SAN MATEO MEDICAL CENTER MEDICAL-SURGICAL NURSING

KNOWLEDGE AND SKILLS CHECKLIST LICENSED VOCATIONAL NURSE

___________________________ ______________ ________________ REGISTRY NURSE NAME TITLE DATE INSTRUCTIONS: Please check the appropriate column that best describes your experience level for each knowledge competency and skill. Choose 1 for Limited Experience through 4 for Very Experienced. Evaluate yourself based on experiences within the last two years.

Name: ______________________

Self-Assessed Experience Rating Scale

Limited Experience 1 2 3 4 Very Experienced 1 2 3 4 Assessment & Care Of Patient W/ Or Requiring: 1. Acute Cholecystitis 2. Adrenal Disorders 3. Angina 4. Amputation 5. Asthma 6. Bowel Obstruction 7. Bronchoscopy 8. Burns 9. Cardiac Arrest 10. Cardiac Catheterization 11. Cardiomyopathy 12. Carotid Endarterectomy 13. Cerebral Vascular Accident (CVA) 14. Cirrhosis 15. Coma 16. Congestive Heart Failure (CHF) 17. COPD 18. Delirium Tremens 19. Diabetes Insipidus 20. Diabetes Mellitus 21. Encephalitis 22. Femoral-Popliteal Bypass 23. GI Bleeding 24. Hepatic Failure 25. Hepatitis 26. HIV/AIDS 27. Hyperthyroidism 28. Hypothyroidism 29. Inflammatory Bowel Disease 30. Leukemia 31. Lobectomy 32. Malignant Tumors 33. Meningitis

Name: ______________________

Self-Assessed Experience Rating Scale

Limited Experience 1 2 3 4 Very Experienced 1 2 3 4 34. Multiple Sclerosis 35. Neuromuscular Disease 36. Osteoporosis 37. Paralytic Ileus 38. Pinned Fractures 39. Pituitary Disorders 40. Pneumonectomy 41. Pneumonia 42. Post Acute MI (>48 Hrs) 43. Post Angioplasty 44. Post Thyroidectomy

45. Post-Operative Care a. GI Surgery b. Orthopedic Surgery c. Ostomy d. Vascular Surgery

46. Renal Failure 47. Rheumatic/Arthritic Disease 48. Seizures 49. Spinal Cord Injury 50. Thrombophlebitis 51. Total Hip Replacement 52. Total Knee Replacement 53. Tuberculosis 54. TURP/TURBP 55. Thyroid Dysfunction 56. Urinary Tract Infection SKILLS 1. Admission Process 2. A-V Fistula Care 3. Brace/Splint Application

4. Catheter Insertion & Care a. Bladder Irrigation b. Foley

i. Female ii. Male

c. Straight i. Female iii. Male

d. Suprapubic 5. Cast Care 6. Chest Physiotherapy

7. Chest Tube & Drainage System a. Care & Maintenance b. Removal c. Set-up

8. EKG Interpretation (if applicable) a. 12 Lead b. Arrhythmia c. Lead Placement

9. Feedings a. Continuous Tube Feeding b. Gavage, Intermittent

10. Gastric Lavage, Iced Saline 11. Gastric Suction

Name: ______________________

Self-Assessed Experience Rating Scale

Limited Experience 1 2 3 4 Very Experienced 1 2 3 4 12. Glascow Coma Scale 13. Halo Traction/Cervical Tongs

14. Hemodynamic Monitoring a. Auscultation b. Doppler c. Palpation

15. Incentive Spirometry

16. Interpretation of Lab Results a. Blood Gases b. Blood Chemistry c. Cardiac Enzymes & Isoenzymes d. CBC e. Coagulation Studies f. Cultures g. Electrolytes h. Urine Dipstick

17. Intestinal Tract Tubes, Placement And Care a. Gastrostomy b. Jejunostomy c. Nasogastric d. Orogastric e. T-tube

18. Intravenous Infusion Therapy (if IV certified) a. Heparin Lock b. Peripheral IV insertion & Maintenance

• Angiocath 20. Lumbar Puncture (assist) 21. Nephrostomy Tube Care 22. Neurological Assessment 23. Nursing Assessment Care Planning

24. Oxygen Therapy Administration a. Bag & Mask b. External CPAP c. Face Mask d. Nasal Cannula e. Trach Collar

25. Pacemaker a. Permanent b. Temporary

26. Peritoneal Dialysis a. Automatic Cycler b. Manual

27. Physical Assessment 28. Restraints

29. Specimen Collection a. Cultures b. Sputum c. Urine

• Catheter • Clean Catch Mid-Stream

30. Suctioning a. Nasal-pharyngeal b. Oral-pharyngeal c. Tracheostomy

31. Temperature

Name: ______________________

Self-Assessed Experience Rating Scale

Limited Experience 1 2 3 4 Very Experienced 1 2 3 4

a. Oral b. Axillary

32. Thoracentesis (assist) 33. Traction Application 34. Vital Signs

35. Wound/Ostomy Care a. Colostomy site care/bag change b. Decubitus Ulcers c. Ileostomy site care/bag change d. Irrigations e. Sterile Dressing changes f. Surgical Wounds with drains

MEDICATIONS 1. Albuterol (Ventolin) 2. Aminophylline 3. Antibiotics 4. Anticoagulants 5. Anticonvulsants 6. Antihypertensive 7. Corticosteoids 8. Digoxin 9. Heparin 10. Insulin 11. Lasix 12. Nitroglycerine 13. Oral Hypoglycemics 14. Thyroid Replacement

15. Delivery Method a. Eye/Ear instillations b. IM Injections c. Meter dosed inhalers d. Nebulizer e. Oral f. Subcutaneous injections g. Z track injections

PAIN MANAGEMENT 1. Pain Level Assessment

2. Care of Patient with: a. Narcotic Agents b. Non-narcotic Agents

EQUIPMENT 1. Cardiac Monitor (if applicable) 2. Glucometer 3. Baxter IV Pumps (if applicable) 4. Dynamap 5. Suction Machine 6. Oxygen Flow Meter 7. Pleurovac 8. Hoyer Lift 9. Specialty Beds 10. Kangaroo pump 11. SCVD machine 12. Pulse Oximetry 13. CPM Machine

AGE APPROPRIATE NURSING CARE Please check the appropriate boxe(s) for each age group and activity for which you have had experience within the last year.

Age Specific Experiences

Adole

scen

t (1

3-1

8 y

rs)

Young A

dult

(19-3

9 y

rs)

Mid

dle

Adults

(40-6

4 y

rs)

Old

er A

dults

(65+

yrs

)

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

2. Understands the different communication needs for each age group and changes communication methods and terminology accordingly.

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

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

The information I have provided in this knowledge and skills checklist is true and accurate to the best of my knowledge. __________________________________________ __________________________ Signature Date