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

  

NEONATAL 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   | Procedures Continued...  
General Health Status   |     Family Teaching
  Assessment   |     Thermoregulation
    Dubowitz/Ballard Gestational Age |       Isolette with Humidity
    Finnegan Scoring |       Radiant Warmer
    APGAR Scoring |       Temperatures
    Head-to-Toe Assessment |       Weaning to Open Crib/Bassinet
    General Condition |   Equipment  
      Activity |     Infant Warmer
      Color |     Isolette
      Cry |     Postitioning Devices
      Length |     Scales
    Vital Signs |   Care of Neonate with  
    Weights |     Small for Gestational Age
    Maternal History |     Intrauterine Growth Retardation
    Hearing Loss |   Medications  
  Procedures   |       Vitamin K
    Blood Glucose Determination |       Eye Prophylaxis
    Cord Care |       Neonatal Drug Action and Reactions
    Eye Care | Cardiovascular  
    Skin Care |   Assessment  
    Consents |     Abnormal Heart Sounds (murmurs)
      Immunization |     Auscultation (rate, rhythm)
      Procedural |     Blood Pressure – arterial line
      Treatment |     Blood Pressure – non-invasive
    Assist with Neonate |     Perfusion
    in Labor and Delivery |     Pulses
    Family Counseling |     Lab Values
      Grieving Process |       Cardiac Enzymes
      Altered Image |       Electrolytes
|
 
 
  1     2     3     4     1     2     3     4
  Procedures   |   Equipment  
    Venipuncture for Lab |     Apnea Monitor
    Assist with |     Chest Tubes
      Arterial Line Insertion |       Insertion
      Central Line Insertion |       Removal
    Cardioversion |       Set-up
    Hemodynamic Monitoring – Invasive |     O2 Therapy Delivery Systems
      Mean Arterial (MAP) |       Bag and Mask
      Central Venous (CVP) |       Self-Inflating Bag and Mask
    Monitoring – Non-invasive |       Nasal Cannula
      Arrhythmia Interpretation |       Nebulizer
  Care of Neonate with   |       Oxyhood
    Cardiac Arrest |       Tent
    Congenital Heart Disease/Defects |       Trach Collar
    Hemodynamic Instability |     Ventilator Management
    Hypovolemic shock |       External CPAP
    Post Cardiac Surgery |       High Frequency Jet Ventilation
  Medications   |       IMV
    Dobutamine |       PEEP
    Dopamine |       Home Ventilator
    Epinephrine |       Pressure Support
    Nipride |       Weaning Modes
    Sodium Bicarbonate |   Care of Neonate with  
Pulmonary   |     Apnea
  Assessment   |     Bronchopulmonary Dysplasia (BPD)
    Breath/Lung Sounds |     Cardiogenic/Hypovolemic Shock
    Breathing Patterns |     Diaphragmatic Hernia
    Lab Values |     Fresh Tracheostomy
      Blood Gases |     Meconium Aspiration
  Procedures   |     Persistent Pulmonary Hypertension
    Airway Management/Suctioning |     Pneumothorax
      Assist with Intubation |     Respiratory Distress Syndrome (RDS)
      Bulb Syringe |     Respiratory Failure
      CPAP (Nasal Prongs) |   Medications  
      Endotracheal Tube Stabilization |     Aminophylline
      Endotracheal Tube Suctioning |     Artificial Surfactants
      Extubation |     Prostagladin
      Intubation | Neurological  
      Tracheostory Suctioning |   Assessment  
    Cardiac Resuscitation |     Intracranial Pressure Monitoring
    Extracorporeal Membrane Oxygenation |     Neurological Status
    Thoracentesis |
    Administration of Artificial Surfactants |
|
 
 
  1     2     3     4     1     2     3     4
Neurological Continued...   |   Care of Neonate with  
  Procedures   |     Cleft Palate
    Assist with Lumbar Puncture |     Colostomy/Ileostomy
    Seizure Precautions |     Gastroschisis/Omphalocele
    Measuring Intracranial Pressure |     GI Bleeding
  Care of Neonate with   |     Inguinal Hernia
    Encephalopathy |     Necrotizing Enterocolitis (NEC)
    Intracranial Hemorrhage |     Post Abdominal Surgery
    Retinopathy |     Reflux Precautions
    Drug Withdrawal |     Tracheoesophageal Fistula (TEF)
    Hydrocephalus |   Medications/Supplements  
    Spina Bifida |     AquaMephyton (Vitamin K)
    Brain Death/Organ Procurement |     Tube Feeding Solutions
    Externalized VP Shunt/Reservoirs | Endocrine/Metabolic/Renal/Genitourinary  
    Increased ICP |   Assessment  
    CNS Infections |     Fluid and Electrolyte Balance
    Seizures |     Lab Values
  Medications   |       Bilirubin
    Anti-convulsants |       Blood Glucose
Gastrointestinal   |       Urine Occult Blood
  Assessment   |       Urine pH
    Bowel Sounds |       Urine Specific Gravity
    Nutritional Status/Weight |       Ketone Bodies
    Abdominal Girth |   Procedures  
    Palate |     Collection of Urine Specimens
    Suck/Swallow Ability |       Assist with Supra Pubic Tap
  Procedures   |       Catheter
    Feeding |       Diaper/Bag
      Assist with Breast Feeding |     Phototherapy
      Bottle |     Post Circumcision Care
      Breast Milk Handling/Storage |   Equipment  
      Gavage |     Bililite
    Placement of Tubes |   Care of Neonate with  
      Jejunal Gastrostomy Tube |     Acute Renal Failure
      Nasogastric/Orogastric Tube |     Disorders of Internal/External Organs
    Test for Occult Blood |     Drug Addiction/Withdrawal
  Equipment   |     Hypo/Hyperkalemia
    Breast Pump |     Hypo/Hypernatremia
    Tube Set-Up |     Malformations of the GU Tract, Kidney
|     Peritoneal Dialysis
  |     Diabetic Mother
  |     Addicted Mother
  |
Page
4
  1     2     3     4    
  Medications   |
    Insulins |
    Glucogon |
    Steroids-Adrenocorticosteroids |
Hematology/Infectious Diseases   |
  Assessment   |
    Vital Signs |
    Lab Values |
      CBC/Differential |
      Culture Reports |
      Maternal Lab Reports |
      Blood Chemisties |
  Care of Neonate with   |
    Hepatitis Surface Antigen+ Mother |
    HIV Positive Mother |
    Neonatal Sepsis |
    Disseminated Intra Vascular Coagulation |
    Infectious Disease |
  Medications   |
    Immunizations |
    Anticoagulant Agents |
    Anticoagulant Antidotes |
    Antibiotics |
    Antiviral agents |

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 Travel 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