Age of Patients Cared ForNewborn/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 years to 5 years)* 1 2 3 4 School Age Child (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 SkillsDraw Blood Cultures* 1 2 3 4 Perform Blood Draws* 1 2 3 4 Discontinue ART Line* 1 2 3 4 Discontinue PICC Line* 1 2 3 4 Initiate IV Access* 1 2 3 4 Adult Respiratory/Cardiac Arrest* 1 2 3 4 Standard Precautions* 1 2 3 4 Isolation Precautions* 1 2 3 4 Pediatric Respiratory/Cardiac Arrest* 1 2 3 4 Defibrillators* 1 2 3 4 Care of Patients in Restraints* 1 2 3 4 Pain Management* 1 2 3 4 Automated Med Dispensing Systems* 1 2 3 4 List Types:Care Planning* 1 2 3 4 Discharge Planning* 1 2 3 4 Patient/Family Education* 1 2 3 4 Patient Head to Toe Assessment* 1 2 3 4 Dressing Changes* 1 2 3 4 Knowledge of Normal Serum Lab Values* 1 2 3 4 Obtaining Cultures (Blood, Sputum, Swab)* 1 2 3 4 Administration of Blood and Blood Products* 1 2 3 4 PCA Pumps* 1 2 3 4 Infusion PumpCalculate mcg/min and mcg/kg/min* 1 2 3 4 Titrating Medications* 1 2 3 4 Neuro General SkillsCranial Nerve Assessment* 1 2 3 4 ICP Monitoring* 1 2 3 4 Assessment of Neuro Signs* 1 2 3 4 Glascow Coma Scale* 1 2 3 4 Stroke Scale* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Crutchfield Tongs* 1 2 3 4 Halo Traction* 1 2 3 4 Stryker Frame* 1 2 3 4 Seizure Precautions* 1 2 3 4 Neuro – Care of Patient with:Meningitis* 1 2 3 4 Coma* 1 2 3 4 CVA/TIA* 1 2 3 4 Seizure Activity* 1 2 3 4 Overdose* 1 2 3 4 Neuro Injury/Trauma* 1 2 3 4 Pre/Post Neuro Surgery* 1 2 3 4 Cranial Hemorrhage* 1 2 3 4 Knowledge of anti-seizure meds* 1 2 3 4 Knowledge and use of sedatives* 1 2 3 4 Knowledge and use of Analgesics* 1 2 3 4 Cardiac General SkillsInterpretation of 12 lead EKG* 1 2 3 4 Interpretation of Arrhythmias* 1 2 3 4 Defibrillation/Cardioversion* 1 2 3 4 Permanent Pacemaker* 1 2 3 4 Temporary Pacemaker* 1 2 3 4 AICD* 1 2 3 4 Art-Line (Transducer Set-Up)* 1 2 3 4 Swan-Ganz (Transducer Set-Up)* 1 2 3 4 Balloon Pump (IABP)* 1 2 3 4 SVO2 Monitoring* 1 2 3 4 Sheath Removal* 1 2 3 4 Interpretation of Cardiac Enzymes* 1 2 3 4 Cardiac – Care of Patient with:Aneurysm* 1 2 3 4 Acute MI/Unstable Angina* 1 2 3 4 CHF* 1 2 3 4 Cardiogenic/Hypovolemic Shock* 1 2 3 4 Pre/Post Cardiac Surgery* 1 2 3 4 Percutaneous Transluminal Coronary Angioplasty* 1 2 3 4 Heart Transplant* 1 2 3 4 Knowledge and Use Of:Atropine* 1 2 3 4 Bretylol* 1 2 3 4 Bumex* 1 2 3 4 Digoxin* 1 2 3 4 Dopamine* 1 2 3 4 Dobutrex* 1 2 3 4 Heparin Drip (Precautions and Maintenance)* 1 2 3 4 Inderal* 1 2 3 4 Isuprel* 1 2 3 4 Nipride* 1 2 3 4 Nitroglycerin* 1 2 3 4 Pronestyl* 1 2 3 4 Titrate Morphine* 1 2 3 4 Thrombolytic Agents* 1 2 3 4 Magnesium Sulfate* 1 2 3 4 Versed* 1 2 3 4 Inocor* 1 2 3 4 Respiratory General SkillsEstablishing an Airway* 1 2 3 4 Oxygen Delivery Systems* 1 2 3 4 Chest Tubes* 1 2 3 4 Pulse Oximetry* 1 2 3 4 Interpretation of ABG* 1 2 3 4 User of Intermittent Positive Pressure Breathing* 1 2 3 4 Use of Pressure Support* 1 2 3 4 Suctioning* 1 2 3 4 Ventilators* 1 2 3 4 Drawing ABG Blood Sample from Art-Line* 1 2 3 4 Respiratory – Care of Patient with:COPD* 1 2 3 4 ARDS* 1 2 3 4 Pre/Post Thoracic Surgery* 1 2 3 4 Pulmonary Embolism* 1 2 3 4 Pulmonary Edema* 1 2 3 4 Pneumonia* 1 2 3 4 Inhalation Injuries* 1 2 3 4 Lung Transplant* 1 2 3 4 Knowledge and Use ofBronchodilators* 1 2 3 4 Corticosteroids* 1 2 3 4 Gastrointestinal General Skills and Patient Care of:NG Tube Insertion* 1 2 3 4 Gastrostomy Tube* 1 2 3 4 Jejunostomy Tube* 1 2 3 4 Enterostomal Care* 1 2 3 4 PEG Tube Pancreatitis* 1 2 3 4 GI Bleed* 1 2 3 4 Esophageal Bleeding* 1 2 3 4 Bowel Obstruction* 1 2 3 4 Whipple Procedures* 1 2 3 4 Liver Transplant* 1 2 3 4 Hepatitis* 1 2 3 4 Paralytic Ileus* 1 2 3 4 Endoscopic Retrograde Cholangio-Pancreatography* 1 2 3 4 Knowledge and Use of:Antiemetics* 1 2 3 4 Proton Pump Inhibitors* 1 2 3 4 TPN/Hyperalimentation* 1 2 3 4 Genitourinary/Renal General SkillsFoley/Straight Catheter Insertion* 1 2 3 4 GU Irrigations (Continuous and Intermittent)* 1 2 3 4 Nephrostomy Tube* 1 2 3 4 Suprapubic Tube* 1 2 3 4 Electrolyte Imbalance/Replacement* 1 2 3 4 Genitourinary/Renal Care of Patient with:TURP* 1 2 3 4 Shunts and Fistulas* 1 2 3 4 Nephrectomy* 1 2 3 4 Renal Transplant* 1 2 3 4 Renal Failure* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 Hemodialysis* 1 2 3 4 Continuous Renal Replacement Therapy* 1 2 3 4 Renal Trauma* 1 2 3 4 Endocrine General Skill and Patient Care with:Diabetic Teaching* 1 2 3 4 Hyper/Hypoglycemia* 1 2 3 4 Diabetic Ketoacidosis* 1 2 3 4 Vascular General SkillsPeripheral Pulses* 1 2 3 4 Dopplers* 1 2 3 4 Peripheral IV Insertion, Care and Maintenance* 1 2 3 4 Care and Maintenance of Central Lines* 1 2 3 4 Assisting with Insertion of Central Lines* 1 2 3 4 Assist with IV Cutdown* 1 2 3 4 Other:Care of Patient with Trauma Wounds* 1 2 3 4 Care of Oncology Patient* 1 2 3 4 Chemotherapy Administration* 1 2 3 4 Care of Patient with Burns* 1 2 3 4 Care of Patient with HIV/AIDS* 1 2 3 4 Hyperbaric Oxygenation* 1 2 3 4 Suicide Precautions* 1 2 3 4 Post Mortem Cares* 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.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
