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Skills Assessment - Intermediate Care/Telemetry
 
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:
Assess heart sounds and peripheral pulses 0   1   2   3  
Initiate cardiac monitoring with alarms 0   1   2   3  
Initiate noninvasive blood pressure monitoring 0   1   2   3  
Interpret arrhythmias 0   1   2   3  
Identify pacemaker malfunction 0   1   2   3  
Intervene appropriately for arrhythmias 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 patient with myocardial infarction 0   1   2   3  
Provide care for the post-op cardiac surgery patient 0   1   2   3  
Provide care for the pre- and post-cardiac cath patient 0   1   2   3  
Provide care for the pre- and post-PTCA/stent/atherectomy patient 0   1   2   3  
Provide care for the post-op peripheral vascular surgery 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  
Establish patent airway 0   1   2   3  
Interpret ABG 0   1   2   3  
 
Neurological:
Identify sudden change in level of consciousness 0   1   2   3  
Assess sensory, motor, speech 0   1   2   3  
Identify and intervene with a seizure 0   1   2   3  
Provide care for the post-op neurosurgical patient 0   1   2   3  
Provide care for the acute stroke patient 0   1   2   3  
Provide care for the comatose patient 0   1   2   3  
 
GI/Renal/Endocrine:
Insert NG, duodenal tube 0   1   2   3  
Provide care for the hemodialysis patient 0   1   2   3  
Provide care for the patient with TPN 0   1   2   3  
Provide care for the patient with enteral nutrition 0   1   2   3  
 
Medication:
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  
Administer IV epinephrine 0   1   2   3  
Administer IV nitroglycerine 0   1   2   3  
Administer IV dobutamine (Dobutrex) 0   1   2   3  
Administer IV milrinone (Primacor) 0   1   2   3  
Administer IV lidocaine 0   1   2   3  
Administer IV diltiazem (Cardizem) 0   1   2   3  
Administer IV verapamil 0   1   2   3  
Administer IV atropine 0   1   2   3  
Administer IV heparin 0   1   2   3  
Administer IV diuretics 0   1   2   3  
Administer IV potassium riders 0   1   2   3  
Administer IV morphine 0   1   2   3  
 
Pain/Wound Management:
Assess pain level/tolerance 0   1   2   3  
Care of the patient with narcotic analgesia 0   1   2   3  
Assess skin for impending breakdown/ stasis ulcer 0   1   2   3  
Assess wound status/ healing 0   1   2   3  
Care of the patient with air fluidized, low air loss beds 0   1   2   3  
Care of the patient with sterile dressing changes 0   1   2   3  
Care of the patient with burns 0   1   2   3  
Care of the patient with pressure sores/decubitus ulcers 0   1   2   3  
 
General:
Transport patient with portable monitor 0   1   2   3  
Interpret cardiac biomarkers (Troponin I, enzymes) 0   1   2   3  
Start peripheral IV 0   1   2   3  
Isolation technique 0   1   2   3  
Administration of blood/blood products 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 65years)  
 
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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