TELEMETRY/CARDIAC CARE/STEPDOWN

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

TELEMETRY/CARDIAC CARE/STEPDOWN 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		\|	Monitoring – Non-invasive
Cardiovascular		\|	12 Lead EKG Interpretation
Assessment		\|	Arrhythmia Interpretation
Abnormal Heart Sounds		\|	Lead Placement: 5 ElectrodeTelemetry
Auscultation (rate, rhythm)		\|	Lead Placement: I, III, V-Leads
Doppler		\|	Lead Placement: Lead II and MCL
Pulses		\|	Rhythm Strip Assessment
Peripheral Edema		\|	Equipment
Neck Vein Distention		\|	Automatic Internal
Lab Values		\|	Cardioverter/Defibrillator
Cardiac Enzymes and Isoenzymes		\|	Pacemakers
Electrolytes		\|	External
Coagulation Studies		\|	Permanent
Digoxin Levels		\|	Temporary Epicardial Wires
Procedures		\|	Temporary External Pacing
Assist with		\|	Temporary Transvenous
Arterial Line Insertion		\|	Intra-aortic Balloon Pump
Central Line Insertion		\|	12 Lead EKG
Open Chest Emergency		\|	Care of Patient with
Pulmonary Arterial		\|	Aneurysm
Catheter/Swan-Ganz Insertion		\|	Acute MI
Transesophageal Echocardiogram		\|	Cardiac Arrest
Cardioversion		\|	Cardiomyopathy
Hemodynamic Monitoring – Invasive		\|	Unstable Angina
Mean Arterial (MAP)		\|	Cardiac Tamponade
Central Venous (CVP)		\|	Femoral-Popliteal Bypass
Femoral Artery Sheath Removal		\|	CHF
Pulmonary Artery/Capillary Wedge		\|	PTCA
Radial Artery		\|	Heart Transplant
Cardiac Index		\|	Open-Heart Surgery
Cardiac Output		\|	Infective Endocarditis
SVO2		\|	Multiple Organ Failure
Click here to Continue		\|	Click here to Continue

Page
		2
	1 2 3 4			1 2 3 4
Care of Patient with (continued)		\|	Procedures
Pericarditis		\|	Airway Management/Suctioning
Post Stent Intracoronary Placement		\|	Endotracheal Suctioning
Post-CABG		\|	Extubation
Post Arthrectomy		\|	Tracheostomy Suctioning
Pre/Post Cardiac Catheterization		\|	Assist with
Shock		\|	Bronchoscopy
Septic		\|	Chest Tube Insertion
Hypovolemic		\|	Emergency Tracheostomy
Cardiogenic		\|	Thoracentesis
Neurogenic		\|	Intubation
Anaphylactic		\|	Oral Airway Insertion
Medications		\|	Chest Physiotherapy
Atropine		\|	Intervention for Respiratory Complications
Anticoagulants		\|	Aspiration
Coagulants		\|	Laryngospasm
ACE Inhibitors		\|	Tension Pneumothorax
Lidocaine		\|	Weaning Modes
Bicarbonate		\|	Equipment
Beta Blockers		\|	Pleurevac or Thoraclex Drainage
Digoxin		\|	Water Seal Drainage
Dopamine		\|	O2 Therapy Delivery Systems
Epinephrine		\|	Ambu Bag and Mask
Isuprel		\|	ET Tube
Nipride		\|	Face Masks
Nitroglycerine		\|	Nasal Cannula
Calcium Channel Blockers		\|	Portable O2 Tank
Thrombolytic Agents		\|	Trach Collar
Pulmonary		\|	Ventilator Management
Assessment		\|	External CPAP
Breath/Lung Sounds		\|	High Frequency Jet Ventilation
Breathing Patterns		\|	IMV
Cough/Secretions		\|	PEEP
Skin/Nail Color		\|	Pressure Support
Lab Values		\|	Weaning Modes
Blood Gases		\|	Nebulizers
Aminophylline Levels		\|	Click here to Continue
Click here to Continue		\|

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

Page
		3
	1 2 3 4			1 2 3 4
Care of Patient with		\|	Musculoskeletal/Integumentary
Acute Pneumonia		\|	Assessment
ARDS		\|	Circulation Checks
COPD		\|	Gait/Mobility
Fresh Tracheostomy		\|	Strength
Pulmonary Edema		\|	Posture
Pulmonary Embolism		\|	Skin Integrity
Pneumonthorax		\|	Procedures
Inhalation Injuries		\|	Crutch Walking
Medications		\|	Use of Assistive Devices
Aminophylline		\|	Body Mechanics
Corticosteroids		\|	Burn Care
Ventolin (Albuterol)		\|	Equipment
Neurological		\|	Special Beds
Assessment		\|	K-Pad
Cranial Nerves		\|	Splints/Immobilizers
Level of Consciousness		\|	Tens
Reflex/Motor Reflexes		\|	Hoyer Lift
Visual or Communication Deficits		\|	Support Devices
Procedures		\|	Cane
Assist with Lumbar Puncture		\|	Cervical Collar
Seizure Precautions		\|	Gain Belt
Spinal Precautions		\|	Sling
Measuring Intracranial Pressure		\|	Walker
Equipment		\|	Wheelchair
Hyper/Hypothermia Blanket		\|	Care of Patient with
Care of Patient with		\|	Amputation
Coma		\|	Cast
Closed Head Injury		\|	Laminectomy/Cervical Fusion
CVA		\|	Burns
Delirium Tremens		\|	Skin Grafts
Intracranial Tumor		\|	Medications
Spinal Cord Injury		\|	Analgesics
Craniotomy		\|	Muscle Relaxants
CNS Infections		\|	Topical Agents
Medications		\|	Click here to Continue
Decadron		\|

Page
		4
	1 2 3 4			1 2 3 4
Gastrointestinal		\|	Renal/Genitourinary
Assessment		\|	Assessment
Bowel Sounds		\|	Fluid and Electrolyte Status
Nutritional Status/Weight		\|	A/V Fistula/Shunt Status
Lab Values		\|	Lab Values
Serum Ammonia		\|	Electrolytes
Serum Amylase		\|	BUN and Creatinine
Liver Function Tests		\|	Procedures
Procedures		\|	Bladder Irrigation
Tube Feeding		\|	Nephrostomy Tube Management
Management of		\|	Peritoneal Dialysis
Jejunostomy Tube		\|	Care of Patient with
T-tube		\|	Acute Renal Failure
TPN and Lipids Administration		\|	Chronic Renal Failure
PPN (Peripheral Parenteral Nurtition)		\|	Hemodialysis
NG Tube Insertion		\|	Peritoneal Dialysis
Paracentesis		\|	TURP
Enemas		\|	Urinary Tract Infection
Removal of Fecal Impaction		\|	Medications
Equipment		\|	KCl
Drains		\|	Diuretics
Tubes		\|	Endocrine/Metabolic
N/G		\|	Assessment
G-Tube		\|	Mental Status
Care of Patient with		\|	Diabetic Coma
Bowel Obstruction		\|	Insulin Reaction
Colostomy		\|	Lab Values
ERCP		\|	Blood Glucose
Esophageal Bleeding		\|	Glucose Tolerance
GI Surgery		\|	Fasting Blood Sugar
Hepatitis		\|	Ketone Bodies
Ileostomy		\|	Serum Calcium
Inflammatory Bowel Disease		\|	Equipment
Liver Failure		\|	Insulin Pumps
Medications/Supplements		\|	Care of Patient with
AquaMephyton (Vitamin K)		\|	Diabetes Mellitus
Anti-emetics		\|	Diabetic Ketoacidosis

Page
		5
	1 2 3 4			1 2 3 4
Medications		\|	Procedures
Insulins		\|	Patient/Family Counseling
Long-acting		\|	Grieving Process
Medium-acting		\|	Altered Image
Short-acting		\|	Patient Teaching
Oral Antihyperglycemics		\|	Relaxation Techniques
Glucogon		\|	Imagery
Thyroid Replacement		\|	Side Effects of Chemotherapy
Steroids-Adrenocorticosteroids		\|	Care of Patient with
Hematology/Oncology		\|	Anemia
Assessment		\|	Immunosuppressed Conditions
Tumor Classifications		\|	DIC
Lab Values		\|	Medications
Blood Count Markers		\|	Antineoplastic Agents
Blood Chemistry		\|	Chemotherapeutic Agents
Anticoagulant Agents		\|
Anticoagulant Antidotes		\|