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Last 4 Of SSN
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I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
Instructions:This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
General Skills
Care of Patient in Restraints: 0★★★★−
Electronic Documentation: 0★★★★−
Isolation Precautions: 0★★★★−
Medicare Documentation: 0★★★★−
Patient/Family Education: 0★★★★−
Written Documentation: 0★★★★−
Care of Patients With
Acute/Chronic Bronchitis: 0★★★★−
ARDS: 0★★★★−
Aspiration Pneumonia: 0★★★★−
Asthma: 0★★★★−
Atelectasis: 0★★★★−
Bacterial/Viral Pneumonia: 0★★★★−
Bronchiectasis: 0★★★★−
Broncho-Pulmonary Dysplasia: 0★★★★−
Cardiac Surgery: 0★★★★−
Congestive Heart Failure: 0★★★★−
Croup: 0★★★★−
Cystic Fibrosis: 0★★★★−
Diabetic Ketoacidosis: 0★★★★−
Emphysema: 0★★★★−
Epiglottitis: 0★★★★−
Failure to Thrive: 0★★★★−
Fem-pop Bypass: 0★★★★−
Gullian Barre: 0★★★★−
Hayaline Membrane Disease (HMD/IRDS): 0★★★★−
Lung Cancer: 0★★★★−
Meconium Aspiration: 0★★★★−
Myasthenia Gravis: 0★★★★−
Myesthena Gravis: 0★★★★−
Myocardial Infarction: 0★★★★−
Near Drowning: 0★★★★−
Neonatal Pneumonia: 0★★★★−
Open Hearts: 0★★★★−
Pacemakers: 0★★★★−
Persistant Fetal Circulation: 0★★★★−
Pulmonary Interstitial Emphysema (PIE): 0★★★★−
Pleural Effusion: 0★★★★−
Pulmonary Edema: 0★★★★−
Pulmonary Embolism: 0★★★★−
Respiratory Failure: 0★★★★−
Respiratory Syncytial Virus: 0★★★★−
Respiratory Distress Syndrome: 0★★★★−
Tracheo-Esophageal Fistula: 0★★★★−
Transient Tachpnea: 0★★★★−
Thoracotomies: 0★★★★−
Tuberculosis: 0★★★★−
Therapy and Procedures
Apnea Monitor: 0★★★★−
Assessment of Breath Sounds: 0★★★★−
Carbogen Delivery: 0★★★★−
Diaphragmatic Breathing: 0★★★★−
Disinfection and Sterilization: 0★★★★−
End-Tidal CO2 Monitoring: 0★★★★−
Nasal-Oral Airway Placement: 0★★★★−
Oximetry: 0★★★★−
Pursed Lip Breathing: 0★★★★−
Transcutaneous Monitoring: 0★★★★−
Oxygen Administration:
Acapella: 0★★★★−
Aerosol Set Up/Mask/Trach: 0★★★★−
Analyze Oxygen: 0★★★★−
BiPAP Nasal/Mask: 0★★★★−
Bronchial Hygiene Therapy: 0★★★★−
Chest Physical Therapy/Postural Drainage: 0★★★★−
CPAP Nasal/Mask: 0★★★★−
Continuous Medication Nebulizer: 0★★★★−
Cough Assisted machine: 0★★★★−
Croup Tent Set Up: 0★★★★−
EzPAP Expansion Therapy: 0★★★★−
Flutter Valve Therapy: 0★★★★−
Hand Held Nebulizer: 0★★★★−
Heated Aerosol Mask/Trach Collar: 0★★★★−
Heliox Delivery: 0★★★★−
Incentive Spirometry (IS): 0★★★★−
Infant Hood Set Up: 0★★★★−
Intrapulmonary Percussive Ventilation (IPV): 0★★★★−
Metered Dose Inhaler: 0★★★★−
Nasal Cannula: 0★★★★−
Nitric Oxide Delivery: 0★★★★−
Oxgen Tank Set Up/Change Tank: 0★★★★−
Partial Rebreather/Non-Rebreather Mask: 0★★★★−
PEP Mask/PEP Valve Therapy: 0★★★★−
Positive Pressure Breathing (IPPB): 0★★★★−
Simple Mask: 0★★★★−
Splint Cough: 0★★★★−
Sputum Induction: 0★★★★−
Venturi Mask: 0★★★★−
Vest Airway Clearance: 0★★★★−
Obtaining Arterial Blood Gases:
ABG Interpretation/Analyzer: 0★★★★−
Airway Pressure Release Ventilation (ARPV): 0★★★★−
Allen Test: 0★★★★−
Arterial Blood Gas Analysis: 0★★★★−
Arterial Line Insertion: 0★★★★−
Arterial Line Maintenance: 0★★★★−
Bronchoscopies/Assist: 0★★★★−
Change, Clean Trach Tubes: 0★★★★−
Check Intracuff Pressures: 0★★★★−
Continuous Positive Airway Pressure (CPAP): 0★★★★−
Endotracheal: 0★★★★−
Extubations: 0★★★★−
Perform Independently: 0★★★★−
Assist Only: 0★★★★−
Femoral Artery: 0★★★★−
Flow/Volume/Pressure Waveform Interpretation: 0★★★★−
High Frequency Ventilator: 0★★★★−
Independent Sychronous Lung Ventilation: 0★★★★−
Inhaler Reservoirs: 0★★★★−
Intra Aortic Balloon Pump (IABP): 0★★★★−
Intubations: 0★★★★−
Inverse Ratio Ventilation: 0★★★★−
Nasotracheal: 0★★★★−
Negative Inspiratory Force: 0★★★★−
Peak Flow Rat Monitoring: 0★★★★−
Positive End Expiratory Pressure (PEEP): 0★★★★−
Pressure Assist/Control: 0★★★★−
Pressure Regulated Volume Control (PRVC): 0★★★★−
Pressure Support Ventilation (PSV): 0★★★★−
Pulmonary Function Testing: 0★★★★−
Pulmonary Stress Testing: 0★★★★−
Radial/Brachial Artery: 0★★★★−
Ventilator Management:
Intermittent Mandatory Ventilation (IMV): 0★★★★−
Pressure Release Modes/Techniques: 0★★★★−
Suctioning: 0★★★★−
Synchronized Intermittent Mandatory Ventilation (SIMV): 0★★★★−
Ventilate Patient with Manual Resuscitator: 0★★★★−
Ventilator Modes: 0★★★★−
Ventilator Set Up/On Tanks: 0★★★★−
Volume Assist/Control: 0★★★★−
Other: 0★★★★−
Settings
Acute Care: 0★★★★−
Adult Critical Care Unit: 0★★★★−
Burn ICU: 0★★★★−
Emergency Room: 0★★★★−
Home Care: 0★★★★−
Medical/Surgical General Floor Care: 0★★★★−
Neonatal ICU Level II: 0★★★★−
Neonatal ICU Level III: 0★★★★−
Pediatric General Floor Care: 0★★★★−
Pediatric ICU: 0★★★★−
Pediatric ICU Level II: 0★★★★−
Pediatric ICU Level III: 0★★★★−
Pulmonary Rehabilitation: 0★★★★−
Pulmonary Function Lab: 0★★★★−
Skilled Nursing: 0★★★★−
Sleep Lab: 0★★★★−
Transplant: 0★★★★−
Transports: 0★★★★−
Equipment
Bird/Avea: 0★★★★−
Drager: 0★★★★−
Puritan-Bennett: 0★★★★−
Sechrist-Infant Star: 0★★★★−
Servo: 0★★★★−
Siemens: 0★★★★−
SIMS: 0★★★★−
Age
Newborn (birth – 30 days): 0★★★★−
Infant (30 days – 1 year): 0★★★★−
Toddler (1 – 3 years): 0★★★★−
Preschooler (3 – 5 years): 0★★★★−
School Age (5 – 12 years): 0★★★★−
Adolescents (12 – 18 years): 0★★★★−
Young Adults (18 – 39 years): 0★★★★−
Middle Adults (39 – 64 years): 0★★★★−
Older Adults (64+ years): 0★★★★−
Please list any Additional Skills
Additional training:
Additional equipment:
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