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

MEDICAL/SURGICAL 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
Systems   | Pulmonary  
Cardiovascular   |   Assessment  
  Assessment   |       Breath/Lung Sounds
      Heart Sounds |       Breathing Patterns
      Pulses |       Cough/Secretions
      Neck Vein Distention |       Skin/Nail Color
      Peripheral Edema |       Lab Results  
      Lab Values   |         Blood Gases
        Cardiac Enzymes |   Procedures  
        Electrolytes |       Airway Management  
        Digoxin Levels |         Endotracheal Tube/Suctioning
  Procedures   |         Nasal Airway Suctioning
      Arrest Procedure/CPR Monitoring   |         Oropharyngeal Suctioning
        Basic arrhythmia Interpretation |         Tracheostomy Suctioning
  Equipment   |       Assist with Intubation
      Pacemakers |       Assist with Thoracentesis
      Doppler |       Assist with Chest Tube  
      Antiemboletic Hose |       Insertion/Removal
  Care of Patient with   |       Chest Physiotherapy
      Acute MI |   Equipment  
      Aneurysm |       Oxygen Therapy and  
      Angina |       Medication Delivery Systems  
      Cardiac Arrest |         Bag and Mask
      Congestive Heart Failure |         External CPAP
      Cardiac Catheterization |         Face Masks
      Angioplasty |         Inhalers
      Post-Cardiac Surgery |         Nasal Cannula
  Medications   |         Portable Oxygen Tank
      Heparin Drip |         Trach Collar
      Oral Anticoagulants |       Oximeter
      Oral and IV Antihypertensives |       Ventilators
      Oral and Topical Nitrates |       Incentive Spirometer
      Lasix | Click here to Continue
      Digoxin |
Click here to Continue |



Page
2
  1     2     3     4     1     2     3     4
  Care of Patient with   |   Care of Patient with  
      AIDS |       Aphasia
      ARDS |       Closed Head Injury
      Asthma |       Coma
      Bronchoscopy |       CVA
      COPD |       Cancer of Brain
      Fresh Tracheostomy |       Craniotomy
      Lobectomy |       DTs
      Pneumonectomy |       Meningitis
      Pneumonia |       Neuromuscular Disease
      Pulmonary Embolism |       Seizure Disorder
      Thoracotomy |       Spinal Cord Injury
      Tuberculosis |   Medications  
  Medications   |       Anticonvulsants
      Albuterol |       Antidepressants
      Theophylline |       Mannitol
      Aminophylline |       Decadron
Neurological   |       Solu-Medrol
  Assessment   | Musculoskeletal/Integumentary  
      Level of Consciousness |   Assessment  
      Neuro Check |       Circulation Checks
      Mental Status |       Gait/Mobility
      Motor Movement |       ROM/Joint Movement
      Seizure Activity |       Strength
  Procedures   |       Posture
      Assist with Lumbar Puncture |       Skin Integrity
      Seizure Precautions |   Procedures  
  Equipment   |       Crutch Walking
      Hyper/Hypothermia Blanket |       Pin Care
      Halo Traction |       Cast Care
      Application of Restraints |       Use of Assistive Devices
Click here to Continue |       Body Mechanics
    |       Burn Care
    |   Equipment  
    |       Continuous Motion Devices
    |       Special Beds
    |       Traction
    |       Prosethics
    |       K-Pad
    |       Splints/Immobilizers
    |       TENS
    |       Hoyer Lift
    | Click here to Continue



Page
3
  1     2     3     4     1     2     3     4
      Support Devices   |   Care of Patient with  
        Cane |       Bowel Obstruction
        Cervical Collar |       Colostomy/Ileostomy
        Sling |       GI Bleeding
        Walker |       GI Surgery
        Wheelchair |       Hepatitis
  Care of Patient with   |       Inflammatory Bowel Disease
      Amputation |       Liver Failure
      Arthoscopic Surgery |       Fistulas
      Cast |       Pancreatitis
      Osteoporosis |   Medications/Supplements  
      Pinned Fractures |       Antiemetics
      Rheumatic/Arthritic Disease |       Antispasmotics
      Joint Replacement |       Vitamins
      Laminectomy/Cervical Fusion |       Tube Feeding Solutions
      Burns | Renal/Genitourinary  
      Skin Grafts |   Assessment  
  Medications   |       Fluid and Electrolyte Balance
      Analgesics |       A/V Fistula/Shunt
      Muscle Relaxants |       Lab Values  
      Topical Agents |         Electrolytes
Gastriointestinal   |         BUN and Creatinine
  Assessment   |   Procedures  
      Bowel Sounds |       Nephrostomy Tube Care
      Nutritional Status/Weight |       Peritoneal Dialysis
  Procedures   |
      Tube Feeding/Gavage |       Bladder Training
      Lavage |   Equipment  
      Guaiac Test |       Bladder Irrigation
      NG Tube Insertion |       Specimen Collection/Urine Test
      Ostomy Care |   Care of Patient with  
      Paracentesis |       Hemodialysis
      Removal of Fecal Impaction |       Peritoneal Dialysis
      Enemas |       Renal Surgery
  Equipment   |       Renal Failure
      Feeding Pumps |       Renal Transplant
      Drains |       TURP
      Tubes   |       Urinary Tract Infection
        N/G |       Cystoscopy
        T-Tube |   Medications  
        Miller Abbott |       KCl
        Blakemore |       Diuretics
        G-Tube | Click here to Continue
Click here to Continue |



Page
4
  1     2     3     4     1     2     3     4
Endocrine/Metabolic   |  Procedures  
  Assessment   |       Douche
      Diabetic Coma |       Breast Self-Exam
      Insulin Reaction |   Care of Patient with  
      Mental Status |       Hysterectomy/Oopharectomy
      Lab Values   |       Breast Biopsy
        Thyroid Function |       Lumpectomy
        Glucose Tolerance |       Mastectomy
        Fasting Blood Sugar |       Ectopic Pregnancy
        Ketone Bodies |       PID
        Serum Calcium |       Endometriosis
  Procedures   |       Uterine Bleeding
      Glucose Monitoring |   Medications  
      Diabetic Teaching |       Antifungal/Protozoan Agents
  Equipment   |       Hormone Replacement
      Insulin Pumps | Hematology/Oncology  
        Blood Glucose Sticks |   Assessment  
  Care of Patient with   |       Skin Lesions/Tumors
      Diabetes Mellitus |       Family History
      Disorders of Adrenal Gland |       Cardinal Signs of Cancer
      Disorders of Pituitary Gland |       Tumor Classifications
      Hyperthyroidism |       Lab Values  
      Hypothyroidism |         Blood Counts
      Thyroidectomy |         Blood Chemistry
  Medications   |   Procedures  
      Steroids/Adrenocorticosteroids |       Patient/Family Counseling  
      Glucogon |         Grieving Process
      Insulin   |         Altered Image
        Regular |       Patient Teaching  
        NPH |         Relaxation Techniques
        Lente |         Imagery
        Humulin U |         Side Effects of Chemotherapy
      Thyroid Replacement |       Bone Marrow Aspiration
      Oral Antihyperglycemics |   Care of Patient with  
Gynecologic   |       Bone Marrow Transplant
  Assessment   |       Anemia
      External Genitalia |       Immunosuppressed Conditions
      Menstrual Cycle |       Radiation Therapy/Implants
      Obstetric History |       Inpatient Chemotherapy
      STDs/Infections |       Inpatient Hospice
  |       Leukemias
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