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Pediatric Intensive Care Skills Checklist

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Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 1 = Never Performed     2 = Limited Experience     3 = Comfortable Performing     4 = Proficient


CARE OF PATIENTS WITH  1   2   3   4 
Acute Renal Failure
Acute Tumor Lysis Snydrome
Acyanotic Heart Disease
Anorexia/Bulimia
Bacterial Endocarditis
Blunt Trauma
Bone Marrow Transplant
Brain Death/Organ Procurement
Bronchiolitis
Bronchopulmonary Dysplasia (BPD)
Burns
   a. First Degree
   b. Second Degree
   c. Third Degree
Cardiac Catherization
Cardiac Defects
   a. Coarctation of the Aorta
   b. Hypoplastic Heart
   c. Septal Defects
   d. Tetralogy of Fallot
   e. Transposition of the Great Vessels
Cardiac Transplant
Cardiomyopathy
Choking/Asphyxiation
Chronic Respiratory Disease
Crohn's Disease
Coma
Craniofacial Reconstruction
Croup
Cystic Fibrosis
Cytomegalovirus (CMV)
Developmental Delay
Diabetes Insipidus
Diabetic Coma
Encephalitis
Epiglottitis
Externalized VP Shunt/Reservoir
Flail Chest
Foreign Body Aspiration
Gastroenteritis/Severe Dehydration
Gastroesophageal Reflux
GI Bleed
Gun Shot/Stab Wound
   a. Abdomen
   b. Chest
   c. Head
Head Trauma
Hepatic Failure
CARE OF PATIENTS WITH  1   2   3   4 
Hepatitis
Hemolytic Uremic Syndrome
Hemothorax
HIV/AIDS
Intussusception
Kawasaki Disease
Leukemia
Malignant Tumors
Meningitis
MRSA
Multiple Trauma
Myocarditis
Near Drowning
Nephritis
Nephrotic Snydrome
Neuromuscular Diseases
Pancreatitis
Pinned Fractures
Poison Ingestion/Overdoses
Pneumonia
Pneumothorax
Post-Operative Care for:
   a. Cardiothoracic Surgery
   b. GI Surgery
   c. Neurosurgery
   d. Orthopedic Surgery
   e. Tracheostomy
   f. ENT Surgery
Radiation Implant
Renal Transplant
Respiratory Failure
Respiratory Syncytial Virus (RSV)
Severe Respiratory Distress
Shock
   a. Anaphylactic
   b. Cardiogenic
   c. Hypovolemic
   d. Septic
SIADH
Sickle Cell Anemia
Spinal Cord Injuries
Status Asthmaticus
Status Epilepticus
Stress Ulcer
Suicidal Patient
Tuberculosis
Thryoid Dysfunction
VRE
MEDICATION ADMINISTRATION  1   2   3   4 
Albuterol (Ventolin)
Aminophylline
Ampicillin
Atropine
Carbamazepine (Tegretol)
Chemotherapeutic Agents
Chloral Hydrate
Clonazapam (Clonopin)
Corticosteroids
Dobutamine
Dopamine
Diazepam (Valium)
Digoxin
Epinephrine
Gentamycin
Growth Hormone
Insulin
Lasix
Metaproterenol (Alupent)
MEDICATION ADMINISTRATION  1   2   3   4 
Nipride
Nitroglycerine
Paralytic Agents
Phenobarbital
Phenytoin (Dilantin)
Prostaglandin
Sodium Bicarbonate
Thyroid Replacement
Vancomycin
Continuous IV infusion
Eye/ear Instillations
IM Injections
IV Push
Metered Dose Inhalers
Nebulizer
Rectal Infusion/Suppository
SQ Injections
Z-track Injections
PROCEDURES/SKILLS  1   2   3   4 
CAVH
Chemotherapy - Peds Protocols
Chest physiotherapy
Chest tube & drainage system
   a. Set up
   b. Assist with insertion
   c. Care & maintenance
   d. Troubleshooting
   e. Removal
EKG Intrepretation
   a. 12 lead
   b. Arrhythmias
   c. Lead placement
End Tidal CO2 Measurement
Extracorporeal Membrane Oxygenation
Extubation
Feedings
   a. Breastfeeding - assist
   b. Breastmilk handling/storage
   c. Bottle
   d. Continuous tube feeding
   e. Gavage, intermittent
Foley/Straight Cath insertion & care
   a. Male
   b. Female
Gastric Lavage
Gastric Suction, low intermittent
Gastrostomy Tube/Site Care
Glascow Coma Scale
Hemodialysis
Hemodynamic Monitoring, Invasive
   a. Swan-Ganz cath insertion assist
   b. Swan-Ganz cath care
   c. MAP
   d. CVP
   e. PAWP/Wedge/PA
   f. Cardiac Output
   g. Cardiac Index
   h. SVO2
   i. Arterial line insertion assist
   j. Arterial line care
Hemodynamic Monitoring, non-invasive
   a. Auscultation
   b. Doppler
   d. Palpation
Interpretation of Lab Results
   a. Blood gases
   b. Bilirubin
   c. CBC
   d. Cultures
   e. Electrolytes
   f. Stool for occult blood
   g. Thyroid Studies
   h. Urine dipstick
Intracranial Pressure Monitoring
Intestinal Tract Tube Insertion/Care
   a. Gastrostomy button
   b. Nasogastric
   c. Nasojejunal
   d. Orogastric tubes
Intravenous Infusions
   a. Blood & Blood Products
      - Albumin
      - Auto infusion
      - Cryoprecipitate
      - Fresh Frozen Plasma (FFP)
      - Packed RBCs
   b. Central line care
      - Broviac
      - Groshong
      - Hickman
      - Percutaneous Arterial Line
      - Percutaneous Venous Line
      - PICC
      - Portacath
      - Quinton
PROCEDURES/SKILLS  1   2   3   4 
Intravenous Infusions (continued)
   c. Hyperalimentation
   d. Intralipids
   e. Peripheral IV insertion & care
      - Angiocath
      - Butterfly
      - Scalp Vein
   f. Saline Lock/Heparin Lock
Intubation (assist with)
Isolation Procedures
Lumbar Puncture (assist with)
Oral Airway Insertion
Oxygen Therapy Administration
   a. Bag & mask
   b. ET tube
   c. Oxyhood
   d. Face mask
   e. Nasal cannula
   f. Trach Collar
   g. Tent
   h. Ambu bag
Peritoneal Dialysis
   a. Automatic cycler
   b. Manual
Specimen Collection
   a. Blood
      - Arterial stick
      - Central line
      - Heel stick
      - Venous stick
   b. Cultures
      - Blood
      - Wound
      - Sputum
   d. Urine
      - Catheter
      - Diaper
      - Suprapubic tap (assist)
      - Urine bag
Splint Application
Suctioning
   a. ET tube - closed
   b. ET tube - open
   c. Nasopharyngeal
   d. Tracheostomy
   e. Oral/Yankauer
Suicide Precautions
Temperature
   a. Axillary
   b. Oral
   c. Tympanic
   d. Rectal
Thoracentesis/Paracentesis - assist with
Traction Application
Wound/Ostomy Care
   a. Colostomy care/bag change
   b. Ileostomy care/bag change
   c. Irrigations
   d. Pressure Ulcers
      - Staging
      - Care
   e. Sterile Dressing Changes
   f. Surgical Wounds with Drains
PAIN MANAGEMENT  1   2   3   4 
Pain assessment using pain scales
Epidural analgesia
IV conscious sedation
Patient controlled analgesia (PCA)
PAIN MANAGEMENT  1   2   3   4 
Narcotic Agents
Non-narcotic agents
Non-pharmacological measures
EQUIPMENT  1   2   3   4 
Blood Warmer
BP Transducer
Cardiac Monitor
Centrifuge
Defibrillator
Glucometer
Infusion Pumps (specific brands)
   -
   -
Oxygen Flow Meter
Phototherapy Equipment
   a. Bili blanket
   b. Bili lights
   c. Bili meter
Pulse Oximeter
Radiant Warmer
EQUIPMENT  1   2   3   4 
Specialty Beds
   a. Air fluidized
   b. Low air loss
   c. Rotating
   d. Stryker
   e. other specify -
Trascutaneous O2 & CO2 Monitor
Transport Incubator
Ventilator
   a. CPAP
   b. High frequency jet
   c. Pressure
   d. Transport
   e. Volume
   f. Oscillating
ASSESSMENT/OTHER  1   2   3   4 
Abdominal Girth Measurement
Admission of patients to unit
Assess Breath Sounds
Assess Heart Sounds
Care Planning
Charge Nurse responsibilities
Circulation Checks
Computerized Charting
ASSESSMENT/OTHER  1   2   3   4 
Fontanel Assessment
Head circumference measurement
Neurological Assessments
Patient Teaching
Thermal Environment Maintenance
Use of Restraints
Vital Signs




   


Age Specific Skills

Check the box under EACH age
group that you have experience
with and are comfortable with for each skill below.		 Neonates
(0-30 days)		 Infants
(1 mo-1 yr)		 Toddlers
(1-3 yrs)		 Preschool
(4-6 yrs)		 School Age
(7-12 yrs)		 Adolescent
(13-18 yrs)		 Young Adult
(19-39 yrs)		 Middle Adults
(40-64 yrs)		 Older Adults
(65+ yrs)
Understands the different communication needs for the age group & changes communication methods and terminology accordingly
Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately
Understands the different safety risks for the age group and alters the environment accordingly
Understands the normal growth and development for the age group and adapts care accordingly





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