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

  

PEDIATRIC 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   |     Hemodynamic Monitoring – Invasive  
General Health Status   |       Mean Arterial (MAP)
  Assessment   |       Central Venous (CVP)
    Growth and Development |       Pulmonary Artery/Capillary Wedge
    Signs and Symptoms of Neglect/Abuse |       Cardiac Index
  Procedures   |       Cardiac Output
    Application of Restraints |       SVO2
  Care of Child with   |     Monitoring – Non-invasive  
    ENT Surgery |       12 Lead EKG Interpretation
    Anorexia/Bulimia |       Arrhythmia Interpretation
    Ingestions/Overdose |       Lead Placement
    Kawasaki Disease |       Rhythm Strip Assessment
    Suicide Ideation/Attempt |   Equipment  
  Medications   |     Auto Internal Cardioverter/Defibrillator
    Pediatric Drug Actions and Reactions |     Cardiac Monitor
Cardiovascular   |   Care of a Child with  
  Assessment   |     Bacterial Endocarditis
    Abnormal Heart Sounds/Murmurs |     Cardiac Arrest
    Auscultation (rate, rhythm) |     Cardiogenic Shock
    Perfusion |     Cardiomyopathy
    Lab Values   |     Congenital Heart Disease/Defects
      Cardiac Enzymes and Isoenzymes |     Congestive Heart Failure
      Electrolytes |     Hypovolemic Shock
  Procedures   |     Myocarditis
    Assist with   |     Pericarditis
      Arterial Line Insertion |     Post Cardiac Catheterization
      Central Line Insertion |     Post Cardiac Surgery
      Pulmonary Arterial   |     Rheumatic Fever
      Catheter/Swan-Ganz Insertion |     Pacemaker
    Umbilical Artery Catheter/Umbilical   |     Cardioversion
    Vein Catherter Insertion |     Defibrillation
    Cardioversion |     Heart Transplant
|

 
 
  1     2     3     4     1     2     3     4
  Medications   |   Equipment  
    Dobutamine (Dobutrex) |     Apnea Monitor
    Dopamine |     PleurEvac or Thoraclex Drainage
    Epinephrine |     Water Seal Drainage
    Nipride (Nitroprusside) |     O2 Therapy Delivery Systems  
    Nitroglucerine |       Ambu Bag and Mask
    Sodium Bicarbonate |       Isolette
Pulmonary   |       Nasal Cannula
  Assessment   |       Nebulizer
    Breath/Lung Sounds |       Oxyhood
    Breathing Patterns |       Tent
    Cough/Secretions |       Trach Collar
    Skin/Nail Color |     Ventilator Management  
    Lab Values   |       CPAP
      Blood Gases |       High Frequency Jet Ventilation
      Aminophylline Levels |       IMV
  Procedures   |       PEEP
    Airway Management/Suctioning   |       Pressure Ventilator
      Endotracheal Suctioning |       Volume Ventilator
      Extubation |       Weaning Modes
      Nasal Airway Suctioning |     Nebulizers
      Sputum Specimen Collection |     Oximeter
      Tracheostomy Suctioning |   Care of a Child with  
    Assist with   |     Acute Pneumonia
      Bronchoscopy |     Bronciolitis
      Chest Tube Insertion and Removal |     Chronic Respiratory Disease
      Emergency Tracheostomy |     Epiglottitis
      Thoracentesis |     Flail Chest
      Intubation |     Foreign Body Aspiration
      Oral Airway Insertion |     Fresh Tracheostomy
    Chest Physiotherapy |     Hemothorax
    End Tidal O2 |     Laryngotracheal Bronchitis/Croup
    ECMO (Extracorporeal   |     Pneumothorax
    Membrane Oxygenation) |     Respiratory Distress Syndrome
    Intervention for Respiratory   |     Respiratory Failure
    Complications   |     Status Asthmaticus
      Aspiration |     Near Drowning
      Laryngospasm |     Pulmonary Edema
    Obtaining Blood Gases |     Inhalation Injuries
|     Chest Wall Injuries
   

 
 
  1     2     3     4     1     2     3     4
  Medications   |   Procedures  
    Aminophylline |     Crutch Walking
    Corticosteroids |     Pin Care
    Prostaglandin |     Cast Care
Neurological   |     Use of Assistive Devices
  Assessment   |     Body Mechanics
    Cranial Nerves |     Burn Care
    Glasgow Coma Scale |   Equipment  
    Level of Consciousness |     Special Beds
    Pathologic Reflexes |     Traction
    Reflex/Motor Reflexes |     Prostheses
    Visual or Communication Deficits |     K-Pad
  Procedures   |     Splints/Immobilizers
    Assist with Lumbar Puncture |     TENS
    Seizure Precautions |     Support Devices  
    Spinal Precautions |       Cane
    Measuring Intracranial Pressure |       Cervical Collar
  Equipment   |       Gain Belt
    Hyper/Hypothermia Blanket |       Sling
  Care of Child with   |       Walker
    Skull Fracture |       Wheelchair
    Closed Head Injury |   Care of Patient with  
    Coma |     Amputation
    Cranial Hemorrhage |     Arthroscopic Surgery
    Externalized VP Shunts |     Cast
    Increased ICP |     Pinned Fractures
    Meningitis |     Burns
    Neuromuscular Disease |     Skin Grafts
    Intracranial Tumor |   Medications  
    Spinal Cord Injury |     Analgesics
    Craniotomy |     Muscle Relaxants
    CNS Infections |     Topical Agents
  Medications   | Gastrointestinal  
    Anti-convulsants |   Assessment  
Musculoskeletal/Integumentary   |     Bowel Sounds
  Assessment   |     Nutritional Status/Weight
    Circulation Checks |     Lab Values  
    Gait/Mobility |       Serum Ammonia
    ROM/Joint Movement |       Serum Amylase
    Strength |       Liver Function Tests
    Posture |
    Skin Integrity |
 

 
 
  1     2     3     4     1     2     3     4
  Procedures   | Renal/Genitourinary  
    Feedings   |   Assessment  
      Tube |     Fluid and Electrolyte Status
      Bottle |     Lab Values  
      Breast Milk Handling |       BUN and Creatinine
      Gavage |       Electrolytes
    Lavage |       Urine Values
    Management of   |   Procedures  
      T-tube |     Insertion and Management of  
      TPN and Lipids Administration |     Foley and Straight Catheters
      PPN (Peripheral Parenteral Nurtition) |     Peritoneal Dialysis
    NG Tube Insertion |   Equipment  
    Paracentesis |     Catheters
    Enemas |     Specimen Collection
  Equipment   |   Care of a Child with  
    Feeding Pumps |     Acute Renal Failure
    Drains |     Chronic Renal Failure
    Tubes   |     Hemodialysis
      N/G |     Peritoneal Dialysis
      T-Tube |     Nephrectomy
      G-Tube |     Nephrotic Syndrome
  Care of Child with   |     Hemolytic Uremic Syndrome
    Blunt Trauma |     Renal Transplant
    Bowel Obstruction |     Renal Rejection Syndrome
    GI Bleeding |     Urinary Tract Infection
    GI Surgery |   Medications  
    Gastroenteritis/Dehydration |     KCl
    Hepatitis |     Diuretics
    Fresh -ostomy | Endocrine/Metabolic  
    Inflammatory Bowel Disease |   Assessment  
    Liver Failure |     Mental Status
    Liver Transplant |     Diabetic Coma
    Pancreatitis |     Insulin Reaction
    Penetrating Trauma |     Lab Values  
  Medications/Supplements   |       Thyroid Studies
    AquaMephyton (Vitamin K) |       Blood Glucose
    Anti-emetics |       Glucose Tolerance
    Anti-spasmotics |       Fasting Blood Sugar
    Tube Feeding Solutions |       Ketone Bodies
    Kayexelate |       Serum Calcium
|

 
 
  1     2     3     4     1     2     3     4
  Procedures   |   Care of a Child with  
    Glucose Monitoring |     Bone Marrow Transplant
    Finger Stick |     Anemia
  Equipment   |     DIC
    Insulin Pumps |     Immunosuppressed Conditions
    Glucose Monitoring Devices   |     Inpatient Chemotherapy
      Electronic |     Leukemias
      Blood Glucose Sticks |     Sickle Cell Anemia/Crisis
  Care of a Child with   |     Malignant Tumors
    Diabetes Mellitus |   Medications  
    Diabetic Ketoacidosis |     Antineoplastic Agents
    Disorders of Adrenal Glands |     Chemotherapeutic Agents
    Disorders of Pituitary Gland |     Anticoagulant Agents
    Disorders of Thyroid Gland |     Anticoagulant Antidotes
    Insulin Shock | SKILLS  
    Disorders of Parathyroid Gland | IV Therapy  
  Medications   |   Peripheral Line  
    Insulins   |     Insertion  
      Long-acting |       Angiocath
      Medium-acting |       Intracath
      Short-acting |       Butterfly
    Oral Antihyperglycemics |       Heparin Lock
    Glucogon |     Maintenance  
    Thyroid Replacement |     Discontinuance
    Steroids-Adrenocorticosteroids |     Patency Assessment
Hematology/Oncology   |     Hang Piggyback
  Assessment   |     IV Push
    Tumor Classifications |   Central Lines  
    Lab Values   |     Insertion of PICC
      Blood Count Markers |     Maintenance/Irrigation
      Blood Chemistry |       PICC
  Procedures   |       Portacath
    Patient/Family Counseling   |       Broviac
      Grieving Process |       Groshong
      Altered Image |       Hickman
    Patient Teaching   |     Cutdown
      Relaxation Techniques |
      Imagery |
      Side Effects of Chemotherapy |
    Bone Marrow Aspiration |
|

 
  1     2     3     4     1     2     3     4
  Blood/Blood Products   | Wound Care/Infectious Disease Management
    Administration   |   Procedures  
      Cryoprecipitate |     Collection of Cultures  
      Whole Blood |       Blood
      Plasma/Extenders |       Sputum
      Packed Cells |       Stool
      Albumin |       Wound
      Lipids |       CSF
    Drawing Blood |     Universal Precautions
  Care of a Child with   |     Isolation/Reverse Isolation Technique
    TPN |     Fever Management
    Multilumen Catheter |     Dressings  
    Portacath |       Wet-Dry
    PICC Line |       Sterile
    CVP |       Packs
Medication Administration   |       Irrigations
  Administration Routes   |     Decubitus Care
    Parenteral   |     Drain Management  
      IV |       Penrose
      IM |       Hemovac
      ID |       Jackson-Pratt
      Subcutaneous |     Suture/Staple Care and Removal
      Z Track |   Care of Patient with  
    Oral |     Draining Wound
    Topical |     Traumatic Wound
    Rectal |     Pressure Ulcers
  Calculation   |     Viral and Bacterial Infections
    IV Rate Calculation |   Medications  
    IV Pump |     Antibiotics
    Pediatric Dosage Calculation |     Antiviral agents
    Unit Dose System |     Immunization sera
Pain Management   | Documentation  
  Assessment   |     Computer Charting System
    Pain Scales for Children |     Multipage Charting Form
    Pain Tolerance |     Nursing Plan of Care Documentation
  Care of a Child with   |
    Epidural Anesthesia/Analgesia |
    IV Conscious Sedation |
    Narcotic Analgesia |
  |
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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