MATRIX PERSONNEL SERVICE, INC.
RN PROFICIENCY RECORD ( SKILLS CHECKLIST )
INTENSIVE CARE UNIT

 


NAME DATE

E -MAIL ADDRESS

 

LEVEL OF PROFICIENCY
Theory - NO Experience
1
Minimal Experience
2
Competent and Experienced
3

SKILLS
1
2
3
PRECAUTIONS
Isolation
Universal Precautions
Respiratory
Contact
Strict
Reverse
Neurological
Seizure
Grand Mal Seizure
Aneurysm
Cardiac
Suicide
INTRAVENOUS THERAPY
Start IV’s
Heparin Lock
Angiocaths
Intracath (Jelco)
Instyle
Mixing IV Medications
Medication Administration
Discontinue Peripheral IV
IVAC Infusion Monitor
IMED Infusion Pump
Institute & Monitor Blood Products
CVP’s
Set-up and Assist with CVP Insertion
Measuring CVP’s
CVP Dressing
Hyperalimentation Solutions
Hyperalimentation Dressings
Hyperalimentation Precautions
Assist with Insertion of Arterial Lines
Assist with Insertion of Swan Ganz
Swan Ganz Catheters PA Pressure
PCWP Reading
Set-up and/or change tubing of Swan Ganz Catheter
RESPIRATORY PROBLEMS
Patient Care after Thoracotomy
Patient Care in Pulmonary Edema
Suctioning Oralpharyngeal Airway
Cuffed Tracheostomy Tubes
Cuffed Endotracheal Tubes
OXYGEN EQUIPMENT
Partial Rebreather
Non-Rebreather
Venturi
IPPB Machine
Ventilators
Volume – VIP
Volume – Emerson
Volume – MA-I
Volume – 7200
IMV
PEEP
CPAP
Chest Physical Therapy
Assist with Intubation
Extubation
TRACHEOSTOMY
Silver
Fenestrated
Portex
Shiley
CHEST TUBES
Assist with Insertion
Water Seal
3 Bottle Suction
Pleurvac
BLOOD GASES
Obtain from Arterial Line
Interpretation of ABG’s/VBG’s
Arterial Puncture
NEURO AND ORTHO EQUIPMENT
Circo – Electric Bed
Stryker Frame
Halo Traction
Crutchfield Tongs
Roto Bed
Balkan Frame
Buck’s Extension
Balanced Suspension
K Wires
Other Skeletal Traction
Cast Care
Spika Casts
Soft Cast
Crutch Walking
ICP Monitoring
Pupillary Reaction
GASTROINTESTINAL PROBLEMS
Care of the Patient with Multiple Abdominal Wounds & Drains
Levine Tube
Salem Sump Tube
Care of the Patient with Sengstaken-Balckmore Tube
Miller Abbott
Kaslow (Kantor)
J-Tube
Gastrostomy Tube
RENAL – GU
Care of the Patient in Acute Renal Failure
Foley Catheter
3-Way Foley
Coude
GU Irrigations
Intermittent Irrigations
Continuous Irrigation
Tidal Drainage
Suprapubic Catheter
Nephrostomy Tube
Hemo Dialysis
Peritoneal Dialysis
CARDIOVASCULAR
Care of the Open Heart
Care of the Fresh MI
Cardiac Monitors
Take Rhythm Strips
Dysrhythmia Interpretation
Interpretation of 12 Lead EKG
Telemetry
Automatic Rotating Tourniquets
Temporary Pacer Insertion
Defibrillation and Emergency Drug Therapy
Cardioversion
Anthrombic Pump
Aortic Balloon Pump
Ultrasonic Doppler
Mast Suit
Care of the Patient With
Aneurysms
Fem-Pop Bypass
Thoracic Surgery
Carotid Endarectomy
Tracheal Occlusion
Delirium Tremors
Near Drowning
Adult Respiratory Distress Syndrome
Coronary Artery Bypass
Angioplasty
Hypothermia Management
Overdose
Burns
GI Bleeds
Dehiscence
Nephrectomy
Shock
Acute MI – CHF – Angina
ARRESTS
Initiated Resuscitation
Prepare Meds
Active Participation
CPR
DRAWING BLOOD
Arterial
Venous
Capillary
PREPARATION AND USE OF
Adenosine
Amiodarone
Atropine
Bretylol
Decadron
Dextran
Dobutamine (Dobutrex)
Dopamine
Dilantin
Epinephrine
Heparin
Lidocaine
Mannitol
Nipride
Nitroglycerine Drip
Paralyzing Agents
Phenobarbital
Pronestyl
Streptokinase
Vasopressin



Certification
Expiration Date
Certification
Expiration Date
ACLS
PALS
BLS
TNCC
CEN
Other  
ENPC
Other  


NOTES: Please enter information you feel is important or necessary to give further explanation for the information provided above.

.
The above box is a scrolling text area and will scroll as you type to accommodate text beyond the size of the box.

By typing my name in the space provided below I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities. Type your name here >>>