Dialysis RN Skills Checklist

Age of Patients Cared For 1

Newborn/Neonate (Birth to 30 days)*

1
2
3
4

Infant (1 month to 1 year)*

1
2
3
4

Toddler (1 year to 3 years)*

1
2
3
4

Preschooler (3 year to 5 years)*

1
2
3
4

School Age (5 years to 12 years)*

1
2
3
4

Adolescents (12 years to 18 years)*

1
2
3
4

Young Adults (18 years to 39 years)*

1
2
3
4

Middle Adults (39 years to 64 years)*

1
2
3
4

Older Adults (64 years to 79 years)*

1
2
3
4

Elderly Adults (over 79 years)*

1
2
3
4

General Skills

Standard Precautions*

1
2
3
4

Isolation Precautions*

1
2
3
4

Pediatric Respiratory/Cardiac Arrest*

1
2
3
4

Adult Respiratory/Cardiac Arrest*

1
2
3
4

Crash Carts*

1
2
3
4

Defibrillators*

1
2
3
4

Care of Patient in Restraints*

1
2
3
4

Pain Management*

1
2
3
4

Automated Med Dispensing Systems*

1
2
3
4

Care Planning and Discharge Planning*

1
2
3
4

Patient/Family Education*

1
2
3
4

Peripheral IV Insertion, Care and Maintenance*

1
2
3
4

Renal/Genitourinary

Assessment of Renal/GU System*

1
2
3
4

Insertion of Urinary Catheter*

1
2
3
4

Patient with Nephrostomy Tube*

1
2
3
4

Patient with AV Fistula/A V Graft*

1
2
3
4

Patient with Tunneled/Non-Tunneled Catheter*

1
2
3
4

Patient with Ileal Conduit*

1
2
3
4

Patient with Supra-Pubic Catheter*

1
2
3
4

Patient with Renal Failure*

1
2
3
4

Patient with Nephrectomy*

1
2
3
4

Patient with TURP*

1
2
3
4

Patient on Peritoneal Dialysis*

1
2
3
4

Patient on Hemodialysis*

1
2
3
4

Hemodialysis Skills/Procedures Experience

Acute/Inpatient Dialysis*

1
2
3
4

Chronic/Outpatient Dialysis*

1
2
3
4

Dialysis Home Care*

1
2
3
4

Pediatric Dialysis*

1
2
3
4

Pre-dialysis Nursing Assessment*

1
2
3
4

Set Up / Initiate Dialysis Treatment

Bicarbonate Dialysate*

1
2
3
4

Conductivity Testing*

1
2
3
4

Priming Dialyzer*

1
2
3
4

Checks for Machine/Alarm Settings*

1
2
3
4

Prep Vascular Access*

1
2
3
4

Fistula Gortex/Bovine Graft*

1
2
3
4

Dialysis*

1
2
3
4

Collect Blood Specimens*

1
2
3
4

Volume Status*

1
2
3
4

Vascular Access Function*

1
2
3
4

Arterial and Venous Pressures*

1
2
3
4

Blood Flow Rate*

1
2
3
4

Subjective Response to Treatment*

1
2
3
4

Management of Anticoagulation*

1
2
3
4

Conductivity*

1
2
3
4

Ultrafiltration Calculation*

1
2
3
4

Myron L Water Meter*

1
2
3
4

Administration of Mannitol*

1
2
3
4

Sequential Ultrafiltration/PUF*

1
2
3
4

Documentation of Dialysis Treatment*

1
2
3
4

Fluid Overload*

1
2
3
4

Hypertension*

1
2
3
4

Hypotension*

1
2
3
4

Disequilibrium Syndrome*

1
2
3
4

Hyperkalemia*

1
2
3
4

Seizures*

1
2
3
4

Muscle Cramps*

1
2
3
4

Clotted Access/Poor Blood Flow Rate from Catheter*

1
2
3
4

Pyrogenic Reaction*

1
2
3
4

Hemolysis*

1
2
3
4

Air Embolus*

1
2
3
4

Chest Pain*

1
2
3
4

Anemia*

1
2
3
4

Neuropathy*

1
2
3
4

Pericarditis*

1
2
3
4

Filter Blood Leak*

1
2
3
4

Alarm

Blood Leak Alarm*

1
2
3
4

Arterial Pressure Alarm*

1
2
3
4

Venous Pressure Alarm*

1
2
3
4

Conductivity Alarm*

1
2
3
4

Ultrafiltration Alarm*

1
2
3
4

High Temperature Alarm*

1
2
3
4

Air/Foam Detector Alarm*

1
2
3
4

Power Failure Alarm*

1
2
3
4

Blood Pump Alarm*

1
2
3
4

Please list the EMR systems you have used*

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*

I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*

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TODAY'S DATE*

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