Skills Assessment - PACU
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The following checklist will be used to match your skills and interests with available assignments.
Please enter your information, and we will store this information with your application/profile.
Please indicate your level of proficiency by marking the appropriate number.
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First Name:
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Middle Initial:
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Last Name:
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SSN:
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E-mail Address:
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Home Phone:
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Work Phone:
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Cell Phone:
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City:
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State:
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0. Theory, no practice 1. Limited 2. Confident 3. Very Confident
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General:
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Experience:
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Admit pre-op patient to pre-op holding
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0
1
2
3
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Complete assessments
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0
1
2
3
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Start peripheral IV
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0
1
2
3
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Complete pre-op checklist
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0
1
2
3
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Transport pre-op patient to OR
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0
1
2
3
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Knowledge of post-op complications of general anesthesia
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0
1
2
3
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Knowledge of discharge criteria from PACU
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0
1
2
3
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Transport post-op patient to in hospital units
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0
1
2
3
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Isolation technique
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0
1
2
3
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Cardiovascular:
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Assess heart sounds and peripheral pulses
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0
1
2
3
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Interpret arrhythmias
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0
1
2
3
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Assist with arterial line insertion
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0
1
2
3
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Provide care to the patient with an arterial line
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0
1
2
3
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Draw blood samples from arterial line
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0
1
2
3
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Interpret arterial line waveform/pressures
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0
1
2
3
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Remove arterial line
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0
1
2
3
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Assist with S/G insertion
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0
1
2
3
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Provide care to the patient with S/G
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0
1
2
3
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Provide care to the patient with SvO2 S/G catheter
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0
1
2
3
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Interpret PA waveforms/pressures
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0
1
2
3
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Remove S/G catheter
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0
1
2
3
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Assist with central line insertion
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0
1
2
3
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Draw blood samples from central line
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0
1
2
3
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Remove central line
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0
1
2
3
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Assist with cardioversion
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0
1
2
3
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Set up and run 12 Lead ECG
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0
1
2
3
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Provide care for the post-op cardiac surgery patient
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0
1
2
3
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Provide care for the patient with an IABP
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0
1
2
3
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Provide care for the patient in shock
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0
1
2
3
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Provide care for the post-op peripheral vascular surgery patient
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0
1
2
3
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Provide care for the post-op AAA patient
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0
1
2
3
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Perform CPR
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0
1
2
3
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Perform defibrillation
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0
1
2
3
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Participate as a team member in resuscitation
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0
1
2
3
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Pulmonary:
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Assess lung sounds
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0
1
2
3
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Set up oxygen devices
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0
1
2
3
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Obtain pulse oximetry reading
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0
1
2
3
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Interpret ABG
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0
1
2
3
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Assess ventilator settings
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0
1
2
3
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Troubleshoot ventilator alarms
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0
1
2
3
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Suction using in-line suction catheter
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0
1
2
3
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Use Ambu bag
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0
1
2
3
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Assist with intubation
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0
1
2
3
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Assist with chest tube insertion
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0
1
2
3
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Provide care for the patient with mechanical ventilation
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0
1
2
3
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Provide care for the patient with ARDS/PEEP therapy
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0
1
2
3
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Provide care for the patient with chest tube
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0
1
2
3
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Provide care for the patient with a tracheostomy
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0
1
2
3
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Neurological:
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Identify sudden change in level of consciousness
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0
1
2
3
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Assess sensory, motor, speech
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0
1
2
3
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Assess reflexes (Babinski, gag)
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0
1
2
3
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Identify and intervene for seizure
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0
1
2
3
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Obtain ICP and CPP values
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0
1
2
3
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Provide care for the patient with ICP monitoring
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0
1
2
3
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Provide care for the post-op neurosurgical patient
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0
1
2
3
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Medications:
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Titrate vasoactive drugs
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0
1
2
3
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Calculate mcg/min and mcg/kg/min
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0
1
2
3
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Use IV infusion pump to calculate drug doses
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0
1
2
3
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Use PCA pump
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0
1
2
3
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Use epidural pump
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0
1
2
3
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Administer IV epinephrine
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0
1
2
3
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Administer IV dopamine
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0
1
2
3
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Administer IV norepinephrine (Levophed)
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0
1
2
3
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Administer IV phenylephrine (Neo-Synephrine)
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0
1
2
3
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Administer IV nitroglycerine
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0
1
2
3
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Administer IV nitroprusside (Nipride)
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0
1
2
3
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Administer IV dobutamine (Dobutrex)
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0
1
2
3
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Administer IV milrinone (Primacor)
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0
1
2
3
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Administer IV metoprolol (Lopressor)
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0
1
2
3
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Administer IV lidocaine
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0
1
2
3
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Administer IV amiodarone (Cordarone)
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0
1
2
3
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Administer IV adenosine
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0
1
2
3
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Administer IV diltiazem (Cardizem)
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0
1
2
3
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Administer IV esmolol (Brevibloc)
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0
1
2
3
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Administer IV verapamil
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0
1
2
3
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Administer IV ibutilide
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0
1
2
3
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Administer IV atropine
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0
1
2
3
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Administer IV thrombolytics (TPA, streptokinase)
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0
1
2
3
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Administer IV heparin
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0
1
2
3
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Administer IV GP llb/llla inhibitors (ReoPro, Aggrastat, Integrilin)
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0
1
2
3
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Administer IV benzodiazepines (Valium, Versed, Ativan)
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0
1
2
3
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Administer IV Propofol (Diprivan)
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0
1
2
3
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Administer IV neuromuscular blocking agents (Pavulon, Norcuron)
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0
1
2
3
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Administer IV morphine
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0
1
2
3
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Pain/Wound Management:
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Assess pain level/tolerance
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0
1
2
3
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Care of patient with anesthesia/analgesia
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0
1
2
3
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Care of patient with IV conscious sedation
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0
1
2
3
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Care of patient with narcotic analgesia
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0
1
2
3
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Care of patient with patient controlled analgesia (PCA pump)
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0
1
2
3
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Assess surgical wound status with/without drain(s)
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0
1
2
3
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Care of patient with sterile dressing changes
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0
1
2
3
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Age-Specific Practice Criteria:
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Please check the box corresponding to each
age group for which you have expertise in
providing age-appropriate nursing care.
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Pediatric (1 - 12years)
Adolescents (12 - 18 years)
Adult (19 - 65 years)
Older Adult (Older than 65 years)
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Experience With Age Groups:
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Calculate body weight to verify correct dosing of medication
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0
1
2
3
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Assess immunization status for pediatric, and adolescent
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0
1
2
3
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Set age-appropriate short-term and long-term goals in care planning
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0
1
2
3
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Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years
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0
1
2
3
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