PEDIATRIC CHECKLIST


NAME:       ID #:       DATE:       This Skills Checklist is to be used by nurses with more than one year experience in their discipline and specialty. Please be accurate with your assessment. DESCRIPTION 1 2 3 NEUROLOGICAL: 1. Assessment – level of
consciousness

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b. Apnea monitor DIRECTIONS: Please indicate your level of experience by placing a check (√) in the box. Experience level: 1 NO EXPERIENCE 2 MINIMAL EXPERIENCE-requires
supervision/assistance

3 4

MODERATELY EXPERIENCED-requires initial review, then performs independently VERY EXPERIENCED- proficient

2. Equipment & Procedures: a. Application of splints b. Assist with lumbar puncture c. Cast d. ICP monitoring e. Pinned fractures f. Traction 3. Care of child with: a. Battered child syndrome b. Closed head trauma c. Clubfoot d. Encephalitis e. Febrile seizures f. Meningitis g. Multiple trauma h. Near drowning 4. Medications: a. Corticosteroids b. Dilantin (Phenytoin) c. Phenobarbital RESPIRATORY 1. Assessment: a. Breath sounds b. Rate and work of breathing 2. Equipment & procedures: a. Airway management (1) bulb syringe (2) Nasal airway/suctioning (3) Oral airway/suctioning (4) Tracheostomy/suctioning 1 | Page

DESCRIPTION 1 2 3 4 c. Chest physiotherapy d. Chest tubes e. End tidal CO2 f. Oximeter g. O2 therapy & medication delivery: (1) Bag and mask (2) Isolette (3) Nasal cannula (4) Nebulizer (5) Oxyhood (6) Tent (7) Trach collar h. Water seal drainage system 3. Care of the patient with: a. Bronchiolitis (RSV) b. Bronchopulmonary dysplasia (BPD) c. Cystic fibrosis d. Epiglottitis e. LTB/Croup f. Pertussis g. Pneumonia h. Tonsilitis i. Tuberculosis j. Asthma 4. Medications: a. Alupent (Meraproteranol) b. Aminophylline (Theophylline) c. Isuprel (Isoproterenol) d. Ventolin (Albuterol) CARDIOVASCULAR 1. Assessment:

PEDIATRIC CHECKLIST
a. Auscultation (rate, rhythm, volume) b. Blood pressure/non-invasive c. Heart sounds/murmurs d. Perfusion Name:       DESCRIPTION 1 2 3 4 2. Interpretation of lab results: a. Arterial blood gases b. Hemoglobin & hematocrit 3. Equipment & procedures: Basic EKG interpretation 4. Care of the child with: a. Bacterial endocarditis b. Bowel obstruction c. Cardiac arrest d. Cardiomyopathy e. Myocarditis f. Congenital heart defects/disease g. Pericarditis h. Post cardiac Surgery i. Rheumatic fever j. Tracheoesophageal fistula GASTROINTESTINAL 1.Assessment: a. Abdominal b. Nutritional 2. Equipment & procedures: a. Feedings: (1) Assist with breast feeding (2) Bottle (3) Central Hyperalimentation (4) Gavage (5) Peripheral Hyperalimentation b. Jejunal feeding c. NG and sump tubes to suction d. Penrose drains e. Placement of naso/Orogastric tube f. Wound irrigation/dressing change 2 | Page

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3. Care of the child with: a. Anal fissure b. Cleft lip/palate c. Colostomy d. Diaphrogmatic hernia e. Failure to thrive (FTT) f. Gastroenteritis/dehydration g. GI bleeding h. Ileostomy i. Intestinal parasites ID #:      DESCRIPTION 1 2 3 4 j. Pyloric stenosis k. Surgical abdomen ENDOCRINE/METABOLIC 1. Assessment 2. Equipment & procedures: a. Blood glucose testing type:       3. Care of the child with: a. Adrenal Disorders b. Cushing’s syndrome c. Juvenile diabetes d. Pituitary disorders e. Thyroid malfunction 4. Medications: a. Growth hormone b. Insulin c. Thyroid 5. Interpretation of lab results: a. Blood glucose b. Thyroid studies RENAL/GENITOURINARY 1. Assessment of fluid balance 2. Interpretation of lab results a. BUN & creatinine b. Urinalysis 3. Equipment & procedures: a. Assist with supra-pubic tap b. Catheter insertion (1) Catheter care (2) Female (3) Male (4) Straight (5) Indwelling c. Collection of urine specimen

PEDIATRIC CHECKLIST
4. Care of the child with: a. Circumcision b. Hemodialysis c. Ileal conduit ureteral d. Nephrotic syndrome e. Peritoneal dialysis f. Renal failure g. Urinary tract infection h. Wilm’s tumor Name:       DESCRIPTION ONCOLOGY 1. Assessment of nutritional status 2. Care of the child with:
a. Disseminated intravascular coagulation (DIC)

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(2) Packed red blood cells (3) Whole blood b. Drawing blood from central line c. Drawing venous blood d. Starting IVs (1) Angiocath (2) Butterfly (3) Heparin lock. c. Knowledge of emergency drug
and reaction

action

1 2 3 4

d. Pediatric drug actions & reactions MISCELLANEOUS 1. Interpretation of lab values: a. Blood Chemistry b. Blood hematology ID #:       DESCRIPTION 1 2 3 4 c. Blood gases 2. Care of the child with: a. Central line/catheter/dressing: (1) Broviac (2) Groshong (3) Hickman (4) Portacath (5) Quinton b. Cutdown line/dressing c. Peripheral line/dressing 3. Fever management 4. Isolation 5. AIDS 6. Common childhood communicable diseases 7. Cytomegalo virus (CMV) 8. Hepatitis 9. Lyme disease COMPUTERIZED CHARTING 1. Cerner 2. Eclipsys 3. Epic 4. McKesson 5. Meditech 6. Other: Other: Other:

b. Inpatient chemotherapy c. Anemia d. Leukemia e. Malignant tumors f. Depressed immune system g. Sickle cell anemia h. Hemophilia i. Hodgkin’s disease j. Infectious mononucleosis k. Spleen trauma/splenectomy 3. Medication: a. Chemotherapy certification? No b. Calculation of pediatric doses c. Eye/ear installations d. Knowledge of emergency drugs e. Knowledge of routine pediatric drugs f. Metered dose inhaler g. Prednisone 4. Interpretation of lab results: a. Blood chemistry b. Blood counts 5. Equipment & procedures- reverse (1) Cryoprecipitate 3 | Page

Yes

isolation a. Administration of blood/blood products:

PEDIATRIC CHECKLIST

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PEDIATRIC CHECKLIST
Name:       Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care. A. Newborn/Neonatal (birth – 30 days) B. Infant (30 days – 1 year) C. Toddler (1 – 3 years) D. Preschool (3 – 5 years) E. School Age Children (5 – 12 years) F. Adolescent (12 – 18 years) G. Young Adults (18 – 39 years) H. Middles Adults (40 – 64 years) I. Older Adults (64 + years) EXPERIENCE WITH AGE GROUPS: 1. Able to assess age appropriate behavior, motor skills and physiological norms. A B C D E F G H I

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MY EXPERIENCE IS PRIMARILY IN: NEUROLOGY PULMONARY SURGICAL MEDICAL CARDIAC CARE TELEMETRY                                     years years years years years years

I HAVE CURRENT CERTIFICATIONS FOR: TYPE DATE (MM/DD/YY) ARRHYTHMIA CRITICAL CARE ACLS BCLS TNCC NRP PALS NALS BTLS CCRN Other       Other       COURSE                                                                        

2. Able to adapt care according to normal growth and development. A B C D E F G H I

3. Able to communicate and instruct patient according to their age, maturity and comprehension ability. A B C D E F G H I

The information I have provided in this knowledge and skills checklist it true and accurate to the best of my knowledge.       Signature
(Written/Electronic)

      Date

ID #:       This skills checklist has been reviewed and approved by Nicole Bloxham, RN.       Signature
(Written/Electronic)

4. Able to provide a safe environment according to the specific needs of various age groups. A B C D E F G H I

      Date

ID #:       5 | Page

PEDIATRIC CHECKLIST
Please return to: Northwest Nurse Company, PA ATTN: Records Dept. Fax: (866) 352-4338 Staffing

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Email: records@nns-ic.com

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