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

PEDIATRIC 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
System   |   Medications  
General Health Status   |     Epinephrine
  Assessment   |     Digoxin
    Growth and Development |     Sodium Bicarbonate
  Procedures   | Pulmonary  
    Application of Restraints |   Assessment  
  Care of Child with   |     Breath/Lung Sounds
    ENT Surgery |     Breathing Patterns
    Suicide Ideation/Attempt |     Cough/Secretions
  Medications   |     Skin/Nail Color
    Pediatric Drug Actions and Reactions |     Lab Values
Cardiovascular   |       Blood Gases
  Assessment   |       Aminophylline Levels
    Heart Sounds/Murmurs |   Procedures  
    Auscultation (rate, rhythm) |     Airway Management/Suctioning
    Perfusion |       Extubation
    Lab Values |       Tracheostomy Suctioning
      Hemoglobin and Hematocrit |     Assist with
      Cardiac Enzymes and Isoenzymes |       Chest Tube Removal
      Electrolytes |       Emergency Tracheostomy
  Procedures   |       Intubation
    Monitoring – Non-invasive |       Oral Airway Insertion
      Arrhythmia Interpretation |     Chest Physiotherapy
  Care of a Child with   |     End Tidal O2
    Cardiac Arrest |     Intervention for
    Cardiogenic Shock |     Respiratory Complications
    Congenital Heart Disease/Defects |       Aspiration
    Congestive Heart Failure |       Laryngospasm
    Hypovolemic Shock |     Obtaining Blood Gases
    Pericarditis | Click here to Continue
    Post Cardiac Catheterization |
    Post Cardiac Surgery |
    Rheumatic Fever |
    Pacemaker |
Click here to Continue |

Page
2
  1     2     3     4     1     2     3     4
  Equipment   |   Procedures  
    Apnea Monitor |     Assist with Lumbar Puncture
    PleurEvac or Thoraclex Drainage |     Seizure Precautions
    Water Seal Drainage |     Spinal Precautions
    Chest Tubes |     Measuring Intracranial Pressure
    O2 Therapy Delivery Systems |   Equipment  
      Ambu Bag and Mask |     Hyper/Hypothermia Blanket
      Isolette |   Care of Child with  
      Nasal Cannula |     Club Foot
      Nebulizer |     Increased ICP
      Oxyhood |     Neuromuscular Disease
      Tent |     Osteomyelitis
      Trach Collar |     Osteogenic sarcoma
    Nebulizers |     Spinal Cord Injury
  Care of a Child with   |     CNS Infections
    Acute Pneumonia |   Medications  
    Asthma |     Anti-convulsants
    Bronchiolitis |     Valium
    Chronic Respiratory Disease | Musculoskeletal/Integumentary  
    Cystic Fibrosis |   Assessment  
    Epiglottitis |     Circulation Checks
    Laryngotracheal Bronchitis/Croup |     Gait/Mobility
    Near Drowning |     ROM/Joint Movement
    Inhalation Injuries |     Strength
    Tonsilitis |     Posture
  Medications   |     Skin Integrity
    Aminophylline |   Procedures  
    Corticosteroids |     Crutch Walking
    Isuprel |     Pin Care
    Ventolin (Albuterol) |     Cast Care
Neurological   |     Use of Assistive Devices
  Assessment   |     Body Mechanics
    Cranial Nerves |     Burn Care
    Level of Consciousness | Click here to Continue
    Pathologic Reflexes |
    Reflex/Motor Reflexes |
    Visual or Communication Deficits |
Click here to Continue |




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3
  1     2     3     4     1     2     3     4
  Equipment   |   Equipment  
    Special Beds |     Feeding Pumps
    Traction |     Drains
    Prostheses |     Tubes
    K-Pad |       N/G
    Splints/Immobilizers |       T-Tube
    TENS |   Care of Child with  
    Support Devices |     Anal Fissure
      Cervical Collar |     Cleft Lip/Palate
      Sling |     Trauma
      Walker |     Bowel Obstruction
      Wheelchair |     Diaphragmatic Hernia
  Care of Patient with   |     GE Reflux
    Amputation |     GI Bleeding
    Arthroscopic Surgery |     GI Surgery
    Cast |     Gastroenteritis/Dehydration
    Pinned Fractures |     Hepatitis
    Burns |     Fresh -ostomy
    Skin Grafts |     Inflammatory Bowel Disease
  Medications   |     Liver Failure
    Analgesics |     Pancreatitis
    Muscle Relaxants |     Pyloric Stenosis
    Topical Agents |   Medications/Supplements  
Gastrointestinal   |     AquaMephyton (Vitamin K)
  Assessment   |     Anti-emetics
    Bowel Sounds |     Anti-spasmotics
    Nutritional Status/Weight |     Tube Feeding Solutions
    Lab Values |     Kayexelate
      Serum Ammonia | Renal/Genitourinary  
      Serum Amylase |   Assessment  
      Liver Function Tests |     Fluid and Electrolyte Status
  Procedures   |     Lab Values
    Feedings |       Electrolytes
      Bottle |       BUN and Creatinine
      Gavage |       Urine Values
    Lavage |   Procedures  
    Management of |     Peritoneal Dialysis
      T-tube |
      TPN and Lipids Administration |
      PPN (Peripheral Parenteral Nurtition) |
    NG Tube Insertion |
    Paracentesis |
    Enemas |
Click here to Continue | Click here to Continue
Page
4
  1     2     3     4     1     2     3     4
  Care of a Child with   |   Medications  
    Renal Failure |     Insulins
    Circumcision |       Long-acting
    Glomerularnephritis |       Medium-acting
    Hemodialysis |       Short-acting
    Hypospadias |     Oral Antihyperglycemics
    Ileal Conduit |     Glucogon
    Peritoneal Dialysis |     Thyroid Replacement
    Nephrectomy |     Steroids-Adrenocorticosteroids
    Nephrotic Syndrome | Hematology/Oncology  
    Hemolytic Uremic Syndrome |   Assessment  
    Polycystic Disease |     Tumor Classifications
    Renal Transplant |     Lab Values
    Urinary Tract Infection |       Blood Count Markers
    Wilm’s Tumor |       Blood Chemistry
  Medications   |   Procedures  
    KCl |     Patient/Family Counseling
    Diuretics |       Grieving Process
Endocrine/Metabolic   |       Altered Image
  Assessment   |     Patient Teaching
    Mental Status |       Relaxation Techniques
    Diabetic Coma |       Imagery
    Insulin Reaction |       Side Effects of Chemotherapy
    Lab Values |     Bone Marrow Aspiration
      Thyroid Studies |   Care of a Child with  
      Blood Glucose |     Bone Marrow Transplant
      Glucose Tolerance |     Anemia
      Fasting Blood Sugar |     DIC
      Ketone Bodies |     Hemophilia
      Serum Calcium |     Hodgkin’s Disease
  Equipment   |     Immunosuppressed Conditions
    Insulin Pumps |     Inpatient Chemotherapy
  Care of a Child with   |     Leukemias
    Diabetes Mellitus |     Sickle Cell Anemia/Crisis
    Diabetic Ketoacidosis |     Malignant Tumors
    Disorders of Adrenal Glands |   Medications  
    Disorders of Pituitary Gland |     Antineoplastic Agents
    Disorders of Thyroid Gland |     Chemotherapeutic Agents
    Insulin Shock |     Anticoagulant Agents
Click here to Continue |     Anticoagulant Antidotes

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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