| super: Student name: JOSSiCO McVeever ed copy of this checklist to every lab, simulation, and clinical day. Ensure lab/simulation or clinical faculty demonstration or observation of skills by signing and dating in the appropriate box. Scan a copy of the signed Psychomotor Skills Checklist and upload it into the appropriate drop box in LoudCloud at the end of every didactic course with skills lab experiences and every clinical course. Note: Students are responsible for maintaining the original signed copy of this checklist throughout the duration of the program. Uploading the xd to advance from semester to semester and to graduate. Students are not required to demonstrate 8. Instructions for Students: Take a pri document into the appropriate courses is requi or observe every skill on this form in the clinical Instructions for Lab Faculty: Print, sign, and date below each skill to acknowledge the student's successful demonstration in the lab setting, Students must be signed off by lab faculty for all required skills prior to demonstration in clinical. : Sign and date in the appropriate box next to each skill to acknowledge the student's successful demonstration/ observation I, Students must be signed off by lab faculty on a required skills prior to demonstration in clinical. Students are not expected to observe or 1, however, clinicians should look for opportunities for students to observe and demonstrate as many skills as of the demonstrate all listed skills in ci possible, Studengfignature and Date Level 1: 27/19 Aripiledge that | have demonstrated or observed the (/23]20 jedge thot hove demonstrated or rate. student aoe and Date - Level 3 -dge that | have demonstrated or By signing, Lacknowledge that | have demonstrated or observed the skills cated. indicated. Skil checklists can be found in the textbook Clinical Nursing Skills and Techniques, &th ed., by Perry, Potter, and Ostendorfsruoewrnane: Desgicor McKeever Lab Setting Clinical Setting Lab Faculty Printed Name, Signature, and Date (Include below after student has successfully demonstrated each skill in lab.) Clinician Printed Name, Signature, and Date Student Demoed or | Observed Required Level 1 Lab Skills-*these skills must be signed off in lab prior to demonstration in clinical Documentation and Informatics **Giving a handoff report Asus MMWOH TAS po Documenting nurses’ progress notes KOodlews NEON 95-206 * Adverse event/incident reporting EE Geta alia Vital Signs: ~ *Measuring body temperature 57, LZ, GEM Kay YalPat mse 10.1444, + * Assessing radial pulse F—#LZG, ZV Gj Rat kunswEd, FAssesfing a re Pt oa \" ~ a resi stions Skt, FANG “assessing manual blood pressure Ske, G5 9 \ Rall Wed Kon. 104 _|: sTupent wame: Jeosica, Moen ev” All of * Assessing blood pressure electronically Kee dire MIL 419 wane) LL, sth (o “4 lo jo jo lo *PBA Vital Signs (Level 1) } (2414 Health AsSessment ‘% *General survey SH, we “*Head and neck assessment KeeQiura ors ad sohols Skeletal and néurologic assessment Cree ISSEIRN Ff 3)14 * Monitoring intake and output Kee QQire Noe i014 lo jo Jolo Jojo |o Jo Jo Jo Jo jo jo Jo *PBA - Head-to-Toe Assessment (Level 1) Queene tht "ls/eqSTUDENT NAME: Ai LSSiCOA Mcteev aoe Medical Asepsis *Hand hygiene S Z, ‘, Qi) 15 ae LU pots, 149 Me *isolation precautions Yo ) fGen. movre4.e0 93 hig | Yala nsvel Sterile Technique _ Applying and removing cap, mask, and protective eyewear LED MIAN as)iq fe Patient Handling, Transfer and Positioning *Using safe and effective transfer techniques eo Gee mpr2lrs fhe Moving and positioning clients in bed Cpeer, WOR Bdien 9/3/14 Personal Care and Bed Making “Bathing a client, f= Loe, mp2 2/3/17 Sk “Perineal care LS Gen tne Kn %/3)9© stupent NAME: Jessi Ico. W\ chew or aE * T hygiene a) Re a Pe rg of dentures: D M ao “ ° forming mouth care for unconscious/debilitated client ; D oi" a ° ssist wi mov ZA me) ‘era KoglIm lGse ° o *Making an unoccupied bed Kl l Lo > ne, w. 10 27. 3. i E> Qua marelil hg ‘ ° *Use of a urinal KY EPL MEA o Ke alwys mes ew 0-18 Me = 5 [K “Making an occupied bed oes ae i — {¥ D Cpece, MaIr-2,120) Wa/t Teo | aa + 0 >} *Positioning client on a bedpan or fracture pan 7 yy { {a4 a 4# oD Ko Gh ere Msp DB RVR ° Oxygen Therapy "1 ig nasal cannula or oxygen mask > Geen meptdid 'Yo(1 | KU pfAynitn, | jo *Using incentive spirometry Gueer ste "Ye fig Le lo jo jowea lia Ysa {a4 [a. ‘STUDENT NAME: Jes, icq Meteover *Administering intramuscular injections u hia lie Okebnchy msn] en ge ‘Therapeutic Use of Heat and Cold ‘Midstream urine; Urine specimen from existing indwelling cathe KG, OO Mer 215 \O-V\9 |ehy Galas hs 21 %/e | *Collecting a timed urine specimen KE. Qliw Mev ew 01? @ ‘Blood glucose monitoring *(Level 1 and 3) | <& Gueee, mepvedias '/e/eq Lp FA by MMS o.22.(% “Urine screening for glucose, ketones, protein, blood, and pH KO odes MNEIWE \o-119STUDENT NAME: jessy CO Meveow Optional Additional Skills to Sate in Clinical Anytime During or After Level 1 Health Assessment Genitalia and rectum assessment Exercise and Ambulation Pegforming range-of- motion exercises Ny) qa att elastic stockings and sequential compression device rr Guerre Ena "es ‘Assjsgfig with ambulation and use of canes, crutches, and walker ath Support §yfaces and Special Beds i support surfaces EG MMA Fala Placing a client on an air-suspension or a Safety and Quality Improvement “Applying a physical restraint Seizure precautionsstuoentame:cbssica McVeever- Pain Management and Basic Comfort Measures ipharmacologic pain management Moy Prot Care of ffe Eye and Ear Eye care for nonresponsive clients Care of hearing aids Airway Management Performing oropharyngeal suctioning 2 Ge reveal! elie Dressings and Bandages Applying a dressing tary bandage (Ure 1 [p4[a0 KYeal Bain: 11, ‘Applying a transparent bandage ‘Applying gauze and elastic bandages‘STUDENT NAME; Je SS i COL Meteor’ by Specimen Collection ‘Measuring occult blood in stool L2G ral th hia Sputum collection Elimination Emptying of ostomy bag KORO) WED AD OS Required Level 2 Lab |S-*these skills must be signed off in lab prior to demonstration in clinical -On insertion of an G Tube-in the required *PBA, Medication Administration (Level 2) shunt. ut pal 1/2] e20 Urinary Elimination 7 *PBA - Foley Catheter Insertion (Level 2)_ stuentname: Jpssjca Mc teew ex~ * | Additional Optional Skills to be Demonstrated in Clinical | Anytime During or After Level 2 Intravenous and Vascular Access Therapy ting intravenous therapy Mata ("ean Regulating intravenous flow rate ‘Changing IV solutions ‘Changing infusion tubing Discontinuing short peripheral intravenous access WUbhrn PANE os foo20 Enteral Nutrition Inserting and removing a small-bore nasogastric/nasoenteric feeding tube Verifying feeding tube placement irrigating a feeding tube ‘Checking feeding tube residualsssicn Mele or STUDENT NAME: jejunostomy tube ‘Administering enteral nutrition: Nasoenteric, gastrostomy, or Ostomy Care Pouching a colostomy or an ileostomy Perioperative Care Preparing a client for surgery Wound Care Performing a wound assessment Wound irrigation Managing wound drains Urinary Elimination Insertion of a straight or indwelling urinary catheter bauctieprend tefre Care and removal of an indwelling catheter Wbrsuntptutzenl Taf ooSTUDENT NAME: dessict Mcteovex *| Required Level 3 Lab Skills-tthese skills must be signed offin tab prior to demonstration in clinical Medication Administration *PBA - Medication Administration (Level 3) Intravenous and Vascular Access Therapy *PBA - Central line dressing change Airway Management “Performing tracheostomy care Closed Chest Drainage Systems ‘Managing closed-chest drainage system ‘Specimen Collection *Blood glucose monitoring *(Level 1 and 3) | Antepartum/Intrapartum/Postpartum *Gestational assessment ole *Fundus check lo *Lochia evaluation °stuoenr nawte;, JPSSi COU Meteor oe . “Pali nceessiet oo Jo |. *Breast assessment “Wound assessment | Newborn/Pediatric Newborn head to toe assessment *Vital signs (TPR, BP, pain management, pulse oximetry) “Weight and Height "Measurements (OFC , Chest circumference, abdominal girth) ° *Gestational age assessment lo jo Jo *Reflex assessment ° *Head-to-Toe assessment of pediatric client |: sruoenr name: JESSica, Meveove— a Optional Skills to be Demonstrated in Cl ical Anytime | During or After Level 3 Oxygen Therapy a | ‘Administering oxygen to a client with an artificial airway : ~ > aor Using a peak flow meter o ° Care of a client on a mechanical ventilator o oO irway Management Airway suctioning D x oO Performing endotracheal tube care D ° Parenteral Nutrition ‘Administering parenteral nutrition through a central line D ° ‘Administering parenteral nutrition through a peripheral D ° | Newborn/Pediatric Medication administration to pec nt - parenteral D ° Medication administration to pediatric client - oral D ° Required Level 4 Lab Skills-*these skills must be signed off in *PBA - Medication Administration (Level 4) D oOsruoenrnawe JeSSiCo, Mic eee AT INSTRUCTOR SIGNATURES PEL kd pone Ps [otic Typing J= BLN | Tessica Aspen Vcieny Collins KOoldeto MSN.ONI Be Asan Gaver BRM Wye inthe Hirdoo. RN gR_BSN, RN, Oe Candace Schinde yign Rn Opn? cPen WVatem= MSN Melissa. Petrick, Pal, INS Farce PRy2t- Prec Niroite ew ben Nissa Qelevson Meloerw am we Farley fie fires