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Skills Assessment - Nursery Neonatal Intensive Care
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
Cardiovascular: Experience:
Assess heart sounds and peripheral pulses 0   1   2   3  
Interpret arrhythmia 0   1   2   3  
Intervene appropriately for arrhythmia 0   1   2   3  
Transducer set-up and maintenance UVC/UAC 0   1   2   3  
Obtain specimens UVC/UAC 0   1   2   3  
Hemodynamic monitoring 0   1   2   3  
Assist with Central line insertion 0   1   2   3  
Draw blood samples from central line 0   1   2   3  
Care of patient with acute heart failure 0   1   2   3  
Care of patient with post-op cardiac surgery 0   1   2   3  
Care of patient in shock 0   1   2   3  
Care for the pre- and post-cardiac cath patient 0   1   2   3  
Care for the post-op thoracic surgery 0   1   2   3  
Care of patient with PDA Ligation 0   1   2   3  
Care of patient with Transposition of Great Vessels 0   1   2   3  
Care of patient with tetralogy of Fallot 0   1   2   3  
Participate in resuscitation by performing defibrillation 0   1   2   3  
Participate in resuscitation by preparing emergency drugs 0   1   2   3  
Participate in resuscitation by performing CPR 0   1   2   3  
Participate in resuscitation as a team member 0   1   2   3  
 
Pulmonary:
Assess lung sounds 0   1   2   3  
Set up O2 devices 0   1   2   3  
Pulse oximetry monitoring 0   1   2   3  
Open, establish airway 0   1   2   3  
Interpret ABG 0   1   2   3  
Assess ventilator settings 0   1   2   3  
Suction and care of endotracheal tube 0   1   2   3  
Use Ambu bag 0   1   2   3  
Assist with intubation 0   1   2   3  
Assist with chest tube insertion 0   1   2   3  
Care for the patient with asthma 0   1   2   3  
Care for the patient with mechanical ventilation 0   1   2   3  
Care for the patient with RDS 0   1   2   3  
Care for the patient with chest tubes 0   1   2   3  
Care for the patient with a tracheostomy 0   1   2   3  
Care for the patient with meconium aspiration 0   1   2   3  
Care for the patient with cystic fibrosis 0   1   2   3  
Care for the patient with pulmonary edema 0   1   2   3  
Care for the patient with respiratory distress 0   1   2   3  
Care for the patient with respiratory failure 0   1   2   3  
 
Neurological:
Assess Glasgow Coma Scale 0   1   2   3  
Identify sudden change in LOC 0   1   2   3  
Assess sensory, motor, cry 0   1   2   3  
Assess pupils 0   1   2   3  
Reflex assessment (Babinski, gag) 0   1   2   3  
Identify, intervene for seizure 0   1   2   3  
Care for the patient with ICP monitoring 0   1   2   3  
Care for the patient who is post-op neurosurgical 0   1   2   3  
Care for the patient in a comatose state 0   1   2   3  
Care for the patient by assisting with lumbar puncture 0   1   2   3  
Care for the patient with intracranial hemorrhage 0   1   2   3  
Care for the patient with neuromuscular disease 0   1   2   3  
Care for the patient with meningitis 0   1   2   3  
 
GI/Renal/Endocrine/Nutrition:
Insert N/G, orogastric tube 0   1   2   3  
Care for the patient with gastroenteritis 0   1   2   3  
Care for the patient with dehydration 0   1   2   3  
Care for the patient with Diabetes mellitus 0   1   2   3  
Care for the patient with a GI bleed 0   1   2   3  
Care for the patient with hemodialysis 0   1   2   3  
Care for the patient with DKA 0   1   2   3  
Care for the patient with TPN 0   1   2   3  
Care for the patient with enteral nutrition 0   1   2   3  
Care for the patient with bowel obstruction 0   1   2   3  
Care for the patient with appendicitis 0   1   2   3  
Care for the patient with pH probe 0   1   2   3  
Care for the patient with gastroesophageal reflux 0   1   2   3  
Care for the patient with necrotizing enterocolitis 0   1   2   3  
 
Hematology/Oncology:
Administer blood and blood products 0   1   2   3  
Administer chemotherapeutic agents 0   1   2   3  
Care for the patient with neutropenia 0   1   2   3  
Care for the patient with Sickle Cell Anemia 0   1   2   3  
Care for the patient with HIV 0   1   2   3  
Care for the patient with Leukemia 0   1   2   3  
 
Medications:
Calculate neonate/newborn dosing 0   1   2   3  
Use of Infusion pump 0   1   2   3  
Use of Syringe pump 0   1   2   3  
Use PCA pumps 0   1   2   3  
Use epidural pumps 0   1   2   3  
Administer IV Epinephrine 0   1   2   3  
Administer IV Dopamine 0   1   2   3  
Administer IV Lidocaine 0   1   2   3  
Administer IV Amiodarone (Cordarone) 0   1   2   3  
Administer IV Adenosine 0   1   2   3  
Administer IV Atropine 0   1   2   3  
Administer IV Thrombolytics (i.e., TPA, Streptokinase) 0   1   2   3  
Administer IV Heparin 0   1   2   3  
Administer IV Benzodiazepines (i.e., Valium, Versed, Ativan) 0   1   2   3  
Administer IV Propofol (Diprivan) 0   1   2   3  
Administer IV Neuromuscular blocking agents (i.e., Pavulon,Norcuron) 0   1   2   3  
Administer IV Morphine 0   1   2   3  
 
General:
Assess and care of the newborn 0   1   2   3  
Assess and care of the critically ill newborn 0   1   2   3  
Assess and care of the low birth weight infant 0   1   2   3  
Provide cord care 0   1   2   3  
Knowledge of age-appropriate vital signs 0   1   2   3  
Knowledge of normal serum values 0   1   2   3  
Use of radiant warmers 0   1   2   3  
Use of phototherapy 0   1   2   3  
Care of the patient with sepsis 0   1   2   3  
Care of the patient with hyperbilirubinemia 0   1   2   3  
Assess and manage pain 0   1   2   3  
Admit unstable patient 0   1   2   3  
Transport patient within hospital for testing 0   1   2   3  
Start peripheral IV/scalp vein 0   1   2   3  
Maintain a heparin/saline lock 0   1   2   3  
 
Age-Specific Practice Criteria:
Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Newborn/Neonate (birth - 30 days)  
Infant (30 days - 1 year)  
Toddler (1 - 3 years)  
Preschooler (3 - 5 years)  
School age children (5 - 12 years)  
Adolescents (12 - 18 years)  
Young adults (18-39 years)  
 
Experience With Age Groups:
Able to adapt care to incorporate normal growth and development 0   1   2   3  
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level 0   1   2   3  
Can ensure a safe environment reflecting specific needs of various age groups 0   1   2   3  
 
 
 
 


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