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 SkillsStandard 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 Patients in Restraints* 1 2 3 4 Pain Management* 1 2 3 4 Automated Med Dispensing* 1 2 3 4 Care Planning and 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* 1 2 3 4 Administration of Blood and Blood Products* 1 2 3 4 PCA Pumps* 1 2 3 4 Infusion Pumps* 1 2 3 4 Calculate mcg/min and mcg/kg/min* 1 2 3 4 Titrating Medications* 1 2 3 4 Moderate/Conscious Sedation and Reversal Agents* 1 2 3 4 IV TherapyInitiate Peripheral IV* 1 2 3 4 Discontinue Peripheral IV* 1 2 3 4 Central Line Blood Draw* 1 2 3 4 PICC Line Blood Draw* 1 2 3 4 PICC Line Care and Maintenance* 1 2 3 4 Neuro General Skills and Care of Patient withAssessment of Neuro Signs* 1 2 3 4 Glasgow Coma Scale* 1 2 3 4 Seizure Precautions and Seizure Activities* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Halo Traction* 1 2 3 4 CVA* 1 2 3 4 Overdose* 1 2 3 4 Neuro/Head Injury* 1 2 3 4 Pre/Post Neuro Surgery* 1 2 3 4 Cranial Hemorrhage* 1 2 3 4 Multiple Sclerosis* 1 2 3 4 Post-Op AV Shunt* 1 2 3 4 Medication Knowledge and Use ofDecadron* 1 2 3 4 Dilantin* 1 2 3 4 Magnesium Sulfate* 1 2 3 4 Phenobarbital* 1 2 3 4 Steroids* 1 2 3 4 Valium* 1 2 3 4 Versed* 1 2 3 4 Cardiac General Skills and Care of PatientAuscultation of Cardiac Sounds* 1 2 3 4 Dopplers* 1 2 3 4 Interpretation 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 * 1 2 3 4 Sheath Removal* 1 2 3 4 Interpretation of Cardiac Enzymes* 1 2 3 4 Angina* 1 2 3 4 CHF* 1 2 3 4 Post MI* 1 2 3 4 Pre/Post Cardiac Cath* 1 2 3 4 Pre/Post Cardiac Surgery* 1 2 3 4 Open Sternal Wound* 1 2 3 4 Heart Transplant* 1 2 3 4 Medication Knowledge and Use ofAtropine* 1 2 3 4 Diuretics* 1 2 3 4 Digoxin* 1 2 3 4 Dopamine* 1 2 3 4 Dobutrex* 1 2 3 4 Heparin Drip* 1 2 3 4 Inderal* 1 2 3 4 Inocor* 1 2 3 4 Isuprel* 1 2 3 4 Lidocaine* 1 2 3 4 Nipride* 1 2 3 4 Nitroglycerin* 1 2 3 4 Pronestyl* 1 2 3 4 Morphine* 1 2 3 4 Thrombolytic Agents* 1 2 3 4 Magnesium Sulfate* 1 2 3 4 Versed* 1 2 3 4 Prep/Titration of Emergency Drugs* 1 2 3 4 Respiratory General SkillsEstablishing* 1 2 3 4 Ambuing Techniques* 1 2 3 4 Administration of O2* 1 2 3 4 Chest Tubes* 1 2 3 4 Pulse Oximetry* 1 2 3 4 Interpretation of ABG* 1 2 3 4 Use of IPPB* 1 2 3 4 Incentive Spirometer* 1 2 3 4 Oral Suctioning* 1 2 3 4 Nasotracheal Suctioning* 1 2 3 4 ET Suctioning* 1 2 3 4 Knowledge and Use ofAminophylline* 1 2 3 4 Corticosteroids* 1 2 3 4 Bronchodilators* 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 withTURP* 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 withDiabetic 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 OtherCare 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
