Telemetry Skills Checklist – Professional Nursing Service

Email*

Phone*

Years Experience in Clinical Specialty:*

Directions for Completing Skills Checklist

The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate the level of experience/proficiency with each and, where applicable, the types of equipment and/or systems with which you are familiar.

Use the following KEY as a guideline:
A) Theory Only/No Experience - Didactic instruction only, no hands-on experience.
B) Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months.
C) Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
D) Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

CARDIOVASCULAR

1. Assessment*

2. Interpretation of Lab Results*

3. Equipment & procedures*

	A	B	C	D
Monitotring/Telemetry - Arrhythmia interpretation
Monitoring/Telemetry - Basic 12 lead interpretation
Monitoring/Telemetry - Lead placement: 5 electrode telemetry
Monitoring/Telemetry - Lead placement: I, III, V-leads
Monitoring/Telemetry - Lead placement: Lead II and MCL1
Pacemaker - Pacemaker -
Pacemaker - Temporary epocardial wires
Pacemaker - Temporary external placement
Pacemaker - Temporary transvenous
Assist with - Arterial line insertion
Assist with - Central line insertion
Hemodynamic monitoring - A-line (radial)
Hemodynamic monitoring - CVP monitoring
Hemodynamic monitoring - Femoral artery sheath removal
Hemodynamic monitoring - Swan-Ganz
Perform - Controlled cardioversion
Perform - Emergency defibrillation
Perform - Cardiopulmonary resuscitation (CPR)

4. Care of the patient with:*

	A	B	C	D
Abdominal aortic bypass
Aneurysm
Angina
Cardiac arrest
Cardiomyopathy
Carotid endarterectomy
Congestive heart failure (CHF)
Femoral-popliteal bypass
Post acute MI (24-48 hours)
Post angioplasty
Post arthrectomy (DCA)
Post CABG (24 hours)
Post cardiac catheterization
Post stent placement
Cardiogenic shock

5. Medications*

	A	B	C	D
Atropine
Diuretics
Digoxin
Andrenergics
Beta blockers
Ca+ channel blockers
Lidocaine
Vasopressors
Nitrates
Antiarhythmics
Preparation of emergency medications
Oral, IV and subcutaneous anticoagulants
Thrombolytic agents

PULMONARY

1. Assessment*

2. Interpretation of Lab Results*

3. Equipment and procedures*

	A	B	C	D
Assist with intubation
Assist with thoracentesis
Care of airway management devices/suctioning
Care of patient on ventilator
Care of patient with chest tube
Chest physiotherapy
Establishing an airway
Incentive spirometry
Oxygen therapy & medication delivery systems
Oral airway insertion
Restraints

4. Care of the patient with*

5. Medications*

NEUROLOGICAL

1. Assessment*

2. Equipment and procedures*

3. Care of the patient with:*

	A	B	C	D
Aneurysm precautions
Basal skull fracture
Closed head injury
Coma
TIA/CVA
DT's
Encephalitis
Externalized VP shunts
Meningitis
Multiple sclerosis
Neuromuscular disease
Post Craniotomy
Seizures
Spinal cord injury

4. Medications*

GASTROINTESTINAL

1. Assessment*

2. Interpretation of blood chemistry*

	A	B	C	D
Interpretation of blood chemistry

3. Equipment and procedures*

4. Management of*

5. Care of the patient with*

	A	B	C	D
Bowel obstruction
Colostomy
ERCP
Esophageal bleeding
GI bleeding
GI surgery
Hepatitis
Ileostomy
Inflammatory bowel disease
Liver failure
Liver transplant
Pancreatitis
Paralytic ileus
Whipple procedure
Pre/post open abdominal surgery

RENAL/GENITOURINARY

1. Assessment*

2. Interpretation of BUN & cretinine*

	A	B	C	D
Interpretation of BUN & cretinine

3. Equipment and procedures*

4. Care of the patient with*

RENAL/GENITOURINARY

1. Assessment*

2. Interpretation of lab results*

	A	B	C	D
Interpretation of lab results

3. Care of the patient with*

METABOLIC

1. Assessment*

2. Interpretation of lab results*

3. Equipment and procedures*

4. Care of the patient with*

	A	B	C	D
Cushing's syndrome
Diabetes insipidus
Diabetes mellitus
Diabetic ketoacidosis
Disorders of adrenal gland (Addison's disease)
Drug overdose
Hyperthyroidism
Hypothyroidism
Pheochromocytoma
Post adrenalectomy
Post hypophysectomy
Post thyroidectomy

5. Medications*

METABOLIC

1. Assessment*

2. Equipment and procedures*

3. Care of the patient with*

PHLEBOTOMY/IV THERAPY

1. Equipment and procedures*

2. Care of the patient with*

PAIN MANAGEMENT

2. Care of the patient with*

MISCELLANEOUS

1.*

	A	B	C	D
Infectious diseases (HIV/AIDS)
Antibiotic Resistant Infections
Chemotherapy
Patient education
Informed Consent
Computerized charting
Automated medication dispensing systems
AMA procedures
Suicide precautions

Age Specific:

Please indicate the frequency with which you provide care for each age group:*

Date*

	A	B	C	D
Auscultation (rate, rhythm)
Doppler
Heart sounds/murmurs
Pulses/Circulation checks

	A	B	C	D
ARDS
Bronchoscopy
COPD
Fresh trachostomy
Lobectomy
Pneumonectomy
Pneumonia
Pulmonary edema
Pulmonary embolism
Status asthmaticus
Thoracotomy
Tuberculosis

	A	B	C	D
Aminophylline
Corticosteroids
Atrovent
Antibiotics
Albuterol

	A	B	C	D
Cerebellar function
Cranial nerves
Glasgow coma scale
Level of consciousness
Pathologic reflexes
Administer blood products as ordered by physician to maintain hemodynamic status

	A	B	C	D
Assist with lumbar puncture
Halo traction
Nerve stimulator
Rotation bed
Seizure precautions
use of hyper/hypothermia blanket
Bed alarms

	A	B	C	D
Cardiac Enzymes/Isoenzymes
Coagulation studies

	A	B	C	D
Breath sounds
Breathing patterns

	A	B	C	D
Dilantin
Phenobarbitol
Versed
Lasix/Mannitol
Valium
Morphine sulfate
Oral analgesics/narcotics

	A	B	C	D
Abdominal/bowel sounds
Fluid Balance
Nutritional

Telemetry/Intermediate Care Skills Checklist

Directions for Completing Skills Checklist

CARDIOVASCULAR

PULMONARY

NEUROLOGICAL

GASTROINTESTINAL

RENAL/GENITOURINARY

RENAL/GENITOURINARY

METABOLIC

METABOLIC

PHLEBOTOMY/IV THERAPY

PAIN MANAGEMENT

MISCELLANEOUS

Age Specific: