Skills Assessment - Pediatric
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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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Care for the Infant
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0
1
2
3
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Care for the Toddler
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0
1
2
3
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Care for the Pre-schooler
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0
1
2
3
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Care for the School-ager
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0
1
2
3
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Care for the Adolescent
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0
1
2
3
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Assess pediatric patient head-to-toe
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0
1
2
3
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Knowledge of age-appropriate vital signs
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0
1
2
3
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Knowledge of normal serum values
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0
1
2
3
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Use of radiant warmers
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0
1
2
3
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Use of phototherapy
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0
1
2
3
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Care for the patient with sepsis
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0
1
2
3
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Care for the patient with failure to thrive
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0
1
2
3
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Care for the patient who is near drowning
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0
1
2
3
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Care for the patient with hyperbilirubinemia
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0
1
2
3
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Care for the patient who has overdosed or been poisoned
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0
1
2
3
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Care for the patient who is post Harrington Rod insertion
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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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Intervene appropriately for 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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Care for patients with 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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Care for patient with 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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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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Assist with cardioversion
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0
1
2
3
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Care for the patient with acute heart failure
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0
1
2
3
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Care for the patient requiring temporary pacing
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0
1
2
3
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Care for the post-op cardiac surgery patient
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0
1
2
3
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Care for the patient in shock
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0
1
2
3
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Care for the pre- and post-cardiac cath patient
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0
1
2
3
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Care for the post-op thoracic surgery patient
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0
1
2
3
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Care for the patient with PDA Ligation
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0
1
2
3
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Care for the patient with Tetralogy of Fallot
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0
1
2
3
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Care for the patient with Transposition of Great Vessels
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0
1
2
3
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Participate in resuscitation as a team member
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0
1
2
3
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Participate in resuscitation by performing defibrillation
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0
1
2
3
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Participate in resuscitation by preparing emergency drugs
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0
1
2
3
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Participate in resuscitation by performing CPR
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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 O2 devices
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0
1
2
3
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Pulse oximetry monitoring
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0
1
2
3
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Open, establish patent airway
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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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Suction and care of endotracheal tube
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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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Care for the patient with asthma
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0
1
2
3
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Care for the patient with mechanical ventilation
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0
1
2
3
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Care for the patient with RDS
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0
1
2
3
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Care for the patient with chest tubes
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0
1
2
3
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Care for the patient with a tracheostomy
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0
1
2
3
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Care for the patient with cystic fibrosis
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0
1
2
3
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Care for the patient with pulmonary edema
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0
1
2
3
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Care for the patient with respiratory distress
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0
1
2
3
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Care for the patient with respiratory failure
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0
1
2
3
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Neurological:
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Assess Glasgow Coma Scale
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0
1
2
3
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Identify sudden change in LOC
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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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Reflex assessment (Babinski, gag)
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0
1
2
3
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Identify, intervene for seizure
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0
1
2
3
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Care for the patient with ICP monitoring
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0
1
2
3
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Care for the patient who is post-op neurosurgical
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0
1
2
3
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Care for the patient in a comatose state
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0
1
2
3
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Care for the patient by assisting with lumbar puncture
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0
1
2
3
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Care for the patient with neuromuscular disease
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0
1
2
3
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Care for the patient with meningitis
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0
1
2
3
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Care for the patient with a brain tumor
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0
1
2
3
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GI/Renal/Endocrine/Nutrition:
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Insert nasogastric tube
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0
1
2
3
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Care for the patient with gastroenteritis
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0
1
2
3
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Care for the patient with dehydration
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0
1
2
3
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Care for the patient with Diabetes mellitus
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0
1
2
3
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Care for the patient with a GI bleed
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0
1
2
3
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Care for the patient with hemodialysis
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0
1
2
3
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Care for the patient with DKA
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0
1
2
3
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Care for the patient with TPN
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0
1
2
3
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Care for the patient with enteral nutrition
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0
1
2
3
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Care for the patient with bowel obstruction
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0
1
2
3
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Care for the patient with appendicitis
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0
1
2
3
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Care for the patient with pH probe
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0
1
2
3
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Care for the patient with gastroesophageal reflux
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0
1
2
3
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Hematology/Oncology:
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Administer blood and blood products
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0
1
2
3
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Administer chemotherapeutic agents
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0
1
2
3
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Care for the patient with neutropenia
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0
1
2
3
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Care for the patient with Sickle Cell Anemia
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0
1
2
3
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Care for the patient with HIV
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0
1
2
3
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Care for the patient with Leukemia
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0
1
2
3
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Care for the patient with Hodgkin's Disease
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0
1
2
3
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Medications:
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Calculate pediatric dosing
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0
1
2
3
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Use of Infusion/Syringe pump
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0
1
2
3
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Use PCA pumps
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0
1
2
3
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Use epidural pumps
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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 Epinephrine
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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 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 Atropine
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0
1
2
3
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Administer IV Thrombolytics (i.e., 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 Benzodiazepines (i.e., 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 Management/Miscellaneous:
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Assessment of pain level/tolerance/manage
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0
1
2
3
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Care of the child with Epidural anesthesia/analgesia
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0
1
2
3
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Admit unstable patient
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0
1
2
3
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Transport patient within hospital for testing
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0
1
2
3
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Start peripheral IV/scalp vein
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0
1
2
3
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Maintain a heparin/saline lock
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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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Newborn/Neonate (birth - 30 days)
Infant (30 days-1year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (65+)
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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
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0
1
2
3
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