Road Trip Nursing - MEDICAL/SURGICAL SKILLS CHECKLIST

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

MEDICAL/SURGICAL 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
Systems		\|	Pulmonary
Cardiovascular		\|	Assessment
Assessment		\|	Breath/Lung Sounds
Heart Sounds		\|	Breathing Patterns
Pulses		\|	Cough/Secretions
Neck Vein Distention		\|	Skin/Nail Color
Peripheral Edema		\|	Lab Results
Lab Values		\|	Blood Gases
Cardiac Enzymes		\|	Procedures
Electrolytes		\|	Airway Management
Digoxin Levels		\|	Endotracheal Tube/Suctioning
Procedures		\|	Nasal Airway Suctioning
Arrest Procedure/CPR Monitoring		\|	Oropharyngeal Suctioning
Basic arrhythmia Interpretation		\|	Tracheostomy Suctioning
Equipment		\|	Assist with Intubation
Pacemakers		\|	Assist with Thoracentesis
Doppler		\|	Assist with Chest Tube
Antiemboletic Hose		\|	Insertion/Removal
Care of Patient with		\|	Chest Physiotherapy
Acute MI		\|	Equipment
Aneurysm		\|	Oxygen Therapy and
Angina		\|	Medication Delivery Systems
Cardiac Arrest		\|	Bag and Mask
Congestive Heart Failure		\|	External CPAP
Cardiac Catheterization		\|	Face Masks
Angioplasty		\|	Inhalers
Post-Cardiac Surgery		\|	Nasal Cannula
Medications		\|	Portable Oxygen Tank
Heparin Drip		\|	Trach Collar
Oral Anticoagulants		\|	Oximeter
Oral and IV Antihypertensives		\|	Ventilators
Oral and Topical Nitrates		\|	Incentive Spirometer
Lasix		\|
Digoxin		\|
		\|



	1 2 3 4			1 2 3 4
Care of Patient with		\|	Care of Patient with
AIDS		\|	Aphasia
ARDS		\|	Closed Head Injury
Asthma		\|	Coma
Bronchoscopy		\|	CVA
COPD		\|	Cancer of Brain
Fresh Tracheostomy		\|	Craniotomy
Lobectomy		\|	DTs
Pneumonectomy		\|	Meningitis
Pneumonia		\|	Neuromuscular Disease
Pulmonary Embolism		\|	Seizure Disorder
Thoracotomy		\|	Spinal Cord Injury
Tuberculosis		\|	Medications
Medications		\|	Anticonvulsants
Albuterol		\|	Antidepressants
Theophylline		\|	Mannitol
Aminophylline		\|	Decadron
Neurological		\|	Solu-Medrol
Assessment		\|	Musculoskeletal/Integumentary
Level of Consciousness		\|	Assessment
Neuro Check		\|	Circulation Checks
Mental Status		\|	Gait/Mobility
Motor Movement		\|	ROM/Joint Movement
Seizure Activity		\|	Strength
Procedures		\|	Posture
Assist with Lumbar Puncture		\|	Skin Integrity
Seizure Precautions		\|	Procedures
Equipment		\|	Crutch Walking
Hyper/Hypothermia Blanket		\|	Pin Care
Halo Traction		\|	Cast Care
Application of Restraints		\|	Use of Assistive Devices
		\|	Body Mechanics
		\|	Burn Care
		\|	Equipment
		\|	Continuous Motion Devices
		\|	Special Beds
		\|	Traction
		\|	Prosethics
		\|	K-Pad
		\|	Splints/Immobilizers
		\|	TENS
		\|	Hoyer Lift
		\|



	1 2 3 4			1 2 3 4
Support Devices		\|	Care of Patient with
Cane		\|	Bowel Obstruction
Cervical Collar		\|	Colostomy/Ileostomy
Sling		\|	GI Bleeding
Walker		\|	GI Surgery
Wheelchair		\|	Hepatitis
Care of Patient with		\|	Inflammatory Bowel Disease
Amputation		\|	Liver Failure
Arthoscopic Surgery		\|	Fistulas
Cast		\|	Pancreatitis
Osteoporosis		\|	Medications/Supplements
Pinned Fractures		\|	Antiemetics
Rheumatic/Arthritic Disease		\|	Antispasmotics
Joint Replacement		\|	Vitamins
Laminectomy/Cervical Fusion		\|	Tube Feeding Solutions
Burns		\|	Renal/Genitourinary
Skin Grafts		\|	Assessment
Medications		\|	Fluid and Electrolyte Balance
Analgesics		\|	A/V Fistula/Shunt
Muscle Relaxants		\|	Lab Values
Topical Agents		\|	Electrolytes
Gastriointestinal		\|	BUN and Creatinine
Assessment		\|	Procedures
Bowel Sounds		\|	Nephrostomy Tube Care
Nutritional Status/Weight		\|	Peritoneal Dialysis
Procedures		\|
Tube Feeding/Gavage		\|	Bladder Training
Lavage		\|	Equipment
Guaiac Test		\|	Bladder Irrigation
NG Tube Insertion		\|	Specimen Collection/Urine Test
Ostomy Care		\|	Care of Patient with
Paracentesis		\|	Hemodialysis
Removal of Fecal Impaction		\|	Peritoneal Dialysis
Enemas		\|	Renal Surgery
Equipment		\|	Renal Failure
Feeding Pumps		\|	Renal Transplant
Drains		\|	TURP
Tubes		\|	Urinary Tract Infection
N/G		\|	Cystoscopy
T-Tube		\|	Medications
Miller Abbott		\|	KCl
Blakemore		\|	Diuretics
G-Tube		\|
		\|



	1 2 3 4			1 2 3 4
		Procedures
Assessment		\|	Douche
Diabetic Coma		\|	Breast Self-Exam
Insulin Reaction		\|	Care of Patient with
Mental Status		\|	Hysterectomy/Oopharectomy
Lab Values		\|	Breast Biopsy
Thyroid Function		\|	Lumpectomy
Glucose Tolerance		\|	Mastectomy
Fasting Blood Sugar		\|	Ectopic Pregnancy
Ketone Bodies		\|	PID
Serum Calcium		\|	Endometriosis
Procedures		\|	Uterine Bleeding
Glucose Monitoring		\|	Medications
Diabetic Teaching		\|	Antifungal/Protozoan Agents
Equipment		\|	Hormone Replacement
Insulin Pumps		\|	Hematology/Oncology
Blood Glucose Sticks		\|	Assessment
Care of Patient with		\|	Skin Lesions/Tumors
Diabetes Mellitus		\|	Family History
Disorders of Adrenal Gland		\|	Cardinal Signs of Cancer
Disorders of Pituitary Gland		\|	Tumor Classifications
Hyperthyroidism		\|	Lab Values
Hypothyroidism		\|	Blood Counts
Thyroidectomy		\|	Blood Chemistry
Medications		\|	Procedures
Steroids/Adrenocorticosteroids		\|	Patient/Family Counseling
Glucogon		\|	Grieving Process
Insulin		\|	Altered Image
Regular		\|	Patient Teaching
NPH		\|	Relaxation Techniques
Lente		\|	Imagery
Humulin U		\|	Side Effects of Chemotherapy
Thyroid Replacement		\|	Bone Marrow Aspiration
Oral Antihyperglycemics		\|	Care of Patient with
Gynecologic		\|	Bone Marrow Transplant
Assessment		\|	Anemia
External Genitalia		\|	Immunosuppressed Conditions
Menstrual Cycle		\|	Radiation Therapy/Implants
Obstetric History		\|	Inpatient Chemotherapy
STDs/Infections		\|	Inpatient Hospice
		\|	Leukemias

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



Submitting this form may take a few moments, please be patient. Thank you.
© 2004-2008 PPR