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Name:      

Date:      

RN Experience and Skills Checklist

PACU (Post Anesthesia Care Unit)

Instructions: In the following sections, we ask you to rate yourself on your skill and experience/comfort level for specific nursing/medical procedures, medications, etc. that are specific for PACU RN’s. The rating system is as follows:

0=No experience

1=Minimal experience; review and/or supervision required

2=Experienced; able to perform without supervision

3=Extensive experience; can assist others; well skilled

ADMISSION TO PACU:

|0 |1 |2 |3 | |

| | | | |Initial assessment |

| | | | |Airway management |

| | | | |Proper positioning |

| | | | |Assessing vital signs |

| | | | |Assessing skin color, temperature & skin turgor |

| | | | |Neurological status |

| | | | |Assessing Aldrete Score |

| | | | |Assessing Glascow Coma Scale Score |

PHYSICAL ASSESSMENT OF BODY SYSTEMS:

|0 |1 |2 |3 | |

| | | | |Respiratory |

| | | | |Cardiovascular |

| | | | |Neurological |

| | | | |Gastrointestional |

| | | | |Integumentary |

ANESTHESIA:

|0 |1 |2 |3 |Monitor and Recover Patient From: |

| | | | |General Anesthesia |

| | | | |Regional Anesthesia |

| | | | |Spinal Anesthesia |

| | | | |Intrathecal Anesthesia |

| | | | |Epidural Anesthesia |

| | | | |Local Anesthesia |

| | | | |Malignant Hyperthermic Crisis management |

RESPIRATORY:

|0 |1 |2 |3 | |

| | | | |Auscultate breath sounds |

| | | | |Recognize abnormal breath sounds (wheezes, rales, rhonchi) |

| | | | |Implement appropriate nursing interventions for abnormal BS: |

| | | | |Reposition patient |

| | | | |Pulmonary toilet |

| | | | |Use of Bronchodilators and Diuretics |

| | | | |Suction and O2 |

| | | | |Airway insertion and management |

| | | | |Removal of oral or nasal airway |

| | | | |Assess respiratory rate, rhythm, depth, and symmetry |

| | | | |Identify abnormal breathing: |

| | | | |Labored~dyspneic |

| | | | |Obstructed |

| | | | |Laryngospasm |

| | | | |Insufficient Reversal |

| | | | |Oral Suctioning |

| | | | |Nasal Suctioning |

| | | | |Endotracheal Suctioning |

| | | | |Tracheal Suctioning |

| | | | |Administer O2 by face mask |

| | | | |Administer O2 via nasal cannula |

| | | | |Administer O2 via T-piece |

| | | | |Use of Ambu Bag |

| | | | |Assist with intubation |

| | | | |Independent usage of ventilator |

| | | | |Troubleshooting ventilator alarms |

| | | | |Weaning from ventilator |

| | | | |Using an end tidal CO2 monitor |

| | | | |Determine ETT air leak |

| | | | |Measure ETT pressure |

| | | | |ETT extubation |

| | | | |Use of trach collar |

POST OPERATIVE CARE OF THE FOLLOWING PATIENTS:

|0 |1 |2 |3 | |

| | | | |Cardiac Surgery |

| | | | |Thoracic Surgery |

| | | | |Hemothorax |

| | | | |Pneumothorax |

| | | | |Upper Airway Obstruction |

| | | | |Aspiration |

| | | | |Vascular Surgery |

| | | | |Indentify edema/fluid overload |

| | | | |Hypovolemia |

| | | | |Orthopedic Surgery |

| | | | |Cast care |

| | | | |Assessing distal capillary refill, movement, sensation, temp. & pulses |

| | | | |Amputation |

| | | | |Continuous Passive Motion (CPM) |

| | | | |Skeletal Traction |

| | | | |Neurosurgery |

| | | | |ICP monitoring |

| | | | |Cerebral Perfusion Pressure |

| | | | |Implementing seizure precautions |

| | | | |Tonsillectomy and PE tubes |

| | | | |Major abdominal surgery |

| | | | |Assessing bowel sounds |

| | | | |Liver Transplant |

| | | | |Kidney Transplant |

| | | | |Heart Transplant |

| | | | |Lung Transplant |

| | | | |ENT surgery |

| | | | |Mastectomy |

| | | | |Breast Augmentation |

| | | | |Genitourinary surgery |

| | | | |Hysterectomy |

| | | | |Nephrectomy |

| | | | |Prostrate Surgery |

| | | | |Hypospadias |

| | | | |Circumcision |

| | | | |Gynecological surgery |

| | | | |Post-angiogram |

| | | | |Liver biopsy |

| | | | |Eye surgery |

| | | | |HIV+ patient |

| | | | |Multiple trauma patient |

| | | | |Maintaining cervical spinal precautions |

| | | | |Patient with Latex Allergy |

| | | | |Isolation patient |

| | | | |Patient in restraints |

| | | | |Patient experiencing an allergic reaction |

CARDIOVASCULAR:

|0 |1 |2 |3 | |

| | | | |Use of cardiac monitor |

| | | | |Performing 12 lead EKG |

| | | | |Arrhythmia identification |

| | | | |Treatment of arrhythmias |

| | | | |Cardioversion |

| | | | |Defibrillation |

| | | | |Assist with Code Blue |

| | | | |Assist with insertion of a temporary pacemaker |

| | | | |Care of pt. with a temporary or permanent pacemaker |

| | | | |Use of non-invasive temporary pacing equipment |

| | | | |Care of pt. with central line |

| | | | |Care of pt. with arterial line |

| | | | |Care of pt. with pulmonary artery catheters |

| | | | |Care of pt. with Swan Ganz catheters |

| | | | |Care of pt. with Subclavian line |

| | | | |Care of pt. with epidural catheter |

HEMODYNAMIC MONITORING:

|0 |1 |2 |3 | |

| | | | |Equipment maintenance |

| | | | |Dressing changes |

| | | | |Prevention of complications |

| | | | |Leveling waveform analysis |

| | | | |Obtain and interpret Cardiac Output |

| | | | |Obtain and interpret PA pressure |

| | | | |Obtain and interpret Pulmonary Capillary Wedge Pressure |

| | | | |Obtain and interpret Central Venous Pressure |

| | | | |Obtain and interpret Left Atrial Pressure |

MEDICATION ADMINISTRATION:

|0 |1 |2 |3 |Knowledge, complications and treatment: |

| | | | |Antiarrhythmics |

| | | | |Inotropes |

| | | | |Vasopressors |

| | | | |Vasodialators |

| | | | |Heparin |

| | | | |Diuretics |

| | | | |Steroids |

| | | | |IIb/IIIa Receptor Inhibitors |

| | | | |Reversal Agents |

| | | | |Muscle relaxants |

| | | | |Narcotics |

| | | | |Sedatives |

| | | | |H2 Receptor Antagonists |

| | | | |Antiemetics |

| | | | |Epidural anesthesia |

| | | | |Assess epidural anesthesia level |

| | | | |Assess spinal anesthesia level |

| | | | |Beta blockers |

| | | | |Calcium channel blockers |

| | | | |Anticonvulsants |

| | | | |Inhalation agents |

| | | | |Calculate infusion rates |

| | | | |Administer IM and subcutaneous meds |

| | | | |Administer IV meds |

| | | | |Administer NG/G tube meds |

| | | | |Administer PO meds |

| | | | |Administer ear/eye meds |

| | | | |Administer blood and blood products |

CARE OF PATIENT WITH IV’S, TUBES AND DRAINS:

|0 |1 |2 |3 | |

| | | | |Inserting peripheral IV |

| | | | |Discontinuing peripheral IV’s |

| | | | |Use of needle-less IV systems |

| | | | |Use of autotransfusion pump |

| | | | |Accessing Mediports |

| | | | |Accessing PICC lines |

| | | | |Care of pt. with shunts or fistulas |

| | | | |Set up closed drainage system for chest tubes |

| | | | |Recognize chest tube air leak |

| | | | |Assess for subcutaneous emphysema |

| | | | |Measure chest tube drainage |

| | | | |Troubleshoot chest tube problems |

| | | | |Securing chest tube |

| | | | |Care and use of Penrose drain |

| | | | |Care and use of Salem Sump |

| | | | |Care and use of Jackson Pratt tube |

| | | | |Care of T-tube |

| | | | |Care of nephrostomy tube |

| | | | |Care of Colostomy |

| | | | |Care of Jejunostomy |

| | | | |Care of Ileostomy |

| | | | |GU Irrigations |

| | | | |Care of Foley catheter |

| | | | |Care of urethral catheter |

| | | | |Care of suprapubic catheter |

| | | | |Care of cystotomy |

| | | | |Care of NG tube |

OPERATE AND MONITOR UNIT EQUIPMENT:

|0 |1 |2 |3 | |

| | | | |Pxysis |

| | | | |PCA pump |

| | | | |Suction (wall and portable) |

| | | | |Transport monitor |

| | | | |Automatic BP monitor~Dynamap |

| | | | |Omeda |

| | | | |Use of Defibrillator |

| | | | |Use of EKG monitor |

| | | | |Use of Pulse Oximeter |

| | | | |Nitrogen Controls~Tanks |

| | | | |Nitrogen Controls~Wall Units |

| | | | |O2 tanks |

| | | | |02 wall |

| | | | |Blanket warmer |

| | | | |Bair Hugger |

| | | | |Hyper/hypothermia blanket |

| | | | |Blood warmer |

| | | | |Level 1 fluid infuser |

| | | | |Use of IV pumps |

| | | | |Use of invasive pressure monitors |

| | | | |Sequential compression device |

| | | | |Pee Wee weighing scale |

| | | | |PACU gourney |

| | | | |Doppler |

INTERPRET LAB VALUES:

|0 |1 |2 |3 | |

| | | | |CBC’s |

| | | | |Electrolyte imbalances |

| | | | |Blood glucose monitoring |

| | | | |ABG’s |

| | | | |Drawing ABG’s from Art Line |

| | | | |Drawing ABG’s with Arterial Stick |

| | | | |Discontinuing Art line |

| | | | |Drawing venous blood sample |

| | | | |Performing urine dip |

| | | | |Obtaining sputum culture |

STANDARD NURSING CARE:

|0 |1 |2 |3 | |

| | | | |Admit and orient patient |

| | | | |Advance Directives |

| | | | |Pain assessment and Pain Scale |

| | | | |Implements physician orders |

| | | | |Collaborate w/ surgeon, anesthesiologist re: pt. care |

| | | | |Utilize appropriate infection control measures |

| | | | |Practice universal precautions |

| | | | |Document interventions, outcomes and lab studies |

| | | | |MD notifications and follow up care |

| | | | |Monitor Intake and Output |

| | | | |Positioning and transferring patient |

| | | | |Post Mortem care |

| | | | |Supervise unlicensed personnel |

| | | | |Utilization Review |

| | | | |Chart Audit |

PATIENT DISCHARGE:

|0 |1 |2 |3 | |

| | | | |Discharge Planning |

| | | | |Perform a discharge physical assessment |

| | | | |Assess Level of Consciousness |

| | | | |Assess pupillary reactions |

| | | | |Assess motor and sensory function |

| | | | |Assess motor strength (hand grips, head lift) |

| | | | |Assess discharge Aldrete Score |

| | | | |Discharge, transfer or admit patient |

| | | | |Patient education |

OTHER SKILLS/PROCEDURES/SPECIAL TRAINING/SEMINARS:

     

EXPERIENCE:

   Total number of years as a RN    Total number of years as a LVN

Please indicate the number of years of experience for the following areas of expertise:

|   |Administration |

|   |Supervision |

|   |Teaching |

|   |Emergency Department |

|   |Urgent Care |

|   |ER Observation Area |

|   |Trauma |

|   |ICU |

|   |SICU |

|   |MICU |

|   |PICU |

|   |NICU |

|   |CCU |

|   |DOU |

|   |Telemetry |

|   |Medical Floor |

|   |Surgical Floor |

|   |Recovery Room |

|   |Operating Room |

|   |Circulating Nurse OR |

|   |Open Heart Operating Room |

|   |Neurology |

|   |Chemical Dependency |

|   |Geriatrics |

|   |Psychiatic |

|   |Oncology |

|   |Orthopedics |

|   |Critical Care Transport RN |

|   |MICN |

|   |Rehabilitation |

|   |Pediatrics |

|   |Labor and Delivery |

|   |Mother/Baby/Post-partum |

|   |Home Health |   |Public Health |

|   |Research |   |Medical Sales |

|   |Clinic/Urgent Care |

|   |Nurses Aide/Tech |

|   |Paramedic |   |EMT |

|   |Other (specify)       |

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