Telemetry / Progressive Care Skill Checklist Name* First Last Email* Phone*Proficiency: 1 = Minimal Experience 2 = Limited Experience 3 = Competent 4 = Highly SkilledCardiacInterpretation of Arrhythmias* 1 2 3 4 Pacemakers-Permanent* 1 2 3 4 Cardiac Arrest / CPR* 1 2 3 4 Telemetry* 1 2 3 4 Interpretation of Hemodynamic Monitoring* 1 2 3 4 Art Line (Transducer Setup-D/C)* 1 2 3 4 Swan Ganz (Transducer Setup-D/C)* 1 2 3 4 Sheath Removal-Femoral* 1 2 3 4 Aneurysm* 1 2 3 4 Angina* 1 2 3 4 CHF* 1 2 3 4 Post MI* 1 2 3 4 Pre / Post Cardiac Cath* 1 2 3 4 Pre / Post Cardiac Surgery* 1 2 3 4 Open Sternal Wounds (Debridement)* 1 2 3 4 Use & Administration of the Following* 1 2 3 4 Atropine* 1 2 3 4 Digoxin* 1 2 3 4 Dopamine* 1 2 3 4 Inderal* 1 2 3 4 Lidocaine* 1 2 3 4 Neosynephrine / Nipride* 1 2 3 4 Nitroglycerin* 1 2 3 4 Pronestyl* 1 2 3 4 Quinidine* 1 2 3 4 Titrate Morphine* 1 2 3 4 Verapamil* 1 2 3 4 Thrombolytic Agents* 1 2 3 4 Preparation of Emergency Drugs* 1 2 3 4 RespiratoryEstablishing an Airway* 1 2 3 4 Ambuing Techniques* 1 2 3 4 Chest Tubes (Emerson / Pleur-evac)* 1 2 3 4 Pulse Oximetry* 1 2 3 4 Interpretation of ABG* 1 2 3 4 Use of IPPB* 1 2 3 4 Incentive Spirometer* 1 2 3 4 Oral Suctioning* 1 2 3 4 Nasotracheal Suctioning* 1 2 3 4 COPD* 1 2 3 4 ARDS* 1 2 3 4 Pre / Post Thoracic Surgery* 1 2 3 4 Pulmonary Embolism* 1 2 3 4 Pulmonary Edema* 1 2 3 4 Pneumothorax* 1 2 3 4 Pneumonia* 1 2 3 4 Inhalation Injuries* 1 2 3 4 Emphysema* 1 2 3 4 Asthma* 1 2 3 4 Aminophylline* 1 2 3 4 Corticosteroids* 1 2 3 4 Bronkosol* 1 2 3 4 Ventolin* 1 2 3 4 Alupent* 1 2 3 4 NeurologyAssessment of Neuro Signs* 1 2 3 4 Glasgow Coma Scale* 1 2 3 4 Seizure Precautions* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Halo Traction* 1 2 3 4 CVA* 1 2 3 4 Seizure Activity* 1 2 3 4 Overdose* 1 2 3 4 Neuro Injury / Trauma* 1 2 3 4 Head Injury / Trauma* 1 2 3 4 Pre / Post Neuro Surgery* 1 2 3 4 Cranial Hemorrhage* 1 2 3 4 Multiple Sclerosis* 1 2 3 4 Post-Op AV-Shunt* 1 2 3 4 Decadron* 1 2 3 4 Dilantin* 1 2 3 4 Magnesium Sulfate* 1 2 3 4 Phenobarbital* 1 2 3 4 Steroids* 1 2 3 4 Valium* 1 2 3 4 Versed* 1 2 3 4 Cardiac MonitorsHewlett-Packard* 1 2 3 4 Spacelab* 1 2 3 4 Siemens* 1 2 3 4 Marquette* 1 2 3 4 Mennen* 1 2 3 4 Lifecare* 1 2 3 4 Nihon Koder* 1 2 3 4 VascularPeripheral Pulses* 1 2 3 4 Fluid Overload* 1 2 3 4 Ultrasonic Doppler* 1 2 3 4 Starting IV's* 1 2 3 4 Subcutaneous Central Line* 1 2 3 4 Hickman / Broviac / Groshong Catheters* 1 2 3 4 Maintenance of Heparin Lock* 1 2 3 4 TPN / Hyperalimentation* 1 2 3 4 Air Occlusive Dressing* 1 2 3 4 Knowledge of Normal Serum Lab Values* 1 2 3 4 Administration of Blood & Blood Products* 1 2 3 4 Infusion Pumps* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 Hemodialysis* 1 2 3 4 Heparin Drip (Precautions & Maintenance)* 1 2 3 4 HiddenSickle Cell Anemia* 1 2 3 4 Thrombophlebitis* 1 2 3 4 GastrointestinalNG Tube Insertion* 1 2 3 4 Gastrostomy Tube* 1 2 3 4 Jejunostomy Tube* 1 2 3 4 Enterostomal Care* 1 2 3 4 Pancreatitis* 1 2 3 4 G.I. Bleed* 1 2 3 4 Esophageal Bleeding* 1 2 3 4 Bowel Obstruction* 1 2 3 4 Whipple Procedure* 1 2 3 4 Liver Transplant* 1 2 3 4 Paralytic Ileus* 1 2 3 4 E.R.C.P.* 1 2 3 4 Genitourinary / RenalFoley Catheter Insertion* 1 2 3 4 GU Irrigations* 1 2 3 4 Nephrostomy Tube* 1 2 3 4 Suprapubic Tube* 1 2 3 4 Electrolyte Imbalance / Replacement* 1 2 3 4 T.U.R.P.* 1 2 3 4 Shunts & Fistulas* 1 2 3 4 Nephrectomy* 1 2 3 4 Renal Transplant* 1 2 3 4 Renal Trauma* 1 2 3 4 Chronic / Acute Renal Failure* 1 2 3 4 GynecologyGYN Exam / Pap* 1 2 3 4 Self Breast Exam* 1 2 3 4 Tubal Ligation* 1 2 3 4 Ectopic Pregnancy* 1 2 3 4 Mastectomy* 1 2 3 4 Hysterectomy* 1 2 3 4 Repair of Cystocele / Rectocele* 1 2 3 4 OrthopedicTotal Joint Replacement* 1 2 3 4 Arthroscopic Surgery* 1 2 3 4 Bucks Extension* 1 2 3 4 K-Wires / Steinmann Pins* 1 2 3 4 Removal of Hardware* 1 2 3 4 Spica Cast / Body Cast* 1 2 3 4 Cast Removal* 1 2 3 4 Amputation* 1 2 3 4 Skeletal Traction* 1 2 3 4 Ortho Trauma* 1 2 3 4 Laminectomy* 1 2 3 4 Delirium Tremens* 1 2 3 4 HIV Infection* 1 2 3 4 AIDS* 1 2 3 4 Oncology* 1 2 3 4 Chemotherapy* 1 2 3 4 Isolation Techniques* 1 2 3 4 Diabetic Teaching* 1 2 3 4 Patient Teaching* 1 2 3 4 Burn Patients* 1 2 3 4 Accu-Check* 1 2 3 4 VentilatorsBear I* 1 2 3 4 Bear II* 1 2 3 4 Bear IV* 1 2 3 4 Bennett 7200* 1 2 3 4 CPAP* 1 2 3 4 Emerson* 1 2 3 4 Engstrom / Erica* 1 2 3 4 EMV* 1 2 3 4 MA-I* 1 2 3 4 MA-II* 1 2 3 4 Monaghan* 1 2 3 4 Ohio 560* 1 2 3 4 PEEP* 1 2 3 4 Pressure Pre-Set* 1 2 3 4 Servo 900b* 1 2 3 4 Servo 900c* 1 2 3 4 Servo 900e* 1 2 3 4 Siemens* 1 2 3 4 Age Specific CompetencyNewborn / Neonate (Birth - 30 days)* 1 2 3 4 Infant (30 days - 1 year)* 1 2 3 4 Toddler (1 - 3 years)* 1 2 3 4 Preschooler (3 - 5 years)* 1 2 3 4 School Age Children (5 - 12 years)* 1 2 3 4 Adolescents (12 - 18 years)* 1 2 3 4 Young Adults (18 - 39 years)* 1 2 3 4 Middle Adults (39 - 64 years)* 1 2 3 4 Older Adults (64 - 79 years)* 1 2 3 4 Elderly Adults (Over 79+ years)* 1 2 3 4