Cardiac Progressive – 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:*

	A	B	C	D
Normal Heart Tones (i.e.: S1, S2)
Abnormal Heart Tones (i.e.: murmur, gallop, friction rub)
Identification of PMI (Point Maximal Intensity)
Blood Pressure (non-invasive)
Pulses/Circulation via palpation
Pulses/Circulation via Doppler
Insertion site invasive lines
12-lead EKG interpretation
EKG Changes for MI
Arrhythmia interpretation
Implement AC LS/Cardiac protocols
S/S DVT
Check crash cart and restock as necessary

2. Provision of care for:*

	A	B	C	D
AAA (Abdominal Aortic Aneurysm)
Aortic Stenosis
Cardiomyopathy
Cardiac Arrest
Cardiac Catheterization
Carotid Endarterectomy
Cardiac Tamponade
CHF
MI
Mitral Valve Stenosis
Myocardial contusion
Post cardiac surgery complications
Pericardial Window
Post AICD Insertion
Pericardial Effusion
Pericarditis
Pre/Post PTC A
Stent Replacement

3. Procedures:*

	A	B	C	D
Application of fem-stop to sheath site
Application of holter monitor
Removal of radial arterial line
Removal of femoral sheath
Perform venipuncture
Obtain lab specimens from A-line
Obtain lab specimens from Central Line
Perform 12-lead EKG
Proper cardiac monitor lead placement

4. Management of:*

5. Hemodynamic Monitoring:*

6. Management of Pacemakers:*

7. Assist with:*

Pulmonary

1. Assessment:*

	A	B	C	D
Auscultate breath sounds
Identify adventitious lung sounds
Interpretation of pulse oximetry values
Identify S/S of respiratory distress
Identify presence of subcutaneous emphysema
Assess capillary refill

2. Provision of Care for:*

	A	B	C	D
Acute Pneumonia
ARDS
Bronchoscopy
Chest Trauma
COPD
Cor Pulmonale
Fresh Tracheostomy
Lobectomy
Pneumonectomy
Pulmonary Edema
Pulmonary Hypertension
Pulmonary Embolism
Status Asthmaticus
Thoracotomy
Tuberculosis

3. Chest Tubes:*

	A	B	C	D
Perform chest tube set-up
Assist with chest tube insertion
Monitor & record chest tube output
Identify and troubleshoot clotted chest tube
Identify and troubleshoot patient bleeding from chest tube
Identify presence of air leak
Assist with chest tube removal

4. Procedures:*

	A	B	C	D
Perform NT (Nasotracheal) suctioning
Perform suctioning of tracheostomy
Collection of sputum via NT suction
O2 Masks/C annulas
Ambu bag
Chest physiotherapy
Incentive spirometry
Nebulizer set up
Use of pleurevac
Pulse oximetry

5. Assist with:*

Neurology

1. Assessment:*

2. Provision of Care for:*

3. Lumbar puncture*

	A	B	C	D
Lumbar puncture

Gastrointestinal

1. Assessment:*

2. Provision of Care:*

3. Procedures:*

	A	B	C	D
Administration of tube feeding
Administration of gravity feeding
Flexible feeding tube (Dobhoff)
Continuous suction
Iced saline lavage
Insertion and maintenance of N/G Tube
Insertion and maintenance of Rectal Tube
PPN (peripheral parenteral nutrition)
TPN and lipids administration
Utilization of feeding pump

Endocrine

1. Provision of Care:*

2. Procedures:*

3. Equipment:*

Renal

1. Assessment:*

2. Provision of Care:*

3. Procedures:*

Multisystem

1. Perform comprehensive multi-system assessment*

	A	B	C	D
Perform comprehensive multi-system assessment

2. Provision of Care:*

	A	B	C	D
AIDS
Altered mental status
Anaphylactic shock
Anemia
Cancer
Delirium
Dementia
Drug Overdose
Healthcare-acquired infection: catheter-associated urinary tract infections (CAUTI)
Healthcare-acquired infection: central-line associated bloodstream infections (C LABSI)
Hypovolemic shock
Infectious diseases (MRSA, VRE, Influenza)
Psychological disorders (anxiety, depression)
Sepsis/septic shock
Substance abuse

3. Pain Management:*

4. Care of the patient with:*

5. Procedures:*

Integumentary

Assess for:*

2. Provision of Care:*

3. Procedures:*

4. Air fluidized, low airloss beds*

	A	B	C	D
Air fluidized, low airloss beds

Labs

1. Interpretation of:*

Cardiac Progressive Care Pharmacology

1. Provision of Care:*

	A	B	C	D
Perform & manage dosage drip calculations
Assess for therapeutic response
Manage & titrate multiple drips
Continuous Subcutaneous Infusion Pumps
Assess and manage PCA Pumps
Perform and manage IV conscious sedation
Administer appropriate reversal agents
Management of Epidural Administration (anesthesia/analgesia)

2. Medications:*

	A	B	C	D
Aminophylline (Theophylline)
Amiodarone (Cordarone)
Atropine
AquaMephyton (Vitamin K)
Apresoline
Bretylium (Bretylol)
Corticosteroids
Decadron (Dexamethasone)
Digoxin (Lanoxin)
Dilantin (Phenytoin)
Diltiazem (Cardizem)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Lasix (Furosemide)
Epinephrine (Adrenalin)
Esmolol (Brevibloc)
Heparin Drip
Inderal (Propranolol)
Inocor (Amrinone)
Kayexelate
Lactulose (Cephulac)
Levophed
Lidocaine
Metoprolol (Lopressor)
Nitroglycerin (Tridil)
Phenobarbital
Procainamide (Pronestyl)
Sodium Bicarbonate
Valium (Diazepam)
Verapamil (Calan, Isoptin, Verelan)
Ventolin (Albuterol)
Versed

Patient Education

1.*

Patient Advocacy

1.*

	A	B	C	D
Provide care for end-of-life decisions
Adhere to legal procedures regarding notification of organ donation provider
Demonstrate spiritual and cultural considerations for the PCU patient
Provide for the integration of comfort care and death with dignity
Demonstrate effective coping skills in caring for the PCU patient
Perform time out
Obtain/witness informed consent

Age Specific:

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

Date*

	A	B	C	D
Management of Arterial Line
Management of CVP Line
Zero and calibration of transducers
Assess adequate perfusion with invasive lines

	A	B	C	D
Epicardial wires
Epicardial pacing
Transvenous pacing
Transcutaneous pacing
Manipulation of TPM settings
Troubleshoot TPM settings
Permanent Pacemaker
Recognition of failure to sense, capture

	A	B	C	D
Set-Up for cardioversion
Cardioversion
Central line insertion
Arterial line insertion
Pericardiocentesis
Transesophageal echocardiogram

	A	B	C	D
Glasgow Coma Scale
Reflex/Motor Deficits
Visual/Communication Deficits
Cranial nerves
NIH Stroke Scale (NIHSS)

	A	B	C	D
Aneurysm precautions
Closed head injury
Coma
CVA
DT's
Encephalopathy
Intracranial hemorrhage
Seizure disorders
Spinal cord injury
TIA

	A	B	C	D
Blood and blood product administration
Blood transfusion reactions

	A	B	C	D
Emergency Tracheostomy
Emergency Intubation
Thoracentesis

	A	B	C	D
Bowel Obstruction
Colostomy
ERCP
Esophageal Bleed
GI Bleed
Hepatitis
Ileostomy
Inflammatory Bowel Disease
Liver Failure
Liver Transplant
Pancreatitis
Paralytic Ileus
Post GI surgery (resection, etc.)

	A	B	C	D
Diabetes mellitus
Diabetic ketoacidosis
Diabetes Insipidus
Hyperthyroidism
Hypothyroidism
Insulin Shock
Thyroidectomy

Cardiac Progressive Skills Checklist

Directions for Completing Skills Checklist

Cardiovascular

Pulmonary

Neurology

Gastrointestinal

Endocrine

Renal

Multisystem

Integumentary

Labs

Cardiac Progressive Care Pharmacology

Patient Education

Patient Advocacy

Age Specific: