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Skills Assessment - PACU
 
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
 
General: Experience:
Admit pre-op patient to pre-op holding 0   1   2   3  
Complete assessments 0   1   2   3  
Start peripheral IV 0   1   2   3  
Complete pre-op checklist 0   1   2   3  
Transport pre-op patient to OR 0   1   2   3  
Knowledge of post-op complications of general anesthesia 0   1   2   3  
Knowledge of discharge criteria from PACU 0   1   2   3  
Transport post-op patient to in hospital units 0   1   2   3  
Isolation technique 0   1   2   3  
 
Cardiovascular:
Assess heart sounds and peripheral pulses 0   1   2   3  
Interpret arrhythmias 0   1   2   3  
Assist with arterial line insertion 0   1   2   3  
Provide care to the patient with an arterial line 0   1   2   3  
Draw blood samples from arterial line 0   1   2   3  
Interpret arterial line waveform/pressures 0   1   2   3  
Remove arterial line 0   1   2   3  
Assist with S/G insertion 0   1   2   3  
Provide care to the patient with S/G 0   1   2   3  
Provide care to the patient with SvO2 S/G catheter 0   1   2   3  
Interpret PA waveforms/pressures 0   1   2   3  
Remove S/G catheter 0   1   2   3  
Assist with central line insertion 0   1   2   3  
Draw blood samples from central line 0   1   2   3  
Remove central line 0   1   2   3  
Assist with cardioversion 0   1   2   3  
Set up and run 12 Lead ECG 0   1   2   3  
Provide care for the post-op cardiac surgery patient 0   1   2   3  
Provide care for the patient with an IABP 0   1   2   3  
Provide care for the patient in shock 0   1   2   3  
Provide care for the post-op peripheral vascular surgery patient 0   1   2   3  
Provide care for the post-op AAA patient 0   1   2   3  
Perform CPR 0   1   2   3  
Perform defibrillation 0   1   2   3  
Participate as a team member in resuscitation 0   1   2   3  
 
Pulmonary:
Assess lung sounds 0   1   2   3  
Set up oxygen devices 0   1   2   3  
Obtain pulse oximetry reading 0   1   2   3  
Interpret ABG 0   1   2   3  
Assess ventilator settings 0   1   2   3  
Troubleshoot ventilator alarms 0   1   2   3  
Suction using in-line suction catheter 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  
Provide care for the patient with mechanical ventilation 0   1   2   3  
Provide care for the patient with ARDS/PEEP therapy 0   1   2   3  
Provide care for the patient with chest tube 0   1   2   3  
Provide care for the patient with a tracheostomy 0   1   2   3  
 
Neurological:
Identify sudden change in level of consciousness 0   1   2   3  
Assess sensory, motor, speech 0   1   2   3  
Assess reflexes (Babinski, gag) 0   1   2   3  
Identify and intervene for seizure 0   1   2   3  
Obtain ICP and CPP values 0   1   2   3  
Provide care for the patient with ICP monitoring 0   1   2   3  
Provide care for the post-op neurosurgical patient 0   1   2   3  
 
Medications:
Titrate vasoactive drugs 0   1   2   3  
Calculate mcg/min and mcg/kg/min 0   1   2   3  
Use IV infusion pump to calculate drug doses 0   1   2   3  
Use PCA pump 0   1   2   3  
Use epidural pump 0   1   2   3  
Administer IV epinephrine 0   1   2   3  
Administer IV dopamine 0   1   2   3  
Administer IV norepinephrine (Levophed) 0   1   2   3  
Administer IV phenylephrine (Neo-Synephrine) 0   1   2   3  
Administer IV nitroglycerine 0   1   2   3  
Administer IV nitroprusside (Nipride) 0   1   2   3  
Administer IV dobutamine (Dobutrex) 0   1   2   3  
Administer IV milrinone (Primacor) 0   1   2   3  
Administer IV metoprolol (Lopressor) 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 diltiazem (Cardizem) 0   1   2   3  
Administer IV esmolol (Brevibloc) 0   1   2   3  
Administer IV verapamil 0   1   2   3  
Administer IV ibutilide 0   1   2   3  
Administer IV atropine 0   1   2   3  
Administer IV thrombolytics (TPA, streptokinase) 0   1   2   3  
Administer IV heparin 0   1   2   3  
Administer IV GP llb/llla inhibitors (ReoPro, Aggrastat, Integrilin) 0   1   2   3  
Administer IV benzodiazepines (Valium, Versed, Ativan) 0   1   2   3  
Administer IV Propofol (Diprivan) 0   1   2   3  
Administer IV neuromuscular blocking agents (Pavulon, Norcuron) 0   1   2   3  
Administer IV morphine 0   1   2   3  
 
Pain/Wound Management:
Assess pain level/tolerance 0   1   2   3  
Care of patient with anesthesia/analgesia 0   1   2   3  
Care of patient with IV conscious sedation 0   1   2   3  
Care of patient with narcotic analgesia 0   1   2   3  
Care of patient with patient controlled analgesia (PCA pump) 0   1   2   3  
Assess surgical wound status with/without drain(s) 0   1   2   3  
Care of patient with sterile dressing changes 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. Pediatric (1 - 12years)  
Adolescents (12 - 18 years)  
Adult (19 - 65 years)  
Older Adult (Older than 65 years)  
 
Experience With Age Groups:
Calculate body weight to verify correct dosing of medication 0   1   2   3  
Assess immunization status for pediatric, and adolescent 0   1   2   3  
Set age-appropriate short-term and long-term goals in care planning 0   1   2   3  
Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years 0   1   2   3  
 
 
 
 


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