TELEMETRY / INTERMEDIATE CARE KNOWLEDGE & SKILLS

CHECKLIST_
NAME:       DIRECTIONS: Please indicate your level of experience by
ID #:       placing a check (√) in the box. Experience level:
DATE:       1 NO EXPERIENCE
2 MINIMAL EXPERIENCE-requires supervision/assistance
This Skills Checklist is for use by nurses with more than
3 MODERATELY EXPERIENCED-requires initial review,
one year experience in their discipline and specialty.
Please be accurate with your assessment. then performs independently
4 VERY EXPERIENCED- proficient
DESCRIPTION 1 2 3 4
CARDIOVASCULAR DESCRIPTION 1 2 3 4
1. Assessment: 3. Care of the patient with:
a. Auscultation (rate, rhythm) a. Abdominal aortic bypass
b. Heart sounds/murmurs b. Aneurysm
c. Pulses/circulation checks c. Angina
2. Equipment & Procedures: d. Cardiac arrest
a. Arrhythmia Interpretation: e. Congestive heart failure (CHF)
(1) Asystole f. Femoral-popliteal bypass
(2) Atrial fibrillation g. Post acute MI (24-48 hours)
(3) Atrial flutter h. Post angioplasty
(4) Bradycardia i. Post CABG (24 hours)
(5) First degree heart block j. Post cardiac cath
(6) Premature atrial contractions k. Post stent placement
(7) Premature ventricular contractions 4. Medications:
(8) Second degree heart block a. Atropine
(9) Sino ventricular Tachycardia b. Bretylim (Bretylol)
(10) Sinus rhythm c. Cardizem (Ditiazem hydrochloride)
(11) Tachycardia d. Digoxin (Lanoxin)
(12) Third degree heart block e. Dobutamine (Dobutrex)
(13) Ventricular Tachycardia f. Dopamine (Intropin)
(14) Ventricular fibrillation g. Epinephrine (Adrenalin)
(15) Basic 12 lead interpretation h. Heparin
b. Pacemaker: i. Lidocaine (Xylocaine)
(1) Permanent j. Nipride (Nitroprusside)
(2) Temporary k. Nitroglycerine (Tridil)
c. Assist with: l. Indural
(1) Arterial line insertion m. Procainamide
(2) Central Line insertion n. Verapamil
d. Hemodynamic monitoring: PULMONARY
(1) A-line (radial) 1. Assessment:
(2) CVP monitoring a. Breath sounds
e. Perform: b. Breathing patterns
(1) Controlled cardio version 2. Equipment and procedures:
(2) Emergency defibrillation a. Assist with intubation
b. Assist with thoracentesis
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 TELEMETRY / INTERMEDIATE CARE KNOWLEDGE & SKILLS
CHECKLIST_

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
c. Care of airway management devices/suctioning: c. Seizure precautions
(1) Endotracheal tube/suctioning 3. Care of the patient with:
(2) Nasal airway/suctioning a. Closed head injury
(3) Oropharyngeal/suctioning b. Coma
(4) Pulse Oximetry c. CVA/TIA
(5) Tracheostomy/suctioning d. DTs
d. Care of patient on ventilator: e. Encephalitis
(1) Extubation f. Meningitis
(2) Weaning modes h. Post craniotomy
e. Care of patient with chest tube: i. Seizures
(1) Assist with set-up & insertion j. Spinal cord injury
(2) Removal GASTROINTESTINAL
f. Establishing an airway 1. Assessment:
g. Incentive spirometry a. Abdominal/bowel sounds
h. O2 therapy & medication delivery systems: b. Fluid balance
(1) Ambu bag and mask c. Nutritional
(2) ET tube 2. Equipment & procedures:
(3) External CPAP a. Administration of tube feeding
(4) Face masks b. Placement of nasogastric tube
(5) Inhalers c. Salem sump to suction
(6) Nasal cannula 3. Management of:
(7) Tracheostomy a. Gastrostomy tube
i. Oral airway insertion b. Jejunostomy tube
3. Care of the patient with: c. PPN (peripheral parenteral nutrition)
a. ARDS d. TPN and lipids administration
b. Bronchoscopy e. T-tube
c. COPD 4. Care of the patient with:
d. Fresh tracheostomy a. Bowel obstruction
e. Pneumonia b. Colostomy
f. Pulmonary edema c. GI bleeding
g. Pulmonary embolism d. GI surgery
h. Status asthmaticus e. Hepatitis
i. Thoracotomy f. Ileostomy
j. Tuberculosis g. Liver failure
NEUROLOGICAL h. Liver transplant
1. Assessment: i. Pancreatitis
a. Glasgow coma scale j. Whipple procedure
b. Level of consciousness RENAL/GENITOURINARY
2. Equipment and procedures: 1. Assessment:
a. Assist with lumbar puncture a. A-V fistula/shunt
b. Halo traction b. Fluid & electrolyte balance

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 TELEMETRY / INTERMEDIATE CARE KNOWLEDGE & SKILLS
CHECKLIST_

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
2. Equipment & procedures: 2. Equipment & procedures:
a. Insertion & care of straight and Foley catheter: a. Air fluidized, low airloss beds
(1) Female b. Sterile dressing changes
(2) Male c. Wound care/irrigations
(3) Supra-pubic 3. Care of the patient with:
b. Bladder irrigation: a. Decubitus
(1) Continuous b. Surgical wounds with drain(s)
(2) Intermittent c. Traumatic wounds
c. Manual CAPD administration PHLEBOTOMY/IV THERAPY
d. Peritoneal dialysis 1. Equipment & procedures:
3. Care of the patient with: a. Drawing blood from central line
a. Hemodialysis b. Drawing venous blood
b. Nephrectomy c. Starting IVs:
c. Peritoneal dialysis (1) Heparin lock
d. Renal failure d. Administration of blood/blood products:
e. Renal transplant (1) Albumin/plasma
f. TURP (2) Packed red blood cells
METABOLIC (3) Platelets
1. Equipment & procedures: 2. Care of the patient with:
a. Blood glucose monitoring: a. Central line/catheter/dressing:
(1) Blood glucose measuring device: (1) Hickman
Type:       (2) Portacath
2. Care of the patient with: b. Peripheral line/dressing
a. Cushing’s syndrome PAIN MANAGEMENT
b. Diabetes insipidus 1. Assessment of pain level/tolerance
c. Diabetes mellitus 2. Care of the patient with:
d. Diabetic ketoacidosis a. Anesthesia/analgesia
e. Adrenal gland disorders (Addison’s) b. IV conscious sedation
f. Drug overdose c. Narcotic analgesia
g. Hyperthyroidism (Grave’s Disease) d. Patient controlled analgesia (PCA pump)
h. Hypothyroidism MISCELLANEOUS
i. Post adrenalectomy 1. Interpretation of lab values:
j. Post thyroidectomy a. Blood chemistry
3. Medications: b. Blood hematology
a. Hydrocortisone c. Cardiac enzymes
b. IM vasopressin (Pitressin) d. Blood gases
c. Insulin drip 2. Computerized charting
WOUND MANAGEMENT a. Cerner
1. Assessment: b. Eclipsys
a. Skin for impending breakdown c. Epic
b. Surgical wound healing d. McKesson

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 TELEMETRY / INTERMEDIATE CARE KNOWLEDGE & SKILLS
CHECKLIST_
DESCRIPTION 1 2 3 4 MY EXPERIENCE IS PRIMARILY IN:
MISCELLANEOUS (CONT)
2. Computerized charting (cont) NEUROLOGY       years
e. Meditech PULMONARY       years
f. Other: SURGICAL       years
MEDICAL       years
CARDIAC CARE       years
Name:       TELEMETRY       years

Please check the boxes below for each age group for I HAVE CURRENT CERTIFICATIONS FOR:
which you have expertise in providing age-appropriate
nursing care. TYPE COURSE DATE (MM/DD/YY)
ARRHYTHMIA      
A. Newborn/Neonatal (birth – 30 days) CRITICAL CARE      
B. Infant (30 days – 1 year) ACLS      
C. Toddler (1 – 3 years) BLS      
D. Preschool (3 – 5 years) TNCC      
E. School Age Children (5 – 12 years) NRP      
F. Adolescent (12 – 18 years) PALS      
G. Young Adults (18 – 39 years) NALS      
H. Middle Adults (40 – 64 years) Other            
I. Older Adults (64 + years) Other            
Other            
EXPERIENCE WITH AGE GROUPS: Other            
1. Able to assess age appropriate behavior, motor skills
and physiological norms. The information I have provided in this knowledge and
A B C D E F G H I skills checklist it true and accurate to the best of my
knowledge.

2. Able to adapt care according to normal growth and            

development. Signature (Written/Electronic) Date
A B C D E F G H I ID #:      

This skills checklist has been reviewed and approved by

3. Able to communicate and instruct patient according to Nicole Bloxham, RN.
their age, maturity and comprehension ability.
A B C D E F G H I            
Signature (Written/Electronic) Date
ID #:      
4. Able to provide a safe environment according to the
specific needs of various age groups. Please return to: Northwest Nurse Staffing Company, PA
A B C D E F G H I ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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