PPR Healthcare
333 1st. St. North -- Suite 200
Jacksonville Beach, FL 32250
Fax:(888)794-5038

DIALYSIS SKILLS CHECKLIST
Name:   Date:    
Email:    Phone:  
Instructions: Use the following Answer Key to indicate the extent of your previous experience:
Key - for each box mark:   1 - Limited or no experience, 2 - Somewhat experienced but may need review,
    3 - Can function independently, 4 - Competent to supervise
  1     2     3     4     1     2     3     4
NURSING KNOWLEDGE   |   Equipment  
General Health Status   |     Doppler BP Cuff
  Assessment   |     Oxygen Delivery Systems
    Cardiac Status |       Bag and Mask
      Blood Pressure |       Face Mask
    Pulmonary Status |       Inhalers
      Rate |       Nasal Cannula
      Lung Fields |       Portable Oxygen Tank
    Neurological Status |   Care of Dialysis Patient with  
      Neuropathy Status |     Congestive Heart Failure
    GI Status |     Obstructive Pulmonary Disease
    Endocrine Status |     Diabetes
      Parathyroid Function |     Neoplasms
    Musculoskeletal Status |   Medications  
      Bone Density Status |     Digoxin
    Lab Results |     Aminophyllin
      Hemoglobin |     Insulins
      Serum Electrolytes | Renal/Genitourintary Knowledge  
  Procedures   |   Assessment  
    Patient Teaching |     Fluid Balance
    Family Teaching |     Electrolyte Balance
    Blood and Body Fluid Precautions |     Excretion of Waste Products
    Assist with Lumbar Puncture |     Blood Pressure Control
    Oxygenation Management |     Blood Cell Production
      Insertion of Oropharyngeal Airway |     Symptoms of Accumulation of
      Intubation |     Waste Products and Electrolytes
      Oxygen Administration |   Procedures  
    Informed Consent for |     Diet Restrictions
    Medical Procedures |     Fluid Restrictions – Relationship of
Click here to Continue |     diet/fluid intake to weight gain
|     Fluid Restrictions – Relationship to
|     treatment and symptoms
| Click here to Continue

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2
  1     2     3     4     1     2     3     4
  Care of Patient with   |   Machine Alarm Procedures  
    Nephrostomy Tube |     Blood Leak Alarm
    Ileal Conduit |     Arterial Pressure Alarm
    Supra-Pubic Catheter |     Venous Pressure Alarm
    Nephrectomy |     Conductivity Alarm
    TURP |     Ultrafiltration Alarm
  Medications   |     High Temperature Alarm
    Anithypertensives |     Power Failure Alarm
    Erythropoetin |     Blood Pump Alarm
    Phosphate Binders |   Post Dialysis Procedures  
    Vitamin D Replacement |     Dialysis Catheter
    Vitamins |     Fistula/Vein Graft
Dialysis Skills/Procedures   |     Return of Blood
  Dialysis Experience   |     Post Treatment Access Care
    Acute/Inpatient Dialysis |     Equipment Clean Up
    Chronic Outpatient Dialysis |     Sterilization Procedures
    Dialysis Home Care |   Management of Patient with  
    Pediatric Dialysis |     Fluid Overload
    Pre-Dialysis Nursing Assessment |     Hypertension
    Dialysis Patient and Family Teaching |     Hypotension
  Pre-Dialysis Set Up   |     Disequillibrium Syndrome
    Bicarbonate Dialysate |     Hyperkalemia
    Conductivity Testing |     Seizures
    Priming Dialyzer |     Muscle Cramps
    Checks for Machine/Alarm Settings |     Clotted Access/Poor Blood
    Prep Vascular Access |     Flow Rate from Catheter
    Fistula Gortex/Bovine Graft |     Pyrogenic Reaction
    Collect Blood Specimens |     Hemolysis
    Anticoagulation |     Air Embolus
  Dialysis   |     Chest Pain
    Volume Status |     Anemia
    Vascular Access Function |     Neuropathy
    Arterial and Venous Pressures |     Pericarditis
    Blood Flow Rate |     Filter Blood Leak]
    Subjective Response to Treatment |     Cardiopulmonary Arrest
    Management of Anticoagulation |   Medications  
    Conductivity |     Anticoagulants
    Ultrafiltration Calculation |     Coaglulants
    Operation of Myron L Meter | Click here to Continue
    Administration of Blood and |
    Blood Products |
    Administration of Mannitol |
    Sequential Ultrafiltration/PUF |
Click here to Continue |

The information I have provided in this skills checklist is true and accurate to the best of my knowledge. I hereby authorize PPR to release this information to client facilities of PPR in relation to consideration of my employment to those facilities.
 



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