CARDIOVASCULAR

1

2

3

4

5

GASTROINTESTINAL

1

2

3

4

5

1. Assessment

1. Assessment

        a. Auscultation (Rate, Rhythm)

X

        a. Abdominal/Bowel Sounds

X

        b. Doppler

X

        b. Fluid Balance

X

        c. Heart Sounds/Murmurs

X

        c. Nutritional Status

X

2. Equipment & Procedures

2. Interpretation of Blood Chemistry

X

        a. Assist with Insertion and Set Up

3. Equipment & Procedures

                 i. Arterial Line

X

        a. Placement of Nasogastric Tube

X

                 ii. Central Venous Line

X

        b. Salem Sump to Suction

X

                 iii. PA Catheter/Swan-Ganz Insertion

X

        c. Saline Lavage

X

                 iv. Pacemaker

X

4. Care of the Patient with:

        b. Cardioversion

X

        a. Abdominal Trauma

X

        c. Interpret Waveforms & Values

        b. Bowel Obstruction

X

                 i. Arterial Line

X

        c. GI Bleeding

X

                 ii. CVP

X

        d. Hepatitis

X

        d. Monitoring

        e. Liver Failure

X

                 i. Basic 12 Lead Interpretation

X

5. Medications

                 ii. Basic Arrhythmia Interpretation

X

        a. Antiemetics

X

3. Care of the Patient with:

        b. Antispasmodic

X

        a. Acute MI

X

        c. Charcoal

X

        b. Aneurysm

X

        d. Ipecac

X

        c. Angina

X

RENAL/GENITOURINARY

1

2

3

4

5

        d. Cardiac Arrest

X

1. Assessment - Fluid Balance

X

        e. Congestive Heart Failure (CHF)

X

2. Interpretation of Lab Results

         f. Myocarditis

X

        a. BUN & Creatinine

X

4. Medications

        b. Electrolytes

X

        a. ACLS Drugs

3. Equipment & Procedures

                 i. Atropine

X

        a. Insertion / Care of Straight / Foley Catheter

                 ii. Bretylium (Bretylol)

X

                 i. Female

 X

                 iii. Epinephrine (Adrenalin)

X

                 ii. Male

X

                 iv. Lidocaine (Xylocaine)

X

        b. Urine Specimen Collection

X

CARDIOVASCULAR (continued)

1

2

3

4

5

RENAL/GENITOURINARY (continued)

1

2

3

4

5

                 v. Procainamide (Pronestyl)

X

4. Care of the Patient with:

                 vi. Sodium Bicarbonate

X

        a. Acute Renal Failure

X

        b. Other

        b. Peritoneal Lavage

X

                  i. Adenosine (Adenocard)

X

        c. Renal Trauma

X

                 ii. Amiodarone (Cordarone)

X

        d. Urinary Tract Infection

X

                 iii. Digoxin (Lanoxin)

X

ENDOCRINE/METABOLIC

1

2

3

4

5

                 iv. Diltiazem (Cardizem)

X

1. Assessment

                 v. Dobutamine (Dobutex)

X

        a. Signs & Symptoms Diabetic Coma

X

                 vi. Dopamine (Intropin)

X

        b. Signs & Symptoms Insulin Reaction

X

                 v. Esmolol (Brevibloc)

X

2. Equipment & Procedures

                 vi. Lasix (Furosemide)

X

        a. Blood Glucose Monitoring

                 vii. Nitroglycerin (Tridil)

X

                  i. Electronic Measuring Device:

X

                 viii. Nitroprusside (Nipride)

X

                  ii. Performing Finger Stick

X

                  ix. Thrombolytic Therapy

X

3. Care of the Patient with:

PULMONARY

1

2

3

4

5

        a. Diabetic Ketoacidosis

X

1. Assessment

 4. Medications

        a. Breath Sounds

X

        a. Insulin

X

        b. Rate and Work of Breathing

X

        b. Oral Hypoglycemics

X

2. Interpretation of Lab Results

WOUNDS & SURGICAL

1

2

3

4

5

        a. Arterial Blood Gases

X

1. Equipment & Procedures

3. Equipment & Procedures

        a. Application of Steristrips

X

        a. Airway Devices/Suctioning

        b. Assist with Staples

X

                 i. Endotracheal Tube/Suctioning

X

        c. Assist with Sutures

X

                 ii. Nasal Airway/Suctioning

X

        d. Culdocentesis Tray

X

                 iii. Oropharyngeal/Suctioning

X

        e. Set Up Suture Tray

X

                 iv. Sputum Specimen Collection

X

         f. Staple Removal

X

                 v. Tracheostomy/Suctioning

X

        g. Suture Removal

X

        b. Assist with Extubation

X

EENT

1

2

3

4

5

        c. Assist with Intubation

X

1.  Assessment

        d. Assist with Thoracentesis

X

         a. Set up Fluorescent/Woods Lamp Exam

X

        e. Care of the Patient on a Ventilator

X

        b. Visual Acuity

X

         f. Care of Patient with a Chest Tube

2. Equipment & Procedures

                 i. Assist with Set-Up & Insertion

X

        a. Application of Eye Patch

X

                 ii. Measuring

X

        b. Ear Irrigation

X

                 iii. Removal

X

        c. Eye Irrigation

X

        g. Measure Peak Flow

X

        d. Morgan Lens Irrigation

X

PULMONARY (continued)

1

2

3

4

5

EENT (continued)

1

2

3

4

5

        h. Obtaining Arterial Blood Gases

        e. Nasal Packing

                 i. Arterial Line

X

         f. Removal of Contact Lens

                 ii. Femoral Artery

X

TRAUMA/SHOCK

1

2

3

4

5

                 iii. Radial Artery

X

1. Assessment

         i. O2 Therapy & Medication Delivery

        a. Champion Trauma Score

X

                 i. Bag and Mask

X

        b. Poison Index

X

                 ii. ET Tube

X

        c. Triage

X

                 iii. External CPAP

X

2. Equipment & Procedures

                 iv. Face Masks

X

        a. Air Transport of Trauma Patient

X

                 v. Inhalers

X

        b. Application of Mast Suit

X

                 vi. Nasal Cannula

X

        c. Ground Transport

X

                 vii. Nebulizer

X

3. Care of the Patient with:

                 viii. Portable O2 Tank

X

        a. Bites, Animal

X

                 viiii. T-piece

X

        b. Bites, Human

X

                 x. Tracheostomy Collar

X

        c. Bites, Venomous Snake

X

         j. Pulse Oximetry

X

        d. Bites, Venomous Spider

X

         k. Troubleshoot High Pressure Alarms

X

        e. Burns

         l. Troubleshoot  Low Pressure Alarms

X

                i. Rule of Nines

X

 4. Care of the Patient with:

                ii. First Degree

X

        a. Aspiration

X

                iii. Second Degree

X

        b. COPD

X

                iv. Third Degree

X

        c. Hemopneumothorax

X

         f. Dehydration

X

        d. Laryngospasm

X

        g. Electrocution

X

        e. Pneumonia

X

        h. Gunshot/Stab Wound

X

         f. Pneumothorax

X

         i. Hazardous Material Exposure

X

        g. Pulmonary Edema

X

         j. Heat Exhaustion/Stroke

X

        h. Pulmonary Embolism

X

        k. Hypothermia

X

         i. Tension Pneumothorax

X

         l. Major Trauma

X

         j. Tuberculosis

X

        m. Minor trauma

X

 5. Medications

        n. Radiation Exposure

X

        a. Aminophylline (Theophylline)

X

        o. Shock

        b. Bronkosol

X

                 i. Anaphylactic

X

        c. Epinephrine (Adrenalin)

X

                 ii. Cardiogenic

X

        d. Isuprel

X

                 iii. Hypovolemic

X

        e. Steroids

X

                 iv. Neurogenic

X

         f. Terbutaline

X

                 v. Septic

X

NEUROLOGICAL

1

2

3

4

5

        p. Traumatic Amputation

X

 1. Assessment

        q. Biological Weapons

X

NEUROLOGICAL (continued)

1

2

3

4

5

INFECTIOUS DISEASES (cont.d)

1

2

3

4

5

        a. Advanced Neuro Assessment

 1. Interpret Lab Values- CBC, SMA 7

X

                 i. Glasgow Coma Scale

X

 2. Equipment & Procedures

                 ii. Reflex/Motor Deficits

X

        a. Fever Management

X

                 iii. Visual/ Communication Deficit

X

        b. Isolation

X

        b. Level of Consciousness

X

 3. Care of the Patient with AIDS

X

 2. Equipment & Procedures

PHLEBOTOMY & IV THERAPY

1

2

3

4

5

        a. Assist with Lumbar Puncture

X

 1. Equipment & Procedures

        b. Increased ICP Management

        a. Admin. of Blood/Blood Products

                 i. Medications

X

                 i. Autotransfusion

X

                 ii. Positioning

X

                 ii. Cryoprecipitate

X

                 iii. Regulation of ICP

X

                 iii. Packed Red Blood Cells

X

                 iv. Temperature Control

X

                 iv. Plasma/Albumin

X

                 v. Ventilation

X

                  v. Whole Blood

X

        c. Intracranial Pressure Monitoring

       b. Assist with Cutdown

X

 3. Care of the Patient with:

       c. Drawing Venous Blood

X

        a. Basal Skull Fracture

X

       d. Starting IVs Using:

        b. Closed Head Injury

X

                  i. Angiocath

X

        c. CVA / Stroke

X

                  ii. Butterfly

X

        d. DTs / Delirium Tremens

X

                  iii. Heparin Lock

X

        e. Encephalitis

X

2. Care of the Patient with:

         f. Externalized Ventriculo-Peritoneal Shunts

X

        a. Angiography

X

        g. Meningitis

X

        b. Central Line/Catheter/Dressing

        h. Neuromuscular Disease

X

                  i. Broviac/Hickman

X

         i. Overdose

X

                  ii. Groshong

X

         j. Seizures

X

                  iii. PICC

X

        k. Spinal Cord Injury

X

                  iv. Portacath

X

 4. Medications

        c. Pericardiocentesis

X

        a. Decadron (Dexamethasone)

X

PAIN MANAGEMENT

1

2

3

4

5

        b. Dilantin (Phenytoin)

X

1. Assessment of Pain Level/Tolerance

X

        c. Mannitol (Osmitrol)

X

2. Care of the Patient with:

        d. Phenobarbital

X

        a. Epidural Anesthesia/Analgesia

X

        e. Solu-Medrol

X

        b. IV Conscious Sedation

X

ORTHOPEDICS

1

2

3

4

5

PEDIATRICS

1

2

3

4

5

1. Assessment

1. Equipment & Procedures

        a. Circulation Checks

X

        a. Child Abuse/Recognition/Reporting

X

        b. Gait

X

        b. Obtaining Consent to Treat

X

        c. Range of Motion

X

        c. Pediatric Arrest

X

        d. Skin

X

ORTHOPEDICS (continued)

1

2

3

4

5

PEDIATRICS (continued)

1

2

3

4

5

 2. Equipment & Procedures

2. Care of the Patient with:

        a. Assist with Application of Cast

X

        a. Epiglottitis

X

        b. Support Devices

        b. Near Drowning

X

                 i. Cane/Crutch

X

        c. Overdose/Poison Ingestion

X

                 ii. Cervical Collar

X

        d. Status Asthmaticus

X

                 iii. Sling

X

        e. Status Epilepticus

X

                 iv. Transfer Boards

X

GYNECOLOGY

1

2

3

4

5

 3. Care of the Patient with:

 1. Assessment - Assist with Pelvic Exam

 X

        a. Ankle Brace

X

 2. Equipment & Procedures

        b. Ankle Splint

X

        a. Pelvic Tray

X

        c. Cast

X

        b. Rape Kit

X

        d. Knee Immobilizer

X

        c. Reporting Acts of Violence

X

        e. Pinned Fractures

X

 3. Care of the Patient with:

         f. Wrist Splint

X

        a. Abruptio Placenta

X

MISCELLANEOUS

1

2

3

4

5

        b. DIC

X

 1. AMA Procedures

X

        c. Hemorrhage

X

 2. Suicide Precautions

X

        d. Placenta Previa

X

        e. Precipitous Delivery

X

         f. Preeclampsia/Eclampsia

X

        g. Spontaneous Abortion

X

                                  AGE SPECIFIC CARE CRITERIA

    This section serves to clarify your experience and expertise in providing the appropriate care

    and instruction to patients of different age groups. 

     EXPERIENCE WITH AGE GROUPS:

·          Able to adapt care to incorporate normal growth and development.

·          Able to adapt method and terminology of patient instructions to their age, comprehension

        and maturity level.

·          Can ensure a safe environment reflecting specific needs of various age groups.

    Please check  [√ ]  the boxes below for each age group - Indicating the level of expertise you

    believe your experience provides you relative to the experience criteria listed above:

AGE GROUPS

LIMITED

AVERAGE

HIGH

A. Newborn/Neonate (birth - 30 days)

X

B. Infant (30 days - 1 year)

X

C. Toddler (1 - 3 years)

X

D. Preschooler (3 - 5 years)

X

E. School age children (5 - 12 years)

X

F. Adolescents (12 - 18 years)

X

G. Young adults (18 - 39 years)

X

H. Middle adults (39 - 64 years)

X

I.   Older adults (64+)

X

CLINICAL AREA

#YRS

CLINICAL AREA

#YRS

Trauma Referral Center (Level I)

x

Trauma

 x

Community ER (Level II)

x

OTHER:  (Specify)

Rural ER (Level III)

ICU

x

TYPE

DATE

TYPE

EXP. DATE

BCLS

XX/XX

ACLS

XX/XX

Computerized Charting

ENPC

Medication Administration

TNCC

CCRN

CEN

TNCC

MICN

xx/xx

PRINTED NAME:  ________Jane Doe______________________________