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.
Cardiovascular Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Auscultation (Rate/Rhythm) |
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Blood Pressure/Non-Invasive |
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Doppler |
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Heart Sounds/Murmurs |
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Pulses/Circulation Checks |
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Cardiovascular Equipment & Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Basic 12 Lead Interpretation |
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Basic Arrhythmia Interpretation |
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Lead Placement |
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Permanent Pacemaker |
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Temporary Pacemaker |
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Care of Patient with Cardiovascular Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Abdominal Aortic Bypass |
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Aneurysm |
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Angina |
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Cardiac Arrest |
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Cardiomyopathy |
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Carotid Endarterectomy |
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Congestive Heart Failure (CHF) |
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Femoral-Popliteal Bypass |
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Myocarditis |
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Post-Acute Myocardial Infarction (24-48 Hours) |
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Pre/Post Angioplasty |
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Pre/Post Cardiac Catheter |
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Post Cardiac Surgery |
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Thrombophlebitis |
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Drug Overdose/Delirium Tremens (DTs) |
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Heart Transplant |
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Cardiovascular Medications | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Heparin Drip |
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Oral Anticoagulants |
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Oral and IVP Antihypertensives |
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Oral and Topical Nitrates |
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Pulmonary Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Breath Sounds |
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Rate and Work of Breathing |
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Interpretation of Pulmonary Laboratory Results | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Blood Chemistry |
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Arterial Blood Gases |
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Pulmonary Equipment & Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Endotracheal Tube/Suctioning |
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Nasal Airway/Suctioning |
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Oropharyngeal/Suctioning |
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Tracheostomy/Suctioning |
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Sputum Specimen Collection |
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Assist with Intubation |
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Assist with Thoracentesis |
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Assist with Set Up and Insertion of Chest Tube |
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Measuring and Emptying Chest Tube |
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Removal of Chest Tube |
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Chest Physiotherapy |
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Incentive Spirometry |
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Ambu Bag and Mask |
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External CPAP |
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Assist with Extubation |
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Care of Patients with Pulmonary Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Acute Pneumonia |
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Acute Respiratory Distress Syndrome (ARDS) |
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Chronic Obstructive Pulmonary Disease (COPD) |
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Patient with Mechanical Ventilator |
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Pulmonary Edema/Hypertension |
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Pulmonary Embolism |
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Status Asthmaticus |
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Tuberculosis |
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Pulmonary Medications | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Alupent (Metaproterenol) |
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Aminophylline (Theophylline) |
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Bronkosol (Isoetharine Hydrochloride) |
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Corticosteroids |
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Ventolin (Albuterol) |
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Neurological Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cranial Nerves |
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Glasgow Coma Scale |
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Level of Consciousness |
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Reflex/Motor Deficits |
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Visual/Communication Deficits |
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Neurological Equipment & Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assist with Lumbar Puncture |
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Intracranial Pressure Monitoring |
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Seizure Precautions |
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Spinal Precautions |
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Use of Hyper/Hypothermia Blanket |
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Care of Patients with Neurological Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Aneurysm Precautions |
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Basal Skull Fracture |
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Closed Head Injury |
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Coma |
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Cerebrovascular Accident (CVA) |
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Delirium Tremens (DTs) |
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Encephalitis |
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Increased ICP |
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Meningitis |
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Post Craniotomy |
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Spinal Cord Injury |
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Neurological Medications | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Barbiturate |
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Decadron (Dexamethasone) |
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Dilantin (Phenytoin) |
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Phenobarbital |
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Valium (Diazepam) |
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Gastrointestinal Assessments | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Abdominal/Bowel Sounds |
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Nutritional |
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Fluid Balance |
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Interpretation of Gastrointestinal Laboratory Results | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Serum Ammonia |
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Serum Amylase |
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Liver Function Tests (LFTs) |
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Gastrointestinal Equipment & Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Administration of Tube Feeding |
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Feeding Pump |
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Management of Gastrostomy Tube |
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Management of Jejunostomy Tube |
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T-Tube |
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TPN and Lipids Administration |
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Peripheral Parenteral Nutrition (PPN) |
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Placement of Nasogastric Tube |
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Salem Sump to Suction |
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Care of Patients with Gastrointestinal Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Bowel Obstruction |
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Colostomy/Ileostomy |
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GI Bleeding |
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GI Surgery |
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Hepatitis |
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Inflammatory Bowel Diseases |
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Liver Failure |
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Parlytic Ileus |
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Gastrointestinal Medications | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Inderal (Propranolol) |
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Kayexelate |
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Lactulose (Cephulac) |
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Pitressin (Vasopressin) |
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Renal/Genitourinary Assessments | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Arteriovenous Fistula/Shunt |
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Fluid and Electrolyte Imbalance |
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Interpretation of Renal/Genitourinary Laboratory Results | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
BUN and Creatinine |
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Serum Electrolytes |
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Renal/Genitourinary Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Bladder Irrigation |
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Insertion and Care of 3-Way Foley - Female |
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Insertion and Care of 3-Way Foley - Male |
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Routine Specimen Collection |
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24-Hour Specimen Collection |
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Care of Patients with Renal/Genitourinary Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Hemodialysis |
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Nephrectomy |
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Peritoneal Dialysis |
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Renal Failure |
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Transurethral Resection of the Prostate (TURP) |
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Urinary Tract Infection |
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Endocrine/Metabolic Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
S/S Diabetic Coma |
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S/S Insulin Reaction |
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Endocrine/Metabolic Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Blood Glucose Measuring |
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Performing Finger Stick |
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Care of Patients with Endocrine/Metabolic Disease | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Diabetes Mellitus |
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Diabetic Ketoacidosis |
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Disorders of Adrenal Gland (e.g., Addisons Disease) |
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Disorders of Pituitary Gland (e.g., Diabetes Insipidus) |
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Drug Overdose |
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Hyperthyroidism (Graves Disease) |
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Hypothyroidism |
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Insulin Shock |
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Orthopedic Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Circulation Checks |
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Gait |
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Range in Motion |
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Skin |
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Orthopedic Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Continuous Passive Motion Devices |
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Cane |
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Cervical Collar |
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Gait Belt |
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Prosthetic |
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Transfer Boards |
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Walker |
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Wound Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Skin for Impending Breakdown |
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Stasis Ulcers |
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Surgical Wound Healing |
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Wound Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Application of Steristrips |
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Air Fluidized, Low Air Loss Beds |
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Sterile Dressing Changes |
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Wound Care/Irrigations |
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Care of Patient with Wound | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pressure Sores |
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Staged Decubitus Ulcers |
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Surgical Wounds with Drain(s) |
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Traumatic Wounds |
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Interpretation of Infectious Diseases Laboratory Results | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
CBC |
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SMA7 |
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Infectious Diseases Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Fever Management |
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Isolation |
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Care of Patient with Infectious Diseases | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
HIV/AIDS |
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Phlebotomy/IV Therapy Equipment and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Auto Transfusion |
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Administration of Cryoprecipitate |
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Administration of Packed Red Blood Cells |
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Administration of Plasma/Albumin |
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Administration of Whole Blood |
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Drawing Venous Blood |
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Starting Angiocath IVs |
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Starting Butterfly IVs |
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Starting Heparin Lock |
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Care of Patient with IVs | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Angiography |
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Broviac/Hickman |
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Groshong |
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PICC |
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Pericardiocentesis |
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Pain Assessment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pain Level/Tolerance |
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Care of Patient with Pain | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Epidural Anesthesia/Analgesia |
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IV Conscious Sedation |
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Patient Controlled Analgesia (PCA pump) |
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Care of Patient with Trauma/Shock | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Suicide Precautions |
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Disaster Protocols |
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Charge Experience |
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Dehydration |
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Electrocution |
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Gun Shot/Stab Wounds |
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Hazardous Material Exposure |
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Radiation Exposure |
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Anaphylactic Shock |
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Cardiogenic Shock |
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Hypovolemic Shock |
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Neurogenic Shock |
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Septic Shock |
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Burns: Rule of Nines |
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First Degree Burns |
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Second Degree Burns |
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Third Degree Burns |
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Automated Medication Dispensing Systems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Accudose |
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Metro |
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Omnicell |
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Promanager Rx |
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Pyxis |
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eMAR |
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Electronic Documentation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
AllScripts |
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Care360 |
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Cerner |
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CPSI |
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eClinicalWorks |
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Eclipsys |
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EPIC |
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MACLAB |
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McKesson/Paragon |
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Meditech |
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PACS |
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Quadramed |
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Soarian |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn/Neonate (birth to 30 days) |
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Infant (30 days - 1 year) |
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Toddler (1 year to 3 years) |
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Preschooler (3 years to 5 years) |
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School age children (5years to 12 years) |
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Adolescents (12 years to 18 years) |
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Young Adults (18 years to 39 years) |
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Middle Adults (39 years to 64 years) |
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Older Adults (64 years to 79 years) |
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Elderly Adults (over 79+ years) |
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