LPN / LVN SKILLS CHECKLIST
Name:
When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill.

The scale is as follows:
1. Not performed   2. Intermitten experience   3. Very experienced.
CARDIOVASCULAR
  1. Auscultation of heart rate / rhythm   1 2 3
  2. Blood pressure   1 2 3
  3. Doppler   1 2 3
  4. Pulses   1 2 3
  5. Circulatory checks   1 2 3
  6. CPR   1 2 3
  7. ACLS   1 2 3
  8. Post abdominal aortic bypass   1 2 3
  9. Angina   1 2 3
  10. Aneurysm   1 2 3
  11. Congestive heart failure   1 2 3
  12. Fem-pop bypass   1 2 3
  13. Permanent pacemaker   1 2 3
  14. Post carotic endarterectomy   1 2 3
  15. Post acute MI   1 2 3
  16. Post cardiac surgery   1 2 3
  17. Thrombophlebitis   1 2 3
  18. DVT   1 2 3
  19. Administration of post-op cardiac meds   1 2 3
CERTIFICATIONS
  1. BLS   1 2 3
  2. ACLS   1 2 3
DIABETIC CARE
  1. Diabetic Patient Teaching   1 2 3
  2. Diabetic Monitoring   1 2 3
  3. S/S of Hyper / Hypoglycemia   1 2 3
  4. Performing Fingersticks   1 2 3
  5. Glucometer use   1 2 3
  6. Insulin infusion   1 2 3
  7. Regular / Long Acting Insulin   1 2 3
  8. Mixing Insulin   1 2 3
  9. Calculating Caloric Intake   1 2 3
EXPERIENCE IN PRIMARY AREAS
  1. Hospitals   1 2 3
  2. Clinics   1 2 3
  3. Nursing Homes   1 2 3
  4. Home Health   1 2 3
GASTROINTESTINAL
  1. Tube feeding administration - Bolus   1 2 3
  2. Tube feeding administration - Pump   1 2 3
  3. Medication administration via tube   1 2 3
  4. Bowel prep   1 2 3
  5. G.I. Bleeding   1 2 3
  6. Inflammatory Bowel Disease   1 2 3
  7. Guaiac testing   1 2 3
  8. Assessing nutritional status   1 2 3
  9. Enema administration   1 2 3
  10. Assessment of bowel incontinence   1 2 3
  11. Signs/symptoms of fecal impaction   1 2 3
  12. NG tube care   1 2 3
  13. Assessment of NG tube placement   1 2 3
  14. Colostomy care   1 2 3
  15. Assessment of abdomen   1 2 3
  16. Assessment of Bowel sounds   1 2 3
  17. Post op care - Abdominal surgeries   1 2 3
INTRAVENOUS THERAPY
  1. IV certified   1 2 3
  2. Peripheral IV insertion   1 2 3
  3. IV Dosage Calculation   1 2 3
  4. IV Infusion Pumps   1 2 3
  5. IV site care   1 2 3
  6. Central Line site care   1 2 3
  7. Implanted catheter site care   1 2 3
  8. Administration of IV Antibiotics   1 2 3
  9. Administration of IV Fluids   1 2 3
  10. Administration of IV Narcotics   1 2 3
  11. Blood draws from Central Lines   1 2 3
  12. Blood Draws from Implanted Catheter   1 2 3
  13. Blood draws from Peripheral Line   1 2 3
MEDICATION ADMINISTRATION
  1. Dosage Calculation -5 RIGHTS   1 2 3
  2. Documentation on M.A.R. & pt chart   1 2 3
  3. PDR / Drug Book usage   1 2 3
  4. Narcotic Wastage / Verification   1 2 3
  5. Drug Action/Interaction knowledge   1 2 3
  6. Generic Drug Equivalents   1 2 3
  7. Swallowing Precautions   1 2 3
  8. Ear Drops   1 2 3
  9. Eye Drops   1 2 3
  10. Intradermal meds   1 2 3
  11. Intramuscular meds   1 2 3
  12. Oral meds   1 2 3
  13. Parenteral meds   1 2 3
  14. Sublingu al meds   1 2 3
  15. Topical meds   1 2 3
NEUROLOGICAL
  1. Neuro checks   1 2 3
  2. Seizure precautions   1 2 3
  3. Dementias   1 2 3
  4. Neuromuscular disease   1 2 3
  5. CVA   1 2 3
  6. DTs   1 2 3
  7. Aneurysm precautions   1 2 3
  8. Anticonvulsants   1 2 3
  9. Antispasmodics   1 2 3
  10. Long term spinal cord injuries   1 2 3
  11. Pain control measures   1 2 3
  12. Post craniotomy care   1 2 3
  13. Meningitis   1 2 3
  14. TENS unit   1 2 3
ORTHOPEDIC
  1. Circulation assessment   1 2 3
  2. Gait assessment   1 2 3
  3. Range of motion   1 2 3
  4. Continuous passive motion   1 2 3
  5. Cervical collars   1 2 3
  6. Gait belts   1 2 3
  7. Canes / crutches   1 2 3
  8. Slings   1 2 3
  9. Brace application   1 2 3
  10. Traction application   1 2 3
  11. Transfer Boards   1 2 3
  12. Walkers   1 2 3
  13. Wheelchairs   1 2 3
  14. Prosthesis   1 2 3
  15. Casts and care   1 2 3
  16. Amputation care   1 2 3
  17. Post-arthroscopy care   1 2 3
  18. Pinned fractures   1 2 3
  19. Osteoporosis   1 2 3
  20. Care of total hip replacements   1 2 3
  21. Care of total knee replacements   1 2 3
  22. Rheumatic / Arthritic disease   1 2 3
OTHER SKILLS
  1. Charting systems   1 2 3
  2. 24 hr written & verbal reporting   1 2 3
  3. CODE status; ie Full Code or DNR   1 2 3
  4. Accident & Incident reporting   1 2 3
  5. Using the 911 system in LTC setting   1 2 3
  6. Regulatory guidelines related to residents rights in LTC setting.   1 2 3
  7. Regulatory guidelines related to prevention of neglect and abuse of residents   1 2 3
PAIN MANAGEMENT
  1. Pain "level" assessment   1 2 3
  2. Documentation of Characteristics of pain ie: Location, Duration, character   1 2 3
  3. Document effectiveness of pain meds   1 2 3
PSYCHOSOCIAL
  1. Assessment & documentation of any behavioral problems.   1 2 3
  2. Assess & document signs & symptoms of depression.   1 2 3
  3. Assess & document patients response to psychotropic medications.   1 2 3
  4. Assess & document effectiveness of all psychiatric meds patient is given.   1 2 3
  5. Assess & document effectiveness of all groups and therapy.   1 2 3
  6. Parameters for restraint use in LTC   1 2 3
PULMONARY
  1. Airway management   1 2 3
  2. Apnea monitor   1 2 3
  3. Differentiate Breath Sounds   1 2 3
  4. Chest tube care   1 2 3
  5. Chest physiotherapy   1 2 3
  6. Incentive spirometry   1 2 3
  7. Inhaler use   1 2 3
  8. Tracheal/nasotracheal suctioning   1 2 3
  9. Oropharangeal suctioning   1 2 3
  10. Oxygen therapy   1 2 3
  11. Pulse Oximetry   1 2 3
  12. Postural drainage & percussion   1 2 3
  13. Pulmonaide use   1 2 3
  14. Sputum specimen collection   1 2 3
  15. Tracheostomy care / suctioning   1 2 3
  16. Ventilator patient care   1 2 3
UNIVERSAL PRECAUTIONS / INFECTION CONTROL
  1. AIDS / HIV   1 2 3
  2. Hepatitis   1 2 3
  3. MRSA   1 2 3
  4. VRE   1 2 3
  5. Fever management   1 2 3
  6. Decubitus/Wound care (contaminated)   1 2 3
  7. Reverse Isolation   1 2 3
  8. Standard / Universal Precautions   1 2 3
  9. Linen: Transporting, storing, handling  
    1. Clean   1 2 3
    2. Solid   1 2 3
    3. Personal clothing   1 2 3
  10. Double bagging technique   1 2 3
  11. Proper disposal of sharps and waste   1 2 3
URINARY / RENAL
  1. Assessment & care of AV shunt   1 2 3
  2. Post renal surgery   1 2 3
  3. Renal Failure   1 2 3
  4. ESRD   1 2 3
  5. Assessment of urinary incontinence   1 2 3
  6. Assess I & O   1 2 3
  7. Signs & symptoms of UTI   1 2 3
  8. Signs & symptoms of distended bladder   1 2 3
  9. Indwelling catheter insertion - Female   1 2 3
  10. Indwelling catheter insertion - Male   1 2 3
  11. Straight Cath -Male   1 2 3
  12. Straight Cath - Female   1 2 3
  13. Suprapubic catheter care   1 2 3
  14. Urine dipsticks for Ketones   1 2 3
  15. Urine dipsticks for UTI   1 2 3
WOUNDS, PRESSURE S ORES, S KIN IMPAIRMENTS
  1. Assessment and care of Post Op wounds   1 2 3
  2. Assessment, prevention and care of pressure wounds.   1 2 3
  3. Assessment and documentation of skin conditions and wounds.   1 2 3
  4. Sterile dressing changes   1 2 3
  5. Aseptic dressing changes   1 2 3
  6. Wound irrigation   1 2 3
  7. Use of wound care products   1 2 3
  8. Beds - Air fluidized, low air loss beds   1 2 3
  9. Pressure relieving devices   1 2 3
  10. Staple removal   1 2 3
  11. Suture removal   1 2 3
The information I have given is true and accurate to the best of my knowledge. Please sign and date below.
SIGNATURE: (Last 4 digits of your SSN)    Reenter your last 4 digits of your SSN:   DATE:

  
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