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 withavailable 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 Experience1234Very Experienced
Mark One Mark One
A. / Phlebotomy/IV Therapy / 1 / 2 / 3 / 4 / 10 / Care of the patient with: / 1 / 2 / 3 / 41 / Draw Blood: / a. CHF
a. Venous Stick / b. Angina
b. Central Line / c. Hypertension
2 / IV Therapy: / d. Cardiomyopathy
a. Obtain IV Access / e. Cardiopulmonary Arrest
b. Calculate IV Drips / f. Abdominal Aortic Aneurysm
c. Mix IV Medications / h. Carotid Endarterectomy
d. Regulate IV’s / i. Femoral Popliteal Bypass
e. Use IV Infusion Pumps / j. Permanent Pacemaker
f. Perform Central Line Dressing Changes / k. Temporary Pacemaker
g. Administer Chemotherapy / l. External Pacemaker
h. Administer Blood/Blood Products / m. Pre/Post Cardiac Cath
i. Administer TPN/PPN / n. Pre/Post PTCA
j. Maintain Multi-Lumen Central Catheters / 11 / Cardiac Lab Interpretation(CPK, Iso Enzymes)
k. Use Continuous Subcutaneous Infusion Pumps / 12 / Cardiac Rehab/Patient Teaching
l. Monitor PCA Pumps (Patient Controlled Analgesia) / 13 / Use and Administration of:
B. / Cardiovascular / a. Digoxin
1 / Cardiac Monitors / b. Dopamine
2 / Rhythm Strip Measurements / c. Dobutamine
3 / Recognize and Interpret Dysrhythmias / d. Heparin
4 / Obtain 12 Lead EKG’s / 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
Applicants Name:
Mark One Mark One
1 / 2 / 3 / 4 / 1 / 2 / 3 / 4C. / Respiratory / a. Tube Feedings
1 / O2 Masks/Cannulas / b. ILeostomy
2 / Ambu Bags / c. Colostomy
3 / Chest PT / d. Pancreatitis
4 / Incentive Spirometry / e. Bowel Obstruction
5 / Instruction of Coughing/Deep Breathing / f. Abdominal Wounds/ Surgery
6 / Nebulizer Set-up / g. Hemovac
7 / Suctioning / h. Gastrostomy Tube/ Jejunostomy
a. Oral / F. / Genitourinary/Renal
b. Tracheostomy / 1 / Urinary Catheter Insertion
c. Endotracheal / 2 / Bladder Irrigations
8 / Use of Pleurevac (chest drain) / a. Continuous
9 / Sputum Specimen Collection / b. Intermittent
10 / Pulse Oximetry / 3 / Electrolyte Imbalance/Replacement
11 / Care of the Patient with: / 4 / Care of the Patient with:
a. COPD / a. Hemodialysis
b. Tracheostomy / b. T.U.R.P
c. Pre/Post Thoracic Surgery / c. Shunts and Fistulas
d. Pneumonia / d. Nephrectomy
e. Chest Tubes / e. Supra-Pubic Catheter
f. Asthma / f. Nephrostomy Tube
g. Emphysema / G. / Orthopedics
12 / Use and Administration of: / 1 / Cast Care
a. Aminophylline / 2 / Tractions
b. Corticosteroids / a. skin
c. inhalers / b. Skeletal
D. / Neurological / 3 / ROM
1 / Neuro Assessment / 4 / Use of Assistive devices: walkers etc
2 / Glasgow Coma Scale / 5 / Care of the Patient with:
3 / Seizure Precautions / a. Total Joint Replacement
4 / Assist with Lumbar Puncture / b. Amputation
5 / Care of the Patients with: / H. / Miscellaneous
a. Acute Head Injury / 1 / Dressing Changes
b. CVA/TIA / 2 / Use of Air Fluidized Beds
c. DT’s / 3 / Normal Serum Lab Values
d. Spinal Cord Injury / 4 / Universal Precautions-Isolation
e. Pre/Post Neuro Surgery / 5 / Care of Patients with:
f. Halo Traction / a. Pressure Sores
g. Multiple Sclerosis / b. Sickle Cell Anemia
h. Overdose / c. Cancer
6 / Use and Administration of: / d. Alzheimer’s Disease
a. Decadron / e. HIV/AIDS
b. Dilantin / f. Diabetes
c. Phenobarbitol / 6 / Discharge Planning
d. Magnesium Sulfate / 7. / Blood Glucose Monitor Types:
e. Valium / List types / 1.
2.
f. Ativan
E. / Gastrointestinal / 8 / OSHA TB Fit Test Mask Type:
1 / NG Tube Care and Maintenance / List types / 1.
2.
2 / NG Tube Insertion
3 / Bowel Preparation / 9 / Computer Charting Type:
4 / Enterostomal Care / List types / 1.
2.
5 / Care of Patients with:
Applicants Name:
Mark One
1 / 2 / 3 / 4I. / Age of Patients Cared For
1 / Infants and Toddlers (ages 0-3)
2 / Young Children(ages 4-6)
3 / Older Children(ages 7-12)
4 / Adolescents (ages 13-20)
5 / Young Adults (ages 21-39)
6 / Middle Adults (ages 40-64)
7 / Older Adults (ages 65-79)
8 / Adults (ages > 80)
STEPDOWN SKILLS
1 / 2 / 3 / 4
J / This section to be completed by those with PCU/Stepdown experience
ONLY!
1 / Maintain Arterial Line
2 / Draw Blood from Arterial Line
3 / Administer IV Push Medications
4 / Titrate IV drip Medications
5 / Care of Patients with:
a. Acute MI
b. Pulmonary Edema
c. ARDS
d. GI Bleed
e. Liver Transplant
f. Peritoneal
6 / Use and Administration of:
a. Atropine
b. Nipride
c. Thrombolytic Agents
7 / Interpret ABG’s
8 / Ventilator Management
a. Assist with Intubation/Extubation
b. Wean Patient of Ventilator
1 / Maintain Arterial Line
2 / Draw Blood from Arterial Line
3 / Administer IV Push Medications
4 / Titrate IV drip Medications
Telemetry/ Stepdown Checklist Page 1 of 3