTEMS: |
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Respiratory |
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Cardiovascular |
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Neurologic |
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Gastrointestinal |
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Genitourinary |
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Integumentary |
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MONITOR RECOVERY OF PATIENT NORM: |
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General anesthesia |
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Regional anesthesia |
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Local anesthesia |
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PULMONARY: |
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Auscultate breath sounds |
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Recognize abnormal breath sounds |
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IMPLEMENT APPROPRIATE NURSING INTERVENTIONS FOR ABNORMAL BREATH SOUNDS: |
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Reposition patient |
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Pulmonary toilet |
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Bronchodilators, duiretics |
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Suction, O2 |
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Airway insertion/management |
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RECOGNIZE ABNORMAL BREATHING: |
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Assess respiratory rate, rhythm, |
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Labored, dyspneic |
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Obstructed |
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Laryngospasm |
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Insufficient reversal |
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PERFORM SUCTIONING: |
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Oral |
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Nasal |
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Endotracheal |
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Tracheal |
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02 ADMINISTRATOR |
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O2 ADMINISTRATION: |
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Face-trach mask |
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Nasal cannula |
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T-piece |
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CARE OF PATIENT WITH CHEST TUBE: |
ETT mechanical ventilator |
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Set up closed drainage system |
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Recognize air leak |
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Assess for subcutaneous emphysema |
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Measure drainage |
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Troubleshoot problems |
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POST-OPERATIVE CARE FOR THE FOLLOWING PATIENT POPULATIONS: |
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Thoracic surgery |
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Vascular surgery |
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Orthopedic surgery |
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Neurosurgery |
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Tonsillectomy/P.E. tubes |
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Major abdominal surgery |
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ENT surgery |
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Breast surgery |
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Genitourinary surgery |
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Hypospadias |
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Circumcision |
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Gynecological surgery |
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Post-angiogram |
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Liver biopsy |
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Eye surgery |
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Cardiac surgery |
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CARE OF A PATIENT WITH TUBES/DRAINS: |
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Penrose drain |
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Sump |
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Davol |
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Colostomy |
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Jejunostomy |
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Ileostomy |
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Jackson Pratt |
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T-Tube |
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Foley Catheter |
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Urethral |
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Suprapubic |
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Cystotomy |
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NG tube |
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CARDIOVASCULAR: |
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Placement and care of a patient |
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Arrhythmia analysis |
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Cardioversion and defibrillation |
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Assist with insertion of a temporary |
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Care of patient with a permanent or |
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Use of non-invasive temporary |
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Care of the patient with intravascular |
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monitoring equipment: |
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Pulmonary artery catheters |
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Arterial catheters |
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Swan-Ganz catheters |
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Central venous catheters |
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Subclavian lines |
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Epidural catheters |
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Hemodynamic monitoring: |
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Equipment maintenance |
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Dressing changes |
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Prevention of complications |
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Leveling waveform analysis |
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Obtain and interpret: |
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Cardiac output |
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PA pressure |
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PCWP |
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CVP |
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LAP |
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Identify usual dosage, actions and side effects for: |
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Antiarrhythmics |
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Ionotropes |
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Vasopressors |
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Vasodilators |
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Reversal agents |
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Muscle relaxants |
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Betablockers |
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Calcium channel blockers |
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Inhalation agents |
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Calculate infusion rates in dosages |
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Interpret blood lab values for: |
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Electrolyte imbalances/ABG’s |
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OPERATE & MONITOR UNIT EQUIPMENT: |
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Portable suction machine |
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Transport monitor |
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Automatic BP monitor |
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Blanket warmer/Bair Hugger |
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Sequential compression device |
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Pulse oximeter |
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Pee Wee weighing scale |
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Hyper/hypothermia blanket |
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Blood warmer |
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PACU stretcher |
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IV pumps |
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Invasive pressure monitors |
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Implements physician orders |
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Collaborate with surgeon, anesthesiologist |
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Utilizes appropriate infection control |
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Practice universal precautions |
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Document interventions, outcomes, lab |
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Perform a discharge physical assessment: |
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Level of consciousness |
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Pupillary reactions |
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Motor and sensory function |
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Muscular strength |
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ANESTHESIA EQUIPMENT: |
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Blood Warmer |
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BP Monitor |
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Dinamap |
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Omeda |
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Defibrillator |
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EKG Monitor |
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SAO2 Monitor |
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Nitrogen Controls: |
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Tanks |
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Wall Units |
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Thermia Blankets |
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By checking this box, I am
certifying that the information provided in this Clinical Skills Checklist is
true, correct and complete. I understand that any misrepresentation, omission
or falsification on this application is sufficient cause for termination of
employment.
Print Name:
__________________________ Signature:
_____________________ Date: _________