Medical/Surgical Skills Checklist

Necessary information:
Pro-Touch Nurses Identity Code :
(Enter the identity code assigned to you on submitting the preliminary information form)

Certification: RN LPN/LVN Other

Instructions: Use the following Answer Key to indicate the extent of your previous experience:

0 Never Performed

1 Performed, but needs review

2 Can perform, but with supervision

3 Can perform independently

4 Perform with expertise


Skill Description		Choose your most accurate proficiency level
A. PRECAUTIONS		0	1	2	3	4

	1. Regular Isolation
	2. Reverse Isolation
	3. Enteric Isolation
	4. Respiratory Isolation
	5. Wound and Skin Isolation
	6. Universal Precautions


B. MEDICATIONS		0	1	2	3	4

	1. Unit Dose
	2. Administer Medication for 1-10 Patients
	3. Administer Medication for 1-20 Patients
	4. Pediatric Conversions
	5. IM Injections
	6. Subcutaneous Injections


C. I.V.THERAPY		0	1	2	3	4

	1. Venipuncture
	2. I.V.Certified		No		Yes
	3. Heparin Locks
	4. Initialing I.V.Lines
	5. Central Lines & Dressing Changes
	6. Infusion Pumps
	7. Hanging Blood and Blood Products
	8. Care of a Cutdown
	9. Administration of IVPB
	10. IV Additives
	11. Intralipid Administration
	12. Hyperalimentation Administration


D. I.V.MEDS		0	1	2	3	4

	1. Calculation/Administration of:
	a. Aminophyline
	b. Dopamine
	c. Lidocaine
	d. Pitressin
	e. Isuprel
	f. Chemotherapy
	g. Nipride
	h. Lanoxin
	i. Lasix
	j. Bumex
	k. Morphine
	l. Demerol
	m. Decadron
	n. Valium
	o. Librium
	p. Dilantin


E. RESPIRATORY		0	1	2	3	4

	1. Ausculating Breath Sounds
	2. O2Mask
	3. O2 cannula
	4. Venturi Mask
	5. Ambu Bags
	6. O2 Cylinders
	7. Nebulizer Set Up
	8. Suction
	a. Orpharyngeal
	b. Nasopharyngeal
	9. Tracheotomy
	10. Trach Tube
	11. T-Piece
	12. Assisting with Intubation
	13. Assisting with Extubation
	14. Obtaining Arterial Blood Gases
	a. Radial Artery
	b. Brachial Artery
	c. Fenoral Artery
	d. Arterial Line
	15. Interpretation of Blood Gases
	16. Assisting with Chest Tube Insertion
	17. Use of Chest Tube Drainage Systems
	a. Type
	18. Care of a Patient with:
	a. Pulmonary Edema
	b. COPD
	c. ARDS
	d. Pneumothorax


F. GASTROINTESTINAL		0	1	2	3	4

	1. Auscultating Bowel Sounds
	2. Colostomy Care
	3. Gastric Lavage
	4. G.I.Tubes
	a. Nasogastric
	b. Miller-Abbott
	c. Blakemore
	5. Care of the Patient with:
	a. G.I.Bleed
	b. Abdominal Wounds
	c. Acute Abdominal Disorders
	d. Esophogeal Vorices


G. GENITOURINARY		0	1	2	3	4

	1. Catheters
	a. Foley Insertion
	b. 3-Way Foley
	c. Suprabubic


H. ORTHOPEDICS		0	1	2	3	4

	1. Circo-ElectricBed
	2. Crutchfield Traction
	3. Balanced Traction
	4. Cast Care
	5. Neurological Checks


I. CARDIAC		0	1	2	3	4

	1. Auscultate Heart Sounds
	2. Cardiac Monitoring
	3. Recognizing Arrhythmias
	4. Obraining 12 Lead EKGs
	5. Cardiopulmonary Arrest
	a. Resusitiation
	b. Administration pof Code Drugs


J. CARE OF PATIENT WITH:		0	1	2	3	4

	1. Acute MI
	2. Drug Overdose
	3. Cancer.
	4. Emphysema
	5. Asthma
	6. COPD
	7. Pulmonary Edema
	8. Diabetes
	9. Renal Failure.
	10. Hemodialysis
	11. Peritoneal Dialysis
	12. Cirrhosis of Liver
	13. Hepatic Encephalopathy
	14. Decubitus Ulcers
	15. Hypothyroidism
	16. Hyperthyroidism
	17. Femoral Bypass(Vascular) Procedures
	18. Psychiatric Disorders
	19. Gun Shot Wounds
	20. Stab Wounds
	21. Impending DT's