PPR Healthcare Staffing, Inc.
333 1st. St. North -- Suite 200
Jacksonville Beach, FL 32250
Fax:(888) 794-5038
Respiratory Therapy Skills
First Name:
Last Name:
Phone:
Email:
SSN (last 4 only):
Date:
Key - for each box mark:
A. Theory, no practice
B. Intermittent experience
C. One - two years experience
D. Two plus years experience
Specialties and Units
Intensive Care Unit
A
B
C
D
Coronary Care Unit
A
B
C
D
Emergency Department
A
B
C
D
Neonatal ICU Level II
A
B
C
D
Neonatal ICU Level III
A
B
C
D
Pediatrics
A
B
C
D
Pediatric ICU
A
B
C
D
Pulmonary Rehabilitation
A
B
C
D
Sleep Lab
A
B
C
D
Transports
A
B
C
D
Therapies/Procedures
Isolation Procedures
A
B
C
D
Disinfection Procedures
A
B
C
D
Sterile Techniques
A
B
C
D
Oxygen Set Up
A
B
C
D
Nasal
A
B
C
D
Masks
A
B
C
D
Tracheotomy
A
B
C
D
Aerosol Set Up
A
B
C
D
Mask
A
B
C
D
Trach
A
B
C
D
Oxygen Tank Set Up
A
B
C
D
Croup Tent Set Up
A
B
C
D
Infant Hood Set Up
A
B
C
D
Intubate
A
B
C
D
Adult
A
B
C
D
Child
A
B
C
D
Infant
A
B
C
D
Assist with Intubation
A
B
C
D
Extubate
A
B
C
D
Assist with Extubation
A
B
C
D
Suction
A
B
C
D
Nasotracheal
A
B
C
D
Endotracheal
A
B
C
D
Ventilate Patient/Manual
A
B
C
D
Check Intracuff Pressures
A
B
C
D
Change/Clean Trach Tube
A
B
C
D
Airway Placement
A
B
C
D
Oral
A
B
C
D
Nasal
A
B
C
D
Nebulizers
A
B
C
D
Hand Held
A
B
C
D
Ultrasonic
A
B
C
D
Inhaler Reservoirs
A
B
C
D
Inspirease
A
B
C
D
Aerochamber
A
B
C
D
Ventilator Set Up
A
B
C
D
On Tanks
A
B
C
D
Troubleshoot
A
B
C
D
Ventilator
A
B
C
D
Assist/Control
A
B
C
D
CPAC
A
B
C
D
IMV
A
B
C
D
Apnea Monitor
A
B
C
D
High-Frequency Ventilator
A
B
C
D
PEEP
A
B
C
D
Inverse Ratio Ventilator
A
B
C
D
Peak Flow Rate
A
B
C
D
SIMV
A
B
C
D
Oximetry
A
B
C
D
Arterial Blood Gases
A
B
C
D
Allen Test
A
B
C
D
Analyzing
A
B
C
D
Drawing ABGs
A
B
C
D
Radial Artery
A
B
C
D
Brachial Artery
A
B
C
D
Femoral Artery
A
B
C
D
Arterial Line
A
B
C
D
Balloon Pump
A
B
C
D
Set Up
A
B
C
D
Interpretation
A
B
C
D
Calibrate
A
B
C
D
Incentive Spirometry
A
B
C
D
IPPB
A
B
C
D
Chest Physical Therapy
A
B
C
D
Postural Drainage
A
B
C
D
Splinting
A
B
C
D
Medihaler
A
B
C
D
Breathing
A
B
C
D
Pursed Lips
A
B
C
D
Diaphragmatic
A
B
C
D
Segmental
A
B
C
D
Negative Inspiratory Force
A
B
C
D
Vital Capacity
A
B
C
D
Nasal CPAP
A
B
C
D
Bedside Screening
A
B
C
D
Pulmonary Stress Testing
A
B
C
D
Transcutaneous Monitoring
A
B
C
D
Pulmonary Function Testing
A
B
C
D
Assist with Bronchoscopies
A
B
C
D
Cardiac Output Monitoring
A
B
C
D
PALS
A
B
C
D
Resuscitation
NALS
A
B
C
D
ECG
A
B
C
D
Neonatal Resuscitation
A
B
C
D
EEG
A
B
C
D
Baby Bird
A
B
C
D
Pediatric Resuscitation
A
B
C
D
Adult Resuscitation
A
B
C
D
Pulmonary Medications
lbuterol/Proventil/Ventolin
A
B
C
D
Atropine Sulfate
A
B
C
D
Bicarbonate
A
B
C
D
Isoetharine
A
B
C
D
Isopreoterenol
A
B
C
D
Metaproterenal
A
B
C
D
Mycomyst
A
B
C
D
Racemic Epinephrine
A
B
C
D
Terbutaline Sulfate
A
B
C
D
Cremolyn Sodium
A
B
C
D
Aerobid
A
B
C
D
Vanceril
A
B
C
D
Theo-Dur
A
B
C
D
Other Associated Medications
Anectine
A
B
C
D
Atropine
A
B
C
D
Corticosteroids
A
B
C
D
Digitalis
A
B
C
D
Dopamine
A
B
C
D
Lidocaine
A
B
C
D
Morphine Sulfate
A
B
C
D
Nipride
A
B
C
D
Pavulon
A
B
C
D
Valium
A
B
C
D
Care of Patients
Acute/Chronic Bronchitis
A
B
C
D
Asthma
A
B
C
D
Broncho-pulmonary Dysplasia
A
B
C
D
Cardiac Surgery
A
B
C
D
Cystic Fibrosis
A
B
C
D
Epiglottitis
A
B
C
D
Failureto Thrive
A
B
C
D
Hyaline Membrane Disease
A
B
C
D
Respiratory Distress Syndrome
A
B
C
D
Status Asthmaticus
A
B
C
D
Tracheo-Esophageal Fistula
A
B
C
D
Croup
A
B
C
D
Fem-Pop Bypass
A
B
C
D
Guillian Barre
A
B
C
D
Meconium Aspiration
A
B
C
D
Myesthenia Gravis
A
B
C
D
Neonatal Pneumonia
A
B
C
D
Pacer
A
B
C
D
Persistent Fetal Circulation
A
B
C
D
Pulmonary Interstitial Emphysema
A
B
C
D
Thoracotomy
A
B
C
D
Transient Tachypnea/Neoborn
A
B
C
D
AGE SPECIFIC EXPERIENCES AND CERTIFICATIONS
Key - for each box mark:
1 - Limited knowledge and experience,
2 - Some knowledge and experience,
3 - Very knowledgeable and experienced,
4 - Extremely knowledgeable and experienced
Age Specific Experiences
Infants and Toddlers
(birth-2 years)
Children
(3-12 years)
Adolescent
(13-18 years)
Young Adult
(19-39 years)
Middle Adults
(40-64 years)
Older Adult
(65+ years)
1. Knows the normal growth and development for each age group and adapts care accordingly.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
2. Knows the different
communication needs for each age
group and changes communication
methods and terminology
accordingly.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
3. Knows the different safety
risks for each age group and alters
the environment accordingly.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
4. Knows the different
medications, dosages, and possible
side effects for each age group and
administers medications
accordingly.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
My experience is primarily in
(Please indicate number of years):
Medical
year(s)
Neurology
year(s)
Surgical
year(s)
Pulmonary
year(s)
Telemetry
year(s)
Renal/GU
year(s)
Orthopedics
year(s)
Women's
year(s)
Oncology
year(s)
Other
year(s)
Certifications
BCLS
Expiration Date (mm/yyyy)
ACLS
Expiration Date (mm/yyyy)
Other
Expiration Date (mm/yyyy)
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 the information to client facilities of PPR in relation to consideration of my employment to those facilities.
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