RTP HOSPITAL STAFFING

PEDIATRIC 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

Assessment 1 2 3
Auscultation (rate, rhythm, volume) 1 2 3
Blood pressure/non-invasive 1 2 3
Heart sounds/murmurs 1 2 3
Perfusion 1 2 3
Interpretation of lab results 1 2 3
Arterial blood gases 1 2 3
Hemoglobin & hematocrit 1 2 3
Equipment & procedures:
1. Basic EKG interpretation 1 2 3
2. Swan ganz 1 2 3
3. UAC 1 2 3
4. UVC 1 2 3
5. UAC/UVC specimens 1 2 3
6. A-Line 1 2 3
7. Cardiac montitor 1 2 3
Care of the child with:
1. Bacterial endocarditis 1 2 3
2. Cardiac arrest 1 2 3
3. Cardiomyopathy 1 2 3
4. Congenital heart defects/disease 1 2 3
5. Congestive heart failure 1 2 3
6. Myocarditis 1 2 3
7. Pericarditis 1 2 3
8. Post cardiac cath 1 2 3
9. Post cardiac surgery 1 2 3
10. Rheumatic fever 1 2 3
11. Shock 1 2 3
12. Pacemaker 1 2 3
13. Cardioversion 1 2 3
14. Defibrillation 1 2 3
15. Heart transplant 1 2 3
16. Tetralogy of Fallot 1 2 3

ENDOCRINE/METABOLIC

Interpretation of lab results
1. Blood glucose 1 2 3
2. Thyroid studies 1 2 3
Care of the child with:
1. Adrenal disorders 1 2 3
2. Cushing's syndrome 1 2 3
3. Juvenile diabetes 1 2 3
4. Pituitary disorders 1 2 3
5. Thyroid malfunction 1 2 3
6. Diabetic acidosis 1 2 3
Medications
1. Growth hormone 1 2 3
2. Insulin 1 2 3
3. Thyroid 1 2 3

GASTROINTESTINAL

Bowel sounds 1 2 3
Nutritional support 1 2 3
Interp of lab results - Serum electrolytes 1 2 3
Equipment & procedures
1. Feedings 1 2 3
2. Bottle 1 2 3
3. Breast 1 2 3
4. Central hyperalimentation 1 2 3
5. Gavage 1 2 3
6. Peripheral hyperalimentation 1 2 3
7. Gastrostomy/button 1 2 3
8. I-tubes 1 2 3
9. Jejunal feeding 1 2 3
10. NG and sump tubes to suction 1 2 3
11. Penrose drains 1 2 3
12. Placement of naso/orogastric tube 1 2 3
Care of the child with:
1. Anal fissure 1 2 3
2. Cleft lip/palate 1 2 3
3. Colostomy 1 2 3
4. Diaphragmatic hernia 1 2 3
5. Failure to thrive 1 2 3
6. Gastroenteritis/dehydration 1 2 3
7. GI bleeding 1 2 3
8. Ileostomy 1 2 3
9. Intestinal parasites 1 2 3
10. Necrotizing enterocolitis (NEC) 1 2 3
11. Pyloric stenosis 1 2 3
12. Ulcerative colitis 1 2 3

GENITOURINARY

Assessment - fluid balance 1 2 3
Interpretation of lab results 1 2 3
BUN & creatinine 1 2 3
Urinalysis 1 2 3
Equipment & procedures:
1. Assist with suprapubic tap 1 2 3
2. Catheter insertion 1 2 3
3. Catheter care 1 2 3
4. Collection of urine specimen 1 2 3
Care of child with:
1. Circumcision 1 2 3
2. Glomerularnephritis 1 2 3
3. Hemodialysis 1 2 3
4. Hemolytic uremic syndrome (HUS) 1 2 3
5. Hypospadias 1 2 3
6. Ileal conduit ureteral 1 2 3
7. Infantile polycystic disease 1 2 3
8. Renal transplant 1 2 3
9. Nephrotic syndrome 1 2 3
10. Peritoneal dialysis 1 2 3
11. Renal failure 1 2 3
12. Urinary tract infection 1 2 3
13. Wilm's tumor 1 2 3
14. Reconstructive surgery 1 2 3

HEMATOLOGY/ONCOLOGY

Interpretation of lab results 1 2 3
Blood chemistry 1 2 3
Blood counts 1 2 3
Reverse isolation 1 2 3
Care of the child with:
1. AIDS 1 2 3
2. Anemia 1 2 3
3. Bone marrow transplant 1 2 3
4. Communicable diseases 1 2 3
5. Cytomegalo virus (CMV) 1 2 3
6. Depressed immune system 1 2 3
7. Disseminated intravascular coagulation(DIC) 1 2 3
8. Hemophilia 1 2 3
9. Hepatitis 1 2 3
10. Hodgkin's disease 1 2 3
11. Infectious mononucleosis 1 2 3
12. Kawasaki disease 1 2 3
13. Leukemia 1 2 3
14. Lyme disease 1 2 3
15. Soft tissue sarcoma 1 2 3
16. Sickle cell anemia 1 2 3
17. Spleen trauma/splenectomy 1 2 3
18. Solid tumors 1 2 3
19. Chemotherapy 1 2 3
20. Ostogenic sarcoma 1 2 3

MEDICATION AND ADMINISTRATION

Calculation of pediatric doses 1 2 3
Eye/ear installations 1 2 3
Knowledge of emergency drugs 1 2 3
Knowledge of routine pediatric drugs 1 2 3
Metered dose inhaler 1 2 3

NEUROLOGICAL

Assessment - level of consciousness 1 2 3
Equipment & procedures 1 2 3
Application of splints 1 2 3
Assist with lumbar puncture 1 2 3
ICP monitoring 1 2 3
Care of the child with:
1. Battered child syndrome 1 2 3
2. Closed head trauma 1 2 3
3. Clubfoot 1 2 3
4. Encephalitis 1 2 3
5. Febrile seizures 1 2 3
6. Meningitis 1 2 3
7. Multiple sclerosis 1 2 3
8. Multiple trauma 1 2 3
9. Near drowning 1 2 3
10. Neuromuscular disease 1 2 3
11. Osteogenic sarcoma 1 2 3
12. Osteomyelitis 1 2 3
13. Spinal cord injury 1 2 3
Medications:
1. Clonopin (Clonazapam) 1 2 3
2. Corticosteroids 1 2 3
3. Dilantin (Phenytoin) 1 2 3
4. Phenobarbital 1 2 3
5. Tegretol (Carbamazepine) 1 2 3
6. Valium (Diazepam) 1 2 3

ORTHOPEDICS

Casts 1 2 3
Pinned fractures 1 2 3
Traction 1 2 3
Crutchfield tongs 1 2 3
Osteomylitis 1 2 3
Rheumatoid arthritis 1 2 3
Spinia Bifida 1 2 3

PAIN MANAGEMENT

Assessment of pain level/tolerance 1 2 3
Care of the child with:
1. Epidural/anesthesia 1 2 3
2. IV conscious sedation 1 2 3
3. Narcotic/analgesia 1 2 3

PHLEBOTEMY/IV THERAPY

Equipment & procedures
1. Administration of blood/blood products 1 2 3
2. Cryoprecipitate 1 2 3
3. Drawing blood from central line 1 2 3
4. Drawing venous blood 1 2 3
5. Starting IV’s 1 2 3
6. Heparin lock 1 2 3
Care of child with:
1. Central line/catheter/dressing 1 2 3
2. Broviac 1 2 3
3. Groshong 1 2 3
4. Hickman 1 2 3
5. Portacath 1 2 3
6. Quinton 1 2 3
7. Cutdown line/dressing 1 2 3
8. Peripheral line/dressing 1 2 3

RESPIRATORY

Breath sounds 1 2 3
Rate and work of breathing 1 2 3
Equipment & procedures:
1. Airway management devices/suctioning 1 2 3
2. Nasal airway/suctioning 1 2 3
3. Oral airway/suctioning 1 2 3
4. Tracheostomy/suctioning 1 2 3
5. Apnea monitor 1 2 3
6. Oxygen administration 1 2 3
7. Face mask 1 2 3
8. Isolette 1 2 3
9. Trach collar 1 2 3
10. Water seal drainage system 1 2 3
Care of child with
1. Asthma 1 2 3
2. Bronchiolitis (RSV) 1 2 3
3. Bronchopulmonary dysplasia (BPD) 1 2 3
4. Cystic fibrosis 1 2 3
5. Epiglottitis 1 2 3
6. LTB/croup 1 2 3
7. Pertussis 1 2 3
8. Pneumonia 1 2 3
9. Tonsillitis 1 2 3
10. Tuberculosis 1 2 3
Medications:
1. Alupent (Meraproteranol) 1 2 3
2. Aminophylline (Theophylline) 1 2 3
3. Isuprel (Isoproterenol) 1 2 3
4. Ventolin (Albuterol) 1 2 3
Care of child on ventilator:
1. Chemical paralysis procedures 1 2 3
2. Sedation 1 2 3

SPECIFIC PATHOLOGIC CONDITIONS

Normal growth and development 1 2 3
Normal laboratory values 1 2 3
Recognize signs of abuse or neglect 1 2 3
Immunization schedule 1 2 3
Fever management 1 2 3
Isolation 1 2 3
Care of the child with:
1. Anorexia/bulimia 1 2 3
2. Craniofacial reconstruction 1 2 3
3. Depression 1 2 3
4. ENT surgery 1 2 3
5. Eye surgery 1 2 3
6. Ingestion of foreign body 1 2 3
7. Liver transplant 1 2 3
8. Plastic surgery 1 2 3
9. Suicidal threats/actions 1 2 3
10. Terminal illness 1 2 3

WOUND CARE MANAGEMENT

Skin assessment 1 2 3
Surgical wound healing 1 2 3
Care of child with burns 1 2 3
Staged decubitus ulcers 1 2 3
Sterile dressing changes 1 2 3
Surgical wounds with drain(s) 1 2 3
Traumatic wound care 1 2 3
Wound care/irrigations 1 2 3

AGE SPECIFIC PRACTICE CRITERIA

Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.

Newborn/Neonate (birth - 30 days)
Infant (30 days - 1 year)
Preschooler (3 - 5 years)
Toddler (1 - 3 years)
School Age children (5 - 12 years)
Adolescents (12 - 18 years)

PROFESSIONAL EXPERIENCE AND CERTIFICATIONS

Are you BLS certified? Yes No
Are you PALs certified? Yes No
Are you chemotherapy certified? Yes No
Are you pediatric certified? Yes No
Do you have charge experience? Yes No
Number of years of charge experience?
Number of years in PICU?
Number of years in Pediatrics?

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:

Email:jobs@staffhospital.com P.O.Box 225216 S.F. CA 94122 Tel:(866)713-4405 Fax:(866)232-3799