PICU RN Skills Checklist The following checklist is a profile used to assess your Pediatric Intensive Care Unit proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given on this checklist. Please rate your ability as accurately as possible by checking the appropriate option. Step 1 of 6 16% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 – Expert Patient RightsCommunicates and obtains information while respecting the rights and privacy and confidentiality of information.01234Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives.01234Complies with nursing staff responsibility included in the hospital policy related to Organ Donation.01234Meets patient’s and family needs regarding communication, including interpreter services.01234Provides accurate information to baby’s families in a timely manner.01234Neurology - Assessment of the Neurological System:Glasgow coma scale01234Cranial nerves01234Motor response/posturing01234Mental status/cognition/responsiveness01234Pupillary responses01234Developmental appropriateness01234Neurology - Care of Patient with:Acute head injury01234Autonomic dysreflecia01234CNS infections (meningitis, abscess, encephalitis)01234Drug overdose01234Neuromuscular blocking agents (NMBA)01234Train of four01234Seizures01234Spinal fusion01234Spinal cord injury (SCI)01234Steroid protocol for SCI01234Neurology - Rehabilitation of the Neurological Patient Using:Rotorest bed01234Halo traction01234 Cardiovascular - Assessment of the Cardiovascular SystemGeneral appearance/activity level01234Basic EKG interpretation01234Capillary refill01234Care of the patient undergoing cardiac catherization01234Dysrhythmia interpretation01234Edema01234Heart sounds01234Skin color/temperature01234Positioning (knee/chest, posturing)01234Capillary refill01234Pulses01234Use of the defibrillator01234Cardiovascular - Care of Patient with Shock:Cardiogenic01234Neurogenic01234Septic01234Cardiopulmonary arrest (role, documentation)01234Obtaining and interpreting blood lab values01234Administering of blood and blood values01234Caring for a patient with valvular disease01234Medication and AdministrationKnowledge of Indications, Actions, Contraindications, Side Effects, Methods of Administration, Calculation of Dose, Rate of Infusion, caring for and monitoring patient receiving the following:Acetaminophen01234Albuterol01234Antibiotics01234Atropine01234Calcium01234Decadron01234Diazepam01234Digoxin01234Dobutamine01234Dopamine01234Duramorph01234Enalapril01234Epinephrine01234Furosemide01234Growth Hormone01234Heparin01234Insulin01234Lidocaine01234Lorazepam01234Magnesium Sulfate01234Midazolam01234Morphine01234Naloxone01234Neostigmine01234Nitroprusside01234Phenylephrine01234Potassium Chloride01234Propulsid01234Prostaglandin E101234Protamine Sulfate01234Rantidine01234Sodium Bacarbonate01234Sublimaze01234Terbutaline01234Theophylline01234Verapamil01234Wydase01234 "Lines Skills" - Specimen CollectionVenipuncture01234Arterial Puncture01234"Lines Skills" - Care of Patient with Central Vascular Catheter:Arterial line01234Broviac line01234PCVC01234UAC01234UVC01234"Lines Skills" - IV Therapy Including:Starting IV01234Changing IV sites01234Changing IV dressings01234Changing IV tubing01234Administering fluids on continuous IV pumps01234Setting up and monitoring PCA01234"Lines Skills" - Epidurals Including:Administering epidural medications01234Setting up epidurals01234Monitoring of epidurals01234Pulmonary - Assessing the Respiratory System Including:Breath sounds01234Breathing pattern/effort01234Skin/nail bed color01234Sputum (color/character)01234Pulmonary - Administering and Monitoring 02 Therapy:Nasal cannula, hood, endotracheal tube01234Pulse oximetry01234Assisting with intubation/extubation01234Mask01234Continuous O2 sats01234Demonstrating proper use of the Ambu bag01234Care and maintenance of acute airway obstruction (nasopharyngeal airway, oropharyngeal airway)01234Pulmonary - CO2 Monitoring Equipment:TCM01234ETTCO201234Pulmonary - Caring for a Patient with:Acute respiratory failure01234Acute respiratory infections01234Status Asthmaticus01234Flail Chest01234Respiratory Distress Syndrome (RDS)01234Pulmonary edema01234Pulmonary emboli01234Tracheostomy01234Tension Pneumothorax01234Pulmonary - Chest Tube ManagementIdentifies indications01234Assists with placement and removal01234Set up drainage01234Setting up Pleurovac01234Monitor suction level, air leak, and drainage site01234Site care01234Dressing change01234Pulmonary - Ventilators (Use, Mode, and Alarm Complications):Servo 30001234Infant Starr Ventilator01234Oscillator01234Nasal CPAP01234Weaning methods01234Pulmonary - Pleural Tube Management Including:Identifying indications01234Aspirating fluid as ordered01234Monitoring patient during and after aspiration of fluid01234 Patients with Endocrine System Problems - Care of Diabetic Patient:Administration of IV insulin drip01234Capillary blood glucose checks01234Care of the infant/child in diabetic acidosis01234Gastrointestinal/RenalAssessment of bowel sounds01234Appearance/character of urine and stool01234Assessing fluid and electrolyte balance01234Analyzing and interpreting serum values01234Urine specific gravity, osmolality, BUN, creat., urine lytes01234Caring for patient on tube feedings01234Feeding tube placement01234Caring for patient with PEG-J01234Gastrointestinal/Renal - Caring for Patient with Abdominal Surgery Including:Drainage, NG tube01234Ostomy Care01234Wound Care01234Gastrointestinal/Renal - Caring of Patient On:CRRT (CAVH, CVVHD, etc.)01234Hemodialysis01234Peritoneal Dialysis/octopus01234Peritoneal Dialysis/cycler01234Care of renal transplant patient01234Caring for patient in chronic renal failure01234Caring for patient in acute renal failure01234Caring for patient with peritoneal dialysis catheter01234 Other CompetenciesObtaining cultures for septic work-up (blood, sputum, catheter tips)01234Caring for child with Meningococcemia01234Caring for immunocompromised patient01234Caring for patient receiving conscious sedation01234Caring for patient using Jehovah Witness protocol01234Care of a dying child/infant01234Caring for patient during bone marrow aspiration01234Latex precautions guidelines01234Restraint management01234Skin care protocol01234Pain and comfort management01234Infection control management01234Antiembolic devices01234Overbed frame safety01234Intra-hospital transport01234Providing education to patient’s family related to medical condition, self care & health care habits01234Communicating discharge needs & arrangements for support through appropriate documentation01234Years of ExperienceNICUPlease write numbers of years of experience.PICUPlease write numbers of years of experience.PediatricPlease write numbers of years of experience.OtherPlease describe other experience areas.CertificationsBCLSYesNoExpiration Date MM DD YYYY ACLSYesNoExpiration Date MM DD YYYY PALSYesNoExpiration Date MM DD YYYY CCRNYesNoExpiration Date MM DD YYYY Other CertificationsPlease list other certifications. Use the box on the far right to add additional rows.TypeExpiration Date AcceptanceThe information I have given is true and accurate to the best of my knowledge. In addition, I hearby authorize Medestar to release this Pediatric ICU profile to client institutions of Medestar in consideration of my employment with that institution.Signature*
