INTENSIVE CARE SKILLS CHECKLIST

PPR Healthcare Staffing, Inc.
333 1st. St. North -- Suite 200
Jacksonville Beach, FL 32250
Fax:(888)794-5038

INTENSIVE CARE SKILLS CHECKLIST
Name:	Date:
Instructions: Use the following Answer Key to indicate the extent of your previous experience:

Key - for each box mark:		1 - Limited or no experience,	2 - Somewhat experienced but may need review,
		3 - Can function independently,	4 - Competent to supervise

	1 2 3 4			1 2 3 4
System		\|	Equipment
Cardiovascular		\|	Automatic Internal
Assessment		\|	Cardioverter/Defibrillator
Abnormal Heart Sounds		\|	Pacemakers
Auscultation (rate, rhythm)		\|	Intra-aortic Balloon Pump
Doppler		\|	12 Lead EKG
Pulses		\|	Care of Patient with
Peripheral Edema		\|	Aneurysm
Neck Vein Distention		\|	Acute MI
Lab Values		\|	Cardiac Arrest
Cardiac Enzymes and Isoenzymes		\|	Unstable Angina
Electrolytes		\|	Cardiac Tamponade
Coagulation Studies		\|	CHF
Digoxin Levels		\|	PTCA
Procedures		\|	Heart Transplant
Assist with		\|	Open-Heart Surgery
Pulmonary Arterial		\|	Multiple Organ Failure
Catheter/Swan-Ganz Insertion		\|	Pericarditis
CVAH-D		\|	Post Arthrectomy
Hemodynamic Monitoring - Invasive		\|	Pre/Post Cardiac Catheterization
Mean Arterial (MAP)		\|	Shock
Central Venous (CVP)		\|	Septic
Pulmonary Artery/Capillary Wedge		\|	Hypovolemic
Radial Artery		\|	Cardiogenic
Cardiac Index		\|	Neurogenic
Cardiac Output		\|	Anaphylactic
SVO2		\|	Medications
Monitoring - Non-invasive		\|	ACLS Drugs
Arrhythmia Interpretation		\|	Nitroglycerine
Rhythm Strip Assessment		\|	Calcium Channel Blockers
		\|	Thrombolytic Agents
Click here to Continue		\|	Click here to Continue

Page
		2
	1 2 3 4			1 2 3 4
Pulmonary		\|	Care of Patient with
Assessment		\|	Acute Pneumonia
Breath/Lung Sounds		\|	ARDS
Breathing Patterns		\|	Chest Trauma
Cough/Secretions		\|	COPD
Skin/Nail Color		\|	Cor Pulmonale
Lab Values		\|	Fresh Tracheostomy
Blood Gases		\|	Lobectomy
Procedures		\|	Pneumonectomy
Air Leak Troubleshooting		\|	Pulmonary Edema
Mediastinal Chest Tube Removal		\|	Pulmonary Embolism
Pleural Chest Tube Removal		\|	Pneumonthorax
Airway Management/Suctioning		\|	Thoracotomy
Endotracheal Suctioning		\|	Tuberculosis
Extubation		\|	Chest Wall Injuries
Oximetry		\|	Medications
Tracheostomy Suctioning		\|	Alputent (Metaproterenol)
Assist with		\|	Aminophylline
Bronchoscopy		\|	Bronkosol (Isoethaine Hydrochloride)
Chest Tube Insertion		\|	Corticosteroids
Emergency Tracheostomy		\|	Ventolin (Albuterol)
Thoracentesis		\|	Neurological
Intubation		\|	Assessment
Oral Airway Insertion		\|	Cranial Nerves
Intervention for Respiratory Complications		\|	Glasgow Coma Scale
Aspiration		\|	Visual or Communication Deficits
Laryngospasm		\|	Procedures
Tension Pneumothorax		\|	Assist with Lumbar Puncture
Equipment		\|	Seizure Precautions
Water Seal Drainage		\|	Spinal Precautions
O2 Therapy Delivery Systems		\|	Measuring Intracranial Pressure
Ambu Bag and Mask		\|	Aneurysm Precautions
ET Tube		\|	Equipment
Nasal Cannula		\|	Halo Traction
Portable O2 Tank		\|	Crutchfield Tongs
Trach Collar		\|	Stryker Frame
Ventilator Management		\|	Nerve Stimulators
External CPAP		\|	Rotating/Circular Bed
IMV		\|	Hyper/Hypothermia Blanket
PEEP		\|	Click here to Continue
Pressure Support		\|
Weaning Modes		\|
Nebulizers		\|
Click here to Continue

The information I have provided in this skills checklist is true and accurate to the best of my knowledge. I hereby authorize PPR to release this information to client facilities of PPR in relation to consideration of my employment to those facilities.



Submitting this form may take a few moments, please be patient. Thank you.
© 2004-2007 PPR

Page
		3
	1 2 3 4			1 2 3 4
Care of Patient with		\|	Equipment
Cranial Aneurysm		\|	Continuous Motion Devices
Skull Fracture		\|	Special Beds
Closed Head Injury		\|	Traction
Coma		\|	Prostheses
CVA		\|	K-Pad
Cranial Hemorrhage		\|	Splints/Immobilizers
Delirium Tremens		\|	TENS
Increased ICP		\|	Support Devices
Laminectomy		\|	Cane
Meningitis		\|	Cervical Collar
Intracranial Tumor		\|	Sling
Spinal Cord Injury		\|	Walker
Craniotomy		\|	Wheelchair
CNS Infections		\|	Care of Patient with
Medications		\|	Amputation
Decadron		\|	Cast
Solu-Medral		\|	Pinned Fractures
Magnesium Sulfate		\|	Joint Replacement
Mannitol		\|	Laminectomy/Cervical Fusion
Anti-convulsants		\|	Burns
Musculoskeletal/Integumentary		\|	Skin Grafts
Assessment		\|	Medications
Circulation Checks		\|	Muscle Relaxants
Gait/Mobility		\|	Topical Agents
ROM/Joint Movement		\|	Gastrointestinal
Strength		\|	Assessment
Posture		\|	Bowel Sounds
Skin Integrity		\|	Nutritional Status/Weight
Procedures		\|	Lab Values
Crutch Walking		\|	Serum Ammonia
Pin Care		\|	Liver Function Tests
Cast Care		\|	Click here to Continue
Use of Assistive Devices		\|
Body Mechanics		\|
Burn Care		\|
Click here to Continue

Page
		4
	1 2 3 4			1 2 3 4
Procedures		\|	Renal/Genitourinary
Lavage		\|	Assessment
Management of		\|	Fluid and Electrolyte Status
Jejunostomy Tube		\|	A/V Fistula/Shunt Status
T-tube		\|	Lab Values
PPN (Peripheral Parenteral Nurtition)		\|	Electrolytes
NG Tube Insertion		\|	BUN and Creatinine
Paracentesis		\|	Procedures
Enemas		\|	Bladder Irrigation
Removal of Fecal Impaction		\|	Insertion and Management of
Equipment		\|	Supra-pubic Catheter Management
Feeding Pumps		\|	Nephrostomy Tube Management
Salem Pump to Suction		\|	Peritoneal Dialysis
Tubes		\|	Equipment
N/G		\|	Care of Patient with
T-Tube		\|	Acute Renal Failure
Miller Abbott		\|	Chronic Renal Failure
Blakemore		\|	Hemodialysis
G-Tube		\|	Peritoneal Dialysis
Care of Patient with		\|	Nephrectomy
Abdominal Trauma		\|	Renal Transplant
Bowel Obstruction		\|	Hepatitis
Colostomy		\|	TURP
ERCP		\|	Urinary Tract Infection
Esophageal Bleeding		\|	Medications
GI Bleeding		\|	KCl
GI Surgery		\|	Diuretics
Inflammatory Bowel Disease		\|	Endocrine/Metabolic
Liver Failure		\|	Assessment
Pancreatitis		\|	Mental Status
Paralytic Ileus		\|	Diabetic Coma
Medications/Supplements		\|	Insulin Reaction
AquaMephyton (Vitamin K)		\|	Lab Values
Anti-emetics		\|	Thyroid Studies
Anti-spasmotics		\|	Blood Glucose
Tube Feeding Solutions		\|	Glucose Tolerance
Kayexelate		\|	Fasting Blood Sugar

Page
		5
	1 2 3 4			1 2 3 4
Equipment		\|	Medications
Insulin Pumps		\|	Antineoplastic Agents
Care of Patient with		\|	Chemotherapeutic Agents
Diabetes Mellitus		\|	Anticoagulant Agents
Diabetic Ketoacidosis		\|	Anticoagulant Antidotes
Drug Overdose		\|	Click here to Continue
Insulin Shock		\|
Thyroidectomy		\|
Medications		\|
Insulins		\|
Oral Antihyperglycemics		\|
Glucogon		\|
Thyroid Replacement		\|
Hematology/Oncology		\|
Assessment		\|
Tumor Classifications		\|
Lab Values		\|
Blood Count Markers		\|
Blood Chemistry		\|
Procedures		\|
Patient/Family Counseling		\|
Grieving Process		\|
Altered Image		\|
Patient Teaching		\|
Relaxation Techniques		\|
Side Effects of Chemotherapy		\|
Bone Marrow Aspiration		\|
Care of Patient with		\|
Bone Marrow Transplant		\|
Anemia		\|
Immunosuppressed Conditions		\|
Radiation Therapy/Implants		\|
Inpatient Chemotherapy		\|
Leukemias		\|
DIC		\|
Click here to Continue		\|