Telemetry/Stepdown Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyCardiovascular Care of Patient withAcute MI 1 2 3 4 CHF 1 2 3 4 Angina Hypertension 1 2 3 4 Cardiomyopathy Cardiopulmonary Arrest 1 2 3 4 Abdominal Aortic Aneurysm 1 2 3 4 Carotid Endarterectomy 1 2 3 4 Femoral Popliteal Bypass 1 2 3 4 Pre & Post Cardiac Surgery 1 2 3 4 Pre & Post Cardiac Cath 1 2 3 4 Pre & Post PTCA 1 2 3 4 Permanent Pacemaker Temporary PacemakerExternal Pacemaker 1 2 3 4 Cardiac Lab Interpretation 1 2 3 4 Cardiac Patient/Family Teaching 1 2 3 4 RespiratioryRespiratory Assessment 1 2 3 4 Assess Lung Sounds 1 2 3 4 Chest Percussion 1 2 3 4 Establish/Protect Airway 1 2 3 4 Chest tubes/Pleurevac 1 2 3 4 Oxygen Therapy 1 2 3 4 Drawing ABGs 1 2 3 4 Interpretation of ABGs 1 2 3 4 Incentive Spirometry 1 2 3 4 Suctioning: oral nasotracheal endotracheal tube tracheostomy tube 1 2 3 4 Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET 1 2 3 4 Inturbation/extubationambu bag pulse oximetry 1 2 3 4 Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema 1 2 3 4 NeurologyNeurological Assessment 1 2 3 4 Seizure Precautions 1 2 3 4 Assessment and Management of Seizure Activity 1 2 3 4 Assisting with Lumbar Puncture 1 2 3 4 Signs/Symptoms of Increasing ICP 1 2 3 4 Glascow Coma Scale 1 2 3 4 Crutchfield Tongs 1 2 3 4 Circo-electric Bed Halo Traction 1 2 3 4 Stryker Frame 1 2 3 4 Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery 1 2 3 4 GastrointestinalG.I. Assessment 1 2 3 4 Bowel Sounds 1 2 3 4 Inserting N-G Tubes 1 2 3 4 Colostomy Care 1 2 3 4 Measurement of I & O 1 2 3 4 Administration of Tube Feedings 1 2 3 4 Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction 1 2 3 4 Renal/GenitourinaryInsertion and care of: straight cath Indwelling urinary cath: male female 3-way 1 2 3 4 Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp 1 2 3 4 OrthopedicTotal Knee Replacement 1 2 3 4 Bucks Extension 1 2 3 4 Cast Care 1 2 3 4 Crutch Walking 1 2 3 4 K-Wires 1 2 3 4 Spica Casts 1 2 3 4 Balanced Suspension Traction 1 2 3 4 Circulation Checks 1 2 3 4 Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty 1 2 3 4 GeneralBlood Glucose Monitoring 1 2 3 4 Dressing Changes 1 2 3 4 Universal Precautions 1 2 3 4 Isolation 1 2 3 4 Discharge Planning 1 2 3 4 Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS 1 2 3 4 MedicationsUnit Dose 1 2 3 4 Dosage Calculation 1 2 3 4 Pouring from Stock Medication 1 2 3 4 Administration of Code Cart Emergency Drugs 1 2 3 4 Aminophylline 1 2 3 4 Ativan 1 2 3 4 Atropine 1 2 3 4 Chemotherapy Agents 1 2 3 4 Corticosteroids 1 2 3 4 Decadron 1 2 3 4 Digoxin 1 2 3 4 Dilantin 1 2 3 4 Dobutamine 1 2 3 4 Dopamine 1 2 3 4 Heparin Inhalers 1 2 3 4 Lidocaine 1 2 3 4 Lopressor 1 2 3 4 Magenesium Sulfate 1 2 3 4 Nipride Nitroglycerin 1 2 3 4 Phenobarbital 1 2 3 4 Thrombolytic Agents 1 2 3 4 Valium 1 2 3 4 Verapamil 1 2 3 4 IV TherapyInserting IVs Mixing IV solutions 1 2 3 4 Heparin Locks 1 2 3 4 TPN/Hyperalimentation 1 2 3 4 IV push IV drip Infusion pumps Syringe pumps 1 2 3 4 Continuous Subcutaneous Infusion Pumps 1 2 3 4 PCA Pumps 1 2 3 4 Ultrasonic Doppler 1 2 3 4 CVP Lines/Measurement of CVP 1 2 3 4 Central Line Dressing Change 1 2 3 4 Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction 1 2 3 4 Multi-lumen central venous catheters Implanted CVC (port-a-cath) 1 2 3 4 Assessment of IV insertion site 1 2 3 4 Assist with Insertion of Central Line 1 2 3 4 X-ray/Assessment After Insertion 1 2 3 4 Care of Patient with Central Line 1 2 3 4 Charge Nurse Experience? 1 2 3 4 CPR Certified? 1 2 3 4 BCLS Certified? 1 2 3 4 ACLS Certified? 1 2 3 4 Knowledge of Normal Values? 1 2 3 4 Have you had a dysrhythmia course? 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year) 1 2 3 4 Preschooler (ages 2-5 years) 1 2 3 4 Childhood (ages 6-12 years) 1 2 3 4 Adolescents (ages 13-21 years) 1 2 3 4 Young Adults (ages 22-39 years) 1 2 3 4 Adults (ages 40-64 years) 1 2 3 4 Older Adults (ages 65-79 years) 1 2 3 4 Elderly (ages 80+ years) 1 2 3 4 AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Emergency Room RN Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
