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

  

INTENSIVE CARE SKILLS CHECKLIST
First Name:
Last Name:
Phone:
Email:
SSN (last 4 only):
Date:
 
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
System   |   Equipment  
Cardiovascular   |     Automatic Internal  
  Assessment   |     Cardioverter/Defibrillator
    Abnormal Heart Sounds |     Pacemakers  
    Auscultation (rate, rhythm) |     Intra-aortic Balloon Pump
    Doppler |     12 Lead EKG
    Pulses |   Care of Patient with  
    Peripheral Edema |     Aneurysm
    Neck Vein Distention |     Acute MI
    Lab Values   |     Cardiac Arrest
      Cardiac Enzymes and Isoenzymes |     Unstable Angina
      Electrolytes |     Cardiac Tamponade
      Coagulation Studies |     CHF
      Digoxin Levels |     PTCA
  Procedures   |     Heart Transplant
    Assist with   |     Open-Heart Surgery
      Pulmonary Arterial   |     Multiple Organ Failure
      Catheter/Swan-Ganz Insertion |     Pericarditis
    CVAH-D |     Post Arthrectomy
    Hemodynamic Monitoring - Invasive   |     Pre/Post Cardiac Catheterization
      Mean Arterial (MAP) |     Shock  
      Central Venous (CVP) |       Septic
      Pulmonary Artery/Capillary Wedge |       Hypovolemic
      Radial Artery |       Cardiogenic
      Cardiac Index |       Neurogenic
      Cardiac Output |       Anaphylactic
      SVO2 |   Medications  
    Monitoring - Non-invasive   |     ACLS Drugs
      Arrhythmia Interpretation |     Nitroglycerine
      Rhythm Strip Assessment |     Calcium Channel Blockers
  |     Thrombolytic Agents
|
 
 
  1     2     3     4     1     2     3     4
Pulmonary   |   Care of Patient with  
  Assessment   |     Acute Pneumonia
    Breath/Lung Sounds |     ARDS
    Breathing Patterns |     Chest Trauma
    Cough/Secretions |     COPD
    Skin/Nail Color |     Cor Pulmonale
    Lab Values   |     Fresh Tracheostomy
      Blood Gases |     Lobectomy
  Procedures   |     Pneumonectomy
    Air Leak Troubleshooting   |     Pulmonary Edema
      Mediastinal Chest Tube Removal |     Pulmonary Embolism
      Pleural Chest Tube Removal |     Pneumonthorax
    Airway Management/Suctioning   |     Thoracotomy
      Endotracheal Suctioning |     Tuberculosis
      Extubation |     Chest Wall Injuries
      Oximetry |   Medications  
      Tracheostomy Suctioning |     Alputent (Metaproterenol)
    Assist with   |     Aminophylline
      Bronchoscopy |     Bronkosol (Isoethaine Hydrochloride)
      Chest Tube Insertion |     Corticosteroids
      Emergency Tracheostomy |     Ventolin (Albuterol)
      Thoracentesis | Neurological  
      Intubation |   Assessment  
      Oral Airway Insertion |     Cranial Nerves
    Intervention for Respiratory Complications |     Glasgow Coma Scale
      Aspiration |     Visual or Communication Deficits
      Laryngospasm |   Procedures  
      Tension Pneumothorax |     Assist with Lumbar Puncture
  Equipment   |     Seizure Precautions
    Water Seal Drainage |     Spinal Precautions
    O2 Therapy Delivery Systems   |     Measuring Intracranial Pressure
      Ambu Bag and Mask |     Aneurysm Precautions
      ET Tube |   Equipment  
      Nasal Cannula |     Halo Traction
      Portable O2 Tank |     Crutchfield Tongs
      Trach Collar |     Stryker Frame
    Ventilator Management   |     Nerve Stimulators
      External CPAP |     Rotating/Circular Bed
      IMV |     Hyper/Hypothermia Blanket
      PEEP |
      Pressure Support |
      Weaning Modes |
    Nebulizers |
 
 
 
  1     2     3     4     1     2     3     4
  Care of Patient with   |   Equipment  
    Cranial Aneurysm |     Continuous Motion Devices
    Skull Fracture |     Special Beds
    Closed Head Injury |     Traction
    Coma |     Prostheses
    CVA |     K-Pad
    Cranial Hemorrhage |     Splints/Immobilizers
    Delirium Tremens |     TENS
    Increased ICP |     Support Devices  
    Laminectomy |       Cane
    Meningitis |       Cervical Collar
    Intracranial Tumor |       Sling
    Spinal Cord Injury |       Walker
    Craniotomy |       Wheelchair
    CNS Infections |   Care of Patient with  
  Medications   |     Amputation
    Decadron |     Cast
    Solu-Medral |     Pinned Fractures
    Magnesium Sulfate |     Joint Replacement
    Mannitol |     Laminectomy/Cervical Fusion
    Anti-convulsants |     Burns
Musculoskeletal/Integumentary   |     Skin Grafts
  Assessment   |   Medications  
    Circulation Checks |     Muscle Relaxants
    Gait/Mobility |     Topical Agents
    ROM/Joint Movement | Gastrointestinal  
    Strength |   Assessment  
    Posture |     Bowel Sounds
    Skin Integrity |     Nutritional Status/Weight
  Procedures   |     Lab Values  
    Crutch Walking |       Serum Ammonia
    Pin Care |       Liver Function Tests
    Cast Care |
    Use of Assistive Devices |
    Body Mechanics |
    Burn Care |
 

 
 
  1     2     3     4     1     2     3     4
  Procedures   | Renal/Genitourinary  
    Lavage |   Assessment  
    Management of   |     Fluid and Electrolyte Status
      Jejunostomy Tube |     A/V Fistula/Shunt Status
      T-tube |     Lab Values  
      PPN (Peripheral Parenteral Nurtition) |       Electrolytes
    NG Tube Insertion |       BUN and Creatinine
    Paracentesis |   Procedures  
    Enemas |     Bladder Irrigation
    Removal of Fecal Impaction |     Insertion and Management of  
  Equipment   |     Supra-pubic Catheter Management
    Feeding Pumps |     Nephrostomy Tube Management
    Salem Pump to Suction |     Peritoneal Dialysis
    Tubes   |   Equipment  
      N/G |   Care of Patient with  
      T-Tube |     Acute Renal Failure
      Miller Abbott |     Chronic Renal Failure
      Blakemore |     Hemodialysis
      G-Tube |     Peritoneal Dialysis
  Care of Patient with   |     Nephrectomy
    Abdominal Trauma |     Renal Transplant
    Bowel Obstruction |     Hepatitis
    Colostomy |     TURP
    ERCP |     Urinary Tract Infection
    Esophageal Bleeding |   Medications  
    GI Bleeding |     KCl
    GI Surgery |     Diuretics
    Inflammatory Bowel Disease | Endocrine/Metabolic  
    Liver Failure |   Assessment  
    Pancreatitis |     Mental Status
    Paralytic Ileus |     Diabetic Coma
  Medications/Supplements   |     Insulin Reaction
    AquaMephyton (Vitamin K) |     Lab Values  
    Anti-emetics |       Thyroid Studies
    Anti-spasmotics |       Blood Glucose
    Tube Feeding Solutions |       Glucose Tolerance
    Kayexelate |       Fasting Blood Sugar
|       Ketone Bodies
  |       Serum Calcium
  |

 
 
  1     2     3     4     1     2     3     4
  Equipment   |   Medications  
    Insulin Pumps |     Antineoplastic Agents
  Care of Patient with   |     Chemotherapeutic Agents
    Diabetes Mellitus |     Anticoagulant Agents
    Diabetic Ketoacidosis |     Anticoagulant Antidotes
    Drug Overdose |
    Insulin Shock |
    Thyroidectomy |
  Medications   |
    Insulins   |
    Oral Antihyperglycemics |
    Glucogon |
    Thyroid Replacement |
Hematology/Oncology   |
  Assessment   |
    Tumor Classifications |
    Lab Values   |
      Blood Count Markers |
      Blood Chemistry |
  Procedures   |
    Patient/Family Counseling   |
      Grieving Process |
      Altered Image |
    Patient Teaching   |
      Relaxation Techniques |
      Side Effects of Chemotherapy |
    Bone Marrow Aspiration |
  Care of Patient with   |
    Bone Marrow Transplant |
    Anemia |
    Immunosuppressed Conditions |
    Radiation Therapy/Implants |
    Inpatient Chemotherapy |
    Leukemias |
    DIC |
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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