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 (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 to 79 years)** 1 2 3 4 Elderly Adults (over 79+ years)** 1 2 3 4 General SkillsStandard Precautions** 1 2 3 4 Isolation Precautions** 1 2 3 4 Protective Isolation** 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 Basic Cardiac Rhythm Recognition** 1 2 3 4 Advanced Cardiac Rhythm Recognition** 1 2 3 4 Pulse Oximetry** 1 2 3 4 Care of Patient in Restraints** 1 2 3 4 Automated Med Dispensing Systems** 1 2 3 4 List Types:Automated Med Dispensing Systems** 1 2 3 4 List Types:Care Planning & Discharge Planning** 1 2 3 4 Patient/Family Education** 1 2 3 4 Cancer Screening and Detection** 1 2 3 4 GASTROINTESTINALTPN/PPN Administration** 1 2 3 4 G-Tubes/J-Tubes Feeding and Site Care** 1 2 3 4 Enterostomal Care** 1 2 3 4 Dobhoff Insertion** 1 2 3 4 NG Tube Insertion** 1 2 3 4 Colostomy Irrigation** 1 2 3 4 Colostomy Patient Teaching** 1 2 3 4 Tube Feeding Assessments** 1 2 3 4 ADDITIONAL SKILLSManagement of Sudden Wound Dehiscence** 1 2 3 4 Would Debridement** 1 2 3 4 Wet to Dry Dressing Changes** 1 2 3 4 Care of Drains and Tubes** 1 2 3 4 Wound Vac** 1 2 3 4 PAIN MANGEMENTPain Assessment** 1 2 3 4 Nonpharmacologic/ Alternative Strategies** 1 2 3 4 Adjuvant Medications for Pain** 1 2 3 4 Oral Pain Medication Administration** 1 2 3 4 Use of Narcotic Pain Patches** 1 2 3 4 IV Push Narcotics** 1 2 3 4 Use of PCA Pump** 1 2 3 4 Continuous Narcotic Infusion** 1 2 3 4 Continuous Epidural Infusion** 1 2 3 4 MEDICATION KNOWLEDGE AND USE OFSolu-Cortef** 1 2 3 4 Prednisone** 1 2 3 4 Decadron** 1 2 3 4 Antiemetics** 1 2 3 4 Benadryl** 1 2 3 4 BLOOD DRAW & IV THERAPYPeripheral IV Insertion, Maintenance and Discontinuation** 1 2 3 4 Peripheral Venous Blood Draw** 1 2 3 4 Central Venous CathetersHickman** 1 2 3 4 Obtaining Peripheal Blood Cultures** 1 2 3 4 Port-A-Cath Care & Maintenance** 1 2 3 4 Obtaining CVC Blood Cultures** 1 2 3 4 PICC Line Insertion** 1 2 3 4 PICC Line Care and Maintenance** 1 2 3 4 IJ Care & Maintenance** 1 2 3 4 Groshong Care & Maintenance** 1 2 3 4 Administration of IV Fluids** 1 2 3 4 Administration of Antibiotics** 1 2 3 4 Administration of Blood and Blood Products** 1 2 3 4 CHEMOTHERAPY/ BIOTHERAPY ADMINISTRATIONKnowledge of Normal Lab Values** 1 2 3 4 Calculate Body Surface Area** 1 2 3 4 Care of Patients with Extravasation** 1 2 3 4 Manage Cytotoxic Spills** 1 2 3 4 Safe Handling of Cytotoxic Agents** 1 2 3 4 Handle Body Fluids Post Chemo** 1 2 3 4 Methods of Chemotherapy/ Biotherapy AdministrationOral** 1 2 3 4 Subcutaneous** 1 2 3 4 IV Push** 1 2 3 4 IVPB & Continuous Infusion** 1 2 3 4 Intrathecal** 1 2 3 4 Intraperitoneal** 1 2 3 4 Intravesicular** 1 2 3 4 Intrapleural** 1 2 3 4 Knowledge and administrationImmune Therapy** 1 2 3 4 Growth Factors** 1 2 3 4 Monoclonal Antibodies** 1 2 3 4 Chemotherapy hormonal antineplasticsAntineoplastic Antibiotics** 1 2 3 4 Antimetabolites** 1 2 3 4 Plant Alkaloids** 1 2 3 4 Alkylating Agents** 1 2 3 4 EDUCATION AND CARE OF PATIENT WITH FOLLOWING EFFECTS OF CHEMOTHERAPY/ BIOTHERAPYAllergic Reactions - Hives, Itching** 1 2 3 4 Weakness/ Dizziness** 1 2 3 4 Fever/ Chills** 1 2 3 4 Low Blood Pressure** 1 2 3 4 Abnormal Lab Values (Neutropenia, Pancytopenia, etc.)** 1 2 3 4 Fatigue** 1 2 3 4 Nausea/Vomiting** 1 2 3 4 Anorexia** 1 2 3 4 Constipation/Diarrhea** 1 2 3 4 Mucositis/Stomatitis** 1 2 3 4 Renal or Hepatic Toxicity** 1 2 3 4 Cardiac Toxicity** 1 2 3 4 Alopecia** 1 2 3 4 Dermatitis** 1 2 3 4 Cystitis** 1 2 3 4 Neurotoxicity** 1 2 3 4 Pneumonitis** 1 2 3 4 Infertility** 1 2 3 4 Depression/Anxiety** 1 2 3 4 Neuropathy** 1 2 3 4 Altered Skin Integrity** 1 2 3 4 PSYCHOSOCIAL CAREKubler-Ross Stages of Grieving** 1 2 3 4 Identify Support Groups for Patients/Family** 1 2 3 4 Self-Care and Coping Skills** 1 2 3 4 Goal Setting** 1 2 3 4 Advance Directives** 1 2 3 4 Quality of Life Issues** 1 2 3 4 Palliative and Hospice Care** 1 2 3 4 RADIATION THERAPYProvide Radiation Therapy Teaching** 1 2 3 4 Provide Skin Care Post-Radiation** 1 2 3 4 ASSESS FOR S/S OF RADIATION THERAPY COMPLICATIONS/ SIDE EFFECTSExternal Radiotherapy** 1 2 3 4 Total Body Irradiation (TBI)** 1 2 3 4 Nonsealed Radioactive Therapy Intraoperative Radiotherapy (IORT)** 1 2 3 4 Brachytherapy** 1 2 3 4 Radioembolization** 1 2 3 4 Radiation Safety Precautions** 1 2 3 4 BONE MARROW TRANSPLANTAdult BMT** 1 2 3 4 Pediatric BMT** 1 2 3 4 Stem Cell Transplant** 1 2 3 4 Graft Rejection** 1 2 3 4 Venoocclusive Disease/ Graft-Versus-Host Disease (GVHD)** 1 2 3 4 Administration of Interferons** 1 2 3 4 CARE OF PATIENTS WITH FOLLOWING CRISISAnaphylaxis** 1 2 3 4 S.I.A.D.H.** 1 2 3 4 Superior Vena Cava Syndrome** 1 2 3 4 Organ Obstruction** 1 2 3 4 Spinal Cord Compression** 1 2 3 4 Tumor Lysis Syndrome** 1 2 3 4 DIC** 1 2 3 4 Septicemia** 1 2 3 4 Tamponade** 1 2 3 4 Hypercalcemia** 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
