Medical Surgical Skills Checklist

SKILLS CHECKLIST

Medical Surgical
Form Image Element
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. 
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Abdominal Aortic Aneurysm
Angina
Cardiac Arrest
Cardiac Catherization
Cardiogenic Shock
Cardiomyopathy
Carotid Endarterectomy
Congestive Heart Failue
Cardiac Stents
Deep Vein Thrombosis
Post Acute MI (>48 hrs)
Post Angioplasty
Asthma
Bronchoscopy
COPD
Fresh Tracheostomy
Pulmonary Edema
Pneumonectomy
Pneumonia
Pneumothorax
CVA/TIA
Coma
Encephalitis
Head Injuries/Intercranial bleeds
Menigitis
Multiple Sclerosis
Neuromuscular Disease
Seizures
Spinal Cord Injuries
Renal Failure
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Cirrhosis
Hepatic Failure
Cholecysitis
Bowel Obstruction
GI Bleed
Inflammatory Bowel Disease
Paralytic Ileus
Peritonitis
TURP/TURBP
Urinary Tract Infection
Arthroscopic Surgery
Amputation
Osteomylelitis
Osteoporosis
Pinned Fractures
Other Fractures
Rheumatic/Arthritic Disease
Total Hip Replacement
Total Knee Replacement
Diabetes Insipidus
Diabetes Mellitus
Leukemia
Malignant Tumors
Anemia
TURP/TURBP
Urinary Tract Infection
Arthroscopic Surgery
Amputation
Osteomylelitis
Osteoporosis
Pinned Fractures
Rheumatic/Arthritic Disease
Total Hip Replacement
Total Knee Replacement
Diabetes Insipidus
Diabetes Mellitus
Leukemia
Malignant Tumors
Anemia
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Albuteral (Ventolin)
Aminophylline
Antibiotics
Anticoagulants
Anticonvulsants
Antihypertensives
Chemotherapeutic Agents
Corticosteroids
Digoxin
Heparin
Insulin
Lasix
Nitroglycerine
Narcotics
Oral Hypoglycemics
Thyroid Replacement
Starting IV's
Mixing IV's
Regulating IV's
Suppository
TPN Administration
PPN Administration
Patient Controlled Analgesia (PCA)
Blood/Blood Product Administration
Continuous IV Infusion
CAD Pump
Eye/ear instillations
IM injections
Insulin Pump
IV Push
Metered Dose Inhalers
Nebulizer
Piggyback infusions
Rectal infusion
Suppository
SQ injections
Z track injections
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
A-V Fistula Care
Brace/Splint Application
Foley/Straight Cath insertion & care
a.Male
b. Female
Bladder irrigation
Bowel Prep/Cleaning
Care of suprapubic catheter
Cast care
Cast application (assist with)
Central line care
a. Broviac
b. Groshong
c. Hickman
d. PICC
e. Portacath
f. Quinton
Chemotherapy
a. Oral
b. IV
Chest Physiotherapy
Chest Tube & Drainage System
a. Set up
b. Assist with insertion
c. Care & maintenance
d. Troubleshooting
e. Removal
CPR
CVP Measurment
Cardioversion
Defibrillation
EKG - obtaining 12 lead
EKG arrhythmia interpretation
EKG - lead placement
Continuous Tube Feeding
Glascow Coma Scale
Gastric Lavage, Iced Saline
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Gastric Suction
a. Intermittent
b. Continuous
Halo Traction/Cervical Tongs
Interpretation of Lab Results
a. Blood gases
b. Blood chemistry
c. Cardiac enzymes / isoenzymes
d. CBC
e. Coagulation studies
f. Cultures
g. Electrolytes
h. Urine dipstick
Intestinal Tract Tube Insertion/Care
a. Gastrostomy tubes
b. Jejunostomy tubes
c. Nasogastric tubes
d. Orogastric tubes
e. T-tubes (care only)
Isolation Procedures
Nephrostomy Tube Care
Nerve Stimulators
Oral Airway Insertion
Oxygen Therapy Administration
a. Ambu bag
b. Bag & mask
c. BiPAP
d. Face mask
e. Nasal cannula
f. Trach collar
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Pacemaker
a. Permanent
b. Temporary
Peritoneal Dialysis
a. Automatic cycler
b. Manual
Restraints
Saline/Heparin Lock
Specimen Collection
a. Blood
i. central line
ii. venous stick
b. Cultures
c. Sputum
d. Urine
Suctioning
a. Oral/Yankauer
b. Oropharyngeal
c. Nasopharyngeal
d. Tracheostomy
Temperature
a. Axillary
b. Oral
c. Tympanic
Thoracentesis/Paracentesis - assist with
Use of Doppler
Wound/Ostomy Care
a. Colostomy care/bag change
b. Ileostomy care/bag change
c. Irrigations
d. Pressure ulcers
i. staging
ii. care
e. Stasis ulcers
f. Sterile dressing changes
g. Steristrip application
h. Surgical wounds
i. Surgical drains
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Assess Breath Sounds
Assess Heart Sounds
Admission of patients to unit
Care Planning
Charge Nurse responsibilities
Circulation Checks
Computerized Charting
Patient Teaching
Neurological Assessments
Vital Signs
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Pain assessment using pain scales
Epidural analgesia
IV conscious sedation
Patient controlled analgesia (PCA)
Narcotic Agents
Non-narcotic agents
Non-pharmacological measures
 
Never Performed
Limited Experience
Comfortable Performing
Proficient
Automated Med. Dispensing Systems
Automatic BP cuffs
Cardiac/Tele Monitor
Glucometer
Hypo/Hyperthermia blanket
Oxygen Flow meter
Pressure Relief Devices
Pulse Ox
Specialty Beds
a. Air fluidized
b. Low air loss
Ventilator Management/Troubleshooting
Computer Charting Systems
If you use any Equipment, Please Specify below
Do you speak any languages other than English?
Age Specific Skills
Check the box under EACH age group that you have experience with and are comfortable with for each skill below.
Understands the different communication needs for the age group & changes communication methods and terminology accordingly
Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately
Understands the different safety risks for the age group and alters the environment accordingly
Understands the normal growth and development for the age group and adapts care accordingly
 
*