Pediatric ICU Skills Checklist

Pediatric Intensive Care

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Telephone*

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Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Acute Renal Failure
Acute Tumor Lysis Snydrome

Acyanotic Heart Disease

Anorexia/Bulimia

Bacterial Endocarditis

Blunt Trauma

Bone Marrow Transplant

Brain Death/Organ Procurement

Bronchiolitis

Bronchopulmonary Dysplasia (BPD)

Burns

a. First Degree

b. Second Degree

c. Third Degree

Cardiac Catherization

Cardiac Defects

a. Coarctation of the Aorta

b. Hypoplastic Heart

c. Septal Defects

d. Tetralogy of Fallot

e. Transposition of the Great Vessels

Cardiac Transplant

Cardiomyopathy

Choking/Asphyxiation

Chronic Respiratory Disease

Crohn's Disease

Coma

Craniofacial Reconstruction

Croup

Cystic Fibrosis

Cytomegalovirus (CMV)

Developmental Delay

Diabetes Insipidus

Diabetic Coma

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Encephalitis
Epiglottitis

Externalized VP Shunt/Reservoir

Flail Chest

Foreign Body Aspiration

Gastroenteritis/Severe Dehydration

Gastroesophageal Reflux

GI Bleed

Gun Shot/Stab Wound

a. Abdomen

b. Chest

c. Head

Head Trauma

Hepatic Failure

Hepatitis

Hemolytic Uremic Syndrome

Hemothorax

HIV/AIDS

Intussusception

Kawasaki Disease

Leukemia

Malignant Tumors

Meningitis

MRSA

Multiple Trauma

Myocarditis

Near Drowning

Nephritis

Nephrotic Snydrome

Neuromuscular Diseases

Pancreatitis

Pinned Fractures

Poison Ingestion/Overdoses

Pneumonia

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pneumothorax
Post-Operative Care for:

a. Cardiothoracic Surgery

b. GI Surgery

c. Neurosurgery

d. Orthopedic Surgery

e. Tracheostomy

f. ENT Surgery

Radiation Implant

Renal Transplant

Respiratory Failure

Respiratory Syncytial Virus (RSV)

Severe Respiratory Distress

Shock

a. Anaphylactic

b. Cardiogenic

c. Hypovolemic

d. Septic

SIADH

Sickle Cell Anemia

Spinal Cord Injuries

Status Asthmaticus

Status Epilepticus

Stress Ulcer

Suicidal Patient

Tuberculosis

Thryoid Dysfunction

VRE

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Albuterol (Ventolin)
Aminophylline

Amoxicillin

Ampicillin

Atropine

Carbamazepine (Tegretol)

Chemotherapeutic Agents

Chloral Hydrate

Clonazapam (Clonopin)

Corticosteroids

Diazepam (Valium)

Digoxin

Epinephrine

Gentamycin

Growth Hormone

Insulin

Lasix

Metaproterenol (Alupent)

Nitroglycerine

Phenobarbital

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Phenytoin (Dilantin)
Sodium Bicarbonate

Procainamide (Pronestyl)

Thyroid Replacement

Vancomycin

Continuous IV infusion

Eye/ear Installations

IM Injections

Metered Dose Inhalers

Nebulizer

Rectal Infusion/Suppository

SQ Injections

Z-track Injections

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
CAVH
Chemotherapy - Peds Protocols

Chest physiotherapy

Chest tube & drainage system

a. Set up

b. Assist with insertion

c. Care & maintenance

d. Troubleshooting

e. Removal

EKG Intrepretation

a. 12 lead

b. Arrhythmias

c. Lead placement

End Tidal CO2 Measurement

Extracorporeal Membrane Oxygenation

Extubation

Feedings

a. Breastfeeding - assist

b. Breastmilk handling/storage

c. Bottle

d. Continuous tube feeding

e. Gavage, intermittent

Foley/Straight Cath insertion & care

a. Male

b. Female

Gastric Lavage

Gastric Suction, low intermittent

Gastrostomy Tube/Site Care

Hemodialysis - care during/post

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Hemodynamic Monitoring, non-invasive
a. Swan-Ganz cath insertion assist

b.Swan-Ganz cath care

c. MAP

d. CVP

e. PAWP/Wedge/PA

f. Cardiac Output

g. Cardiac Index

h. SVO2

i. Arterial line insertion assist

j. Arterial line care

Hemodynamic Monitoring, non-invasive

a. Auscultation

b. Doppler

c Palpation

Interpretation of Lab Results

a. Blood gases

b. Bilirubin

c. CBC

d. Cultures

e. Electrolytes

f. Stool for occult blood

g. Thyroid Studies

h. Urine dipstick

Intracranial Pressure Monitoring

Intestinal Tract Tube Insertion/Care

a. Gastrostomy button

b. Nasogastric

c. Nasojejunal

d. Orogastric tubes

PROCEDURES / SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Intravenous Infusions
a. Blood & Blood Products

i. Albumin

ii. Auto infusion

iii. Cryoprecipitate

iv. Fresh Frozen Plasma (FFP)

v. Packed RBCs

b. Central line care

i. Broviac

ii. Groshong

iii. Hickman

iv. Percutaneous Arterial Line

v. Percutaneous Venous Line

vi. PICC

vii.Portacath

viii.Quinton

c. Hyperalimentation

d. Intralipids

e. Peripheral IV insertion & care

i. Angiocath

ii. Butterfly

iii. Scalp Vein

f. Saline Lock/Heparin Lock

Intubation (assist with)

Isolation Procedures

Lumbar Puncture (assist with)

Oral Airway Insertion

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Oxygen Therapy Administration
a. Bag & mask

b. ET tube

c. Oxyhood

d. Face mask

e. Nasal cannula

f. Trach Collar

g. Tent

h. Ambu bag

Peritoneal Dialysis

a. Automatic cycler

b. Manual

Specimen Collection

a. Blood

i. Arterial stick

ii.Central line

iii. Heel stick

iv, Venous stick

b. Cultures

i. Blood

ii. Wound

iii. Sputum

c Urine

i. Catheter

ii. Diaper

iiii. Suprapubic tap (assist)

iv. Urine bag

Splint Application

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Suctioning
a. ET tube - closed

b. ET tube - open

c. Nasopharyngeal

d. Tracheostomy

e. Oral/Yankauer

Suicide Precautions

Temperature

a. Axillary

b. Oral

c. Tympanic

d. Rectal

Thoracentesis/Paracentesis - assist with

Traction Application

Wound/Ostomy Care

a. Colostomy care/bag change

b. Ileostomy care/bag change

c. Irrigations

d. Pressure Ulcers

i. Staging

ii. Care

c. Sterile Dressing Changes

d. Surgical Wounds with Drains

ASSESSMENT/OTHER


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Ambulatory Infusion Pumps
Admission of patients to unit

Assess Breath Sounds

Assess Heart Sounds

Care Planning

Charge Nurse responsibilities

Computerized Charting

Fontanel Assessment

Head Circumference Measurement

Neurological Assessments

Patient Teaching

Thermal Environment Maintenance

Use of Restraints

Vital Signs

PAIN MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pain assessment using pain scales
Epidural analgesia

IV conscious sedation

Patient controlled analgesia (PCA)

Narcotic Agents

Non-narcotic agents

Non-pharmacological measures

EQUIPMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Blood Warmer
BP Transducer

Cardiac Monitorv

Centrifuge

Defibrillator

Glucometer

Oxygen Flow Meter

Phototherapy Equipment

a. Bili blanket

b. Bili lights

c. Bili meter

Pulse Oximeter

Radiant Warmer

Specialty Beds

a. Air fluidized

b. Low air loss

c. Rotating

d. Stryker

Trascutaneous O2 & CO2 Monitor

Transport Incubator

Ventilator

a. CPAP

b. High frequency jet

c. Pressure

d. Transport

e. Volume

f. Oscillating

Computer Charting Systems

if you any other Equipment, Please specify below

Infusion Pumps (Specific Brands)

Specialty Beds

ASSESSMENT/OTHER


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Abdominal Girth Measurement
Admission of patients to unit

Assess Breath Sounds

Assess Heart Sounds

Care Planning

Charge Nurse responsibilities

Circulation Checks

Computerized Charting

Fontanel Assessment

Head circumference measurement

Neurological Assessments

Patient Teaching

Thermal Environment Maintenance

Thermal Environment Maintenance

Vital Signs

Do you speak any languages other than English?

Yes

No

If yes, which language(s)?

Age Specific Skills

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

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I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.