Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
| RENAL/GENITOURINARY: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment of Renal/GU System |
 |
||||||
| Insertion of Foley |
|
||||||
| Nephrostomy Tube |
|
||||||
| AV Fistula / AV Graft |
|
||||||
| Tunneled/Non-Tunneled Catheter |
|
||||||
| Ileal Conduit |
|
||||||
| Supra-Pubic Catheter |
|
||||||
| Chronic Renal Failure |
|
||||||
| Acute Renal Failure |
|
||||||
| Nephrectomy |
|
||||||
| Turp |
|
||||||
| Peritoneal Dialysis |
|
||||||
| Hemodialysis |
|
||||||
| HEMODIALYSIS / PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute/Inpatient Dialysis |
|
||||||
| Chronic/Outpatient Dialysis |
|
||||||
| Dialysis Home Care |
|
||||||
| Pediatric Dialysis |
|
||||||
| Predialysis Nursing Assessment |
|
||||||
| Teaching the Dialysis Patient and Family |
|
||||||
| SET-UP / STARTING DIALYSIS TREATMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Collect Blood Specimens |
|
||||||
| Anticoagulation |
|
||||||
| Dialysis |
|
||||||
| Fistula Gortex / Bovine Graft |
|
||||||
| Prep Vascular Access |
|
||||||
| Checking Alarm Settings/Machine |
|
||||||
| Priming Dialyzer |
|
||||||
| Conductivity Testing |
|
||||||
| Bicarbonate Dialysis |
|
||||||
| ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Systems Assessment of Patient |
|
||||||
| Volume Status |
|
||||||
| Vascular Access Function |
|
||||||
| Arterial and Venous Pressures |
|
||||||
| Blood Flow Rate |
|
||||||
| Subjective Response to Treatment |
|
||||||
| Management of Anticoagulation |
|
||||||
| Conductivity |
|
||||||
| Ultrafiltration Calculation |
|
||||||
| Operation of Myron L Meter |
|
||||||
| Administration of Blood/Blood Products |
|
||||||
| Administration of Mannitol |
|
||||||
| Sequential Ultrafiltration / PUF |
|
||||||
| Documentation of Treatment |
|
||||||
| CARE OF PATIENT WITH: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Fluid Overload |
|
||||||
| Hypertension |
|
||||||
| Hypotension |
|
||||||
| Disequilibrium Syndrome |
|
||||||
| Hyperkalemia |
|
||||||
| Seizures |
|
||||||
| Muscle Cramps |
|
||||||
| Clotted Access/Poor Blood Flow Rate From Catheter |
|
||||||
| Pyrogenic Reaction |
|
||||||
| Hemolysis |
|
||||||
| Air Embolus |
|
||||||
| Chest Pain |
|
||||||
| Anemia |
|
||||||
| Neuropathy |
|
||||||
| Pericarditis |
|
||||||
| Filter Blood Leak |
|
||||||
| Cardiopulmonary Arrest |
|
||||||
| DISCONTINUE DIALYSIS: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Dialysis Catheter |
|
||||||
| Fistula / Vein Graft |
|
||||||
| Return of Blood |
|
||||||
| Post Treatment Access Care |
|
||||||
| Equipment Clean Up |
|
||||||
| Sterilization Procedures |
|
||||||
| MISCELLANEOUS: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Care of Immunosupressed Patient |
|
||||||
| Care of Patient with AIDS |
|
||||||
| Isolation Techniques |
|
||||||
| Assessment of Wound Healing |
|
||||||
| Sterile Dressing Changes |
|
||||||
| Phlebotomy / Venous Blood Draw |
|
||||||
| Discussing Organ & Tissue Donation |
|
||||||
| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
|
||||||
| Preschooler (ages 2-5 years) |
|
||||||
| Childhood (ages 6-12 years) |
|
||||||
| Adolescents (ages 13-21 years) |
|
||||||
| Young Adults (ages 22-39 years) |
|
||||||
| Adults (ages 40-64 years) |
|
||||||
| Older Adults (ages 65-79 years) |
|
||||||
| Elderly (ages 80+ years) |
|
||||||