telemetry skills checklist
TRANSCRIPT
Telemetry Skills Checklist
FREEDOM MEDSTAFF INC.
Name: Date:
Years of Experience :
Directions for completing skills checklist:
The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate your level of expereince/proficiency with each area and, where applicable, the types of equipment and/or systems you are familiar with. Use the following key as a guideline:
A) Theory Only/No Expereince--Didactic instruction only, no hands on experience B) Limited Experience--Knows procedure/has used equipment, but has done so
infrequently or not within the last six months C) Moderate Experience--Able to demonstrate equipment/procedure, performs the
task/skill independently with only resource assistance needed. D) Proficient/Competent--Able to demonstrate/perform the task/skill proficiently
without any assistance and can instruct/teach.
A. CARDIOVASCULAR
1. Assessment a. Auscultation (rate, rhythm)
b. Doppler
c. Heart sounds/murmurs
d. Pulses/Circulation checks 2. Interpretation of Lab Results
a . Cardiac Enzymes/lsoenzymes
b. Coagulation studies 3. Equipment & procedures
a. Monltotrlng/Telemetry
(1) Arrhythmia Interpretation
(2) Basic 12 lead interpretation
(3) Lead placement: 5 electrode telemetry
(4) Lead placement: I, III, V-leads (5) Lead placement: Lead II and MCLl
b. Pacemaker
(1) Permanent
(2) Temporary epocardial wires (3) Temporary external placement
( 4) Temporary transvenous
c. Assist with:
(1) Arterial line insertion (2) Central line insertion
d . Hemodynamlc monitoring
(1) A-line (radial)
A
0
0 0
0
0 0
0
0 0 0 0
0 0 0
0
0 0
0
B
0
0 0
0
0 0
0 0
0 0 0
0 0 0
0
0 0
0
C
0
0 0
0
0 0
0 0 0 0 0
0 0 0
0
0 0
0
D
0
0 0
0
0 0
0 0 0 0 0
0 0 0
0
0 0
0
FREEDOM MEDSTAFF INC.
(2) CVP monitoring 0 0 0 0
(3) Femoral artery sheath removal 0 0 0 0
(4) Swan-Ganz 0 0 0 0
e. Perform
( 1) Controlled cardioversion 0 0 0 0
(2) Emergency defibrillation 0 0 0 0
(3) Cardiopulmonary resuscitation (CPR) 0 0 0 0
4 . Care of the patient with:
a. Abdominal aortic bypass 0 0 0 0
b. Aneurysm 0 0 0 0
c. Angina 0 0 0 0
d. Cardiac arrest 0 0 0 0
e. Cardiomyopathy 0 0 0 0
f. Carot id endarterectomy 0 0 0 0
g. Congestive heart failure (CHF) 0 0 0 0
h. Femoral-popliteal bypass 0 0 0 0
I. Post acute MI (24-48 hours) 0 0 0 0 j . Post angioplasty 0 0 0 0
k. Post arthrectomy (DCA) 0 0 0 0
I. Post CABG (24 hours) 0 0 0 0
m. Post cardiac catheterization 0 0 0 0
n. Post stent placement 0 0 0 0
o. Cardiogenic shock 0 0 0 0
5. Medications
a. Atropine 0 0 0 0
b. Diuretics 0 0 0 0
c. Digoxin 0 0 0 0
d. Andrenergics 0 0 0 0
e. Beta blockers 0 0 0 0
f. Ca+ channel blockers 0 0 0 0
g. Lidocaine 0 0 0 0 h. Vasopressors 0 0 0 0
I. Nitrates 0 0 0 0
j . Antiarhythmics 0 0 0 0 k. Preparation of emergency medications 0 0 0 0
I. Oral, IV and subcutaneous anticoagulants 0 0 0 0
m. Thrombolyt ic agents 0 0 0 0
B. PULMONARY
1. Assessment
a. Breath sounds 0 0 0 0
b. Breathing patterns 0 0 0 0
2. I nterpretation of Lab Results
a. Arterial blood gases 0 0 0 0
b. Blood chemistry
3. Equipment and procedures 0 0 0 0
a. Assist with intubation 0 0 0 0
b. Assist with thoracentesis 0 0 0 0
c. Care of airway management devices/suctioning 0 0 0 0
( 1) Endotracheal tube/suctioning
(2) Nasal airway/suctioning 0 0 0 0
(3) Oropharyngeal/suctioning 0 0 0 0
FREEDOM MEDSTAFF INC.
( 4) Oximetry 0 0 0 0
(5) Sputum specimen collection 0 0 0 0
( 6) Tracheostomy/suctioning 0 0 0 0
d. Care of patient on ventilator
(1) Extubation 0 0 0 0
(2) Weaning modes 0 0 0 0
e. Care of patient with chest tube:
(1) Assist with set-up & insertion 0 0 0 0
(2) Mediastinal tube removal 0 0 0 0
(3) Pleural tube removal 0 0 0 0
( 4) Use of Pleurevac or Thoraclex 0 0 0 0
(5) Use of water seal drainage system 0 0 0 0
f. Chest physiotherapy 0 0 0 0
g. Establishing an airway 0 0 0 0
h. Incentive spirometry 0 0 0 0
I. Oxygen therapy & medication delivery systems
(1) Ambu bag and mask (2) ET tube 0 0 0 0
(3) External CPAP
( 4) Face masks 0 0 0 0
(5) Inhalers 0 0 0 0
(6) Nasal cannula 0 0 0 0
(7) Portable oxygen tanks 0 0 0 0
(8) Tracheostomy 0 0 0 0
(9) Transtracheal cannulation 0 0 0 0
j. Oral airway insertion 0 0 0 0
k. Restraints 0 0 0 0
4. Care of the patient with:
a.ARDS 0 0 0 0
b. Bronchoscopy 0 0 0 0
c.COPD 0 0 0 0 d. Fresh trachostomy 0 0 0 0
e. Lobectomy 0 0 0 0
f . Pneumonectomy 0 0 0 0 g. Pneumonia 0 0 0 0
h. Pulmonary edema 0 0 0 0
I. Pulmonary embolism 0 0 0 0
j . Status asthmaticus 0 0 0 0
k. Thoracotomy 0 0 0 0
I. Tuberculosis 0 0 0 0
5. Medications
a. Aminophylline 0 0 0 0
b. Corticosteroids 0 0 0 0
c. Atrovent 0 0 0 0
d. Antibiotics 0 0 0 0
e. Albuterol 0 0 0 0
C. NEURO LOGI CAL
1. Assessment
a. Cerebellar function 0 0 0 0
b. Cranial nerves 0 0 0 0
c. Glasgow coma scale 0 0 0 0
FREEDOM MEDSTAFF INC.
d. Level of consciousness 0 0 0 0
e. Pathologic reflexes 0 0 0 0
2. Equipment and procedures
a. Assist with lumbar puncture 0 0 0 0
b. Halo traction 0 0 0 0
c. Nerve stimulator 0 0 0 0
d. Rotation bed 0 0 0 0
e. Seizure precautions 0 0 0 0
f. Use of hyper/hypothermia blanket 0 0 0 0
g. Bed alarms 0 0 0 0
3. Care of the patient with :
a. Aneurysm precautions 0 0 0 0
b. Basal skull fracture 0 0 0 0
c. Closed head injury 0 0 0 0
d. Coma 0 0 0 0
e. TIA/CVA 0 0 0 0
f. DT's g. Encephalitis 0 0 0 0
h. Externalized VP shunts 0 0 0 0
I. Meningitis 0 0 0 0
j. Mulitple sclerosis 0 0 0 0
k. Neuromuscular disease 0 0 0 0
I. Post Craniotomy 0 0 0 0
m. Seizures 0 0 0 0
n. Spinal cord injury 0 0 0 0
4. Medications
a. Dilantin 0 0 0 0
b. Phenobarbitol 0 0 0 0
c. Versed 0 0 0 0
d. Lasix/Mannitol 0 0 0 0
e. Val ium 0 0 0 0 f. Morphine sulfate 0 0 0 0
g. Oral analgesics/narcotics 0 0 0 0
D. GASTROINTESTINAL 1. Assessment
a. Abdominal/bowel sounds 0 0 0 0
b. Fluid Balance 0 0 0 0
c. Nutritional 0 0 0 0
2. Interpretation of blood chemistry 0 0 0 0
3. Equipment and procedures
a. Administration of tube feeding (1) Feeding pump 0 0 0 0
(2) Gravity feeding 0 0 0 0
b. Flexible feeding tube (Corpak, Dobhoff, etc.) 0 0 0 0
c. Placement of nasogastric tube 0 0 0 0
d. Salem sump to suction 0 0 0 0
e. Saline lavage 0 0 0 0
4. Management of:
a. Gastronomy tube 0 0 0 0
b. Jejunostomy tube 0 0 0 0
c. PPN (peripheral parenteral nutrition) 0 0 0 0
FREEDOM MEDSTAFF INC.
d. TPN and lipids administration 0 0 0 0
e. T-tube 0 0 0 0
5. Care of the patient with:
a. Bowel obstruction 0 0 0 0
b. Colostomy 0 0 0 0
c. ERCP 0 0 0 0
d. Esophageal bleeding 0 0 0 0
e. GI bleeding 0 0 0 0
f. GI surgery 0 0 0 0
g. Hepatitis 0 0 0 0
h. Ileostomy 0 0 0 0
I. Inflammatory bowel disease 0 0 0 0 j. Liver failure 0 0 0 0
k . Liver transplant 0 0 0 0
I. Pancreatitis 0 0 0 0
m. Paralytic ileus 0 0 0 0
n. Whipple procedure 0 0 0 0
o. Pre/post open abdominal surgery 0 0 0 0
E.RENAL/ GENITOURINARY 1. Assessment
a. A-V fistula/shunt 0 0 0 0
b. Fluid & elctrolyte imbalance 0 0 0 0
2. Interpretation of BUN & cretinlne 0 0 0 0
3. Equipment and procedures a. Foley catheter insertion
(1) Female 0 0 0 0
(2) Male 0 0 0 0
b. Supra-pubic
c. Bladder irrigation 0 0 0 0
(1) Continuous 0 0 0 0
(2) Intermittent d. Specimen collection
(1) Routine 0 0 0 0
(2) 24 hour 0 0 0 0
e. Nephrostomy tube ca re f . Manual CAPO administration 0 0 0 0
g. Peritoneal dialysis via automatic cycler
4. Care of the patient with: 0 0 0 0
a. Hemodialysis 0 0 0 0
b. Nephrectomy 0 0 0 0
c. Peritoneal dialysis 0 0 0 0
d. Renal failure 0 0 0 0
e. Renal transplant 0 0 0 0
f. TURP 0 0 0 0
F. GYNECOLOGY 1. Assessment
a. Assist with gynecological exam/PAP 0 0 0 0
b. Breast care/self-examination education 0 0 0 0
2. Interpretation of lab results 0 0 0 0
3. Care of the patient with :
FREEDOM MEDSTAFF INC.
a. Gynecological surgery 0 0 0 0
b. Gynecological malignancy 0 0 0 0
c. Mastectomy 0 0 0 0
d. Hyserectomy 0 0 0 0
G. METABOLIC
1. Assessment
a. S/S diabetic ketoacidosis 0 0 0 0
b. S/S insulin shock 0 0 0 0
2. Interpretation of lab results
a. Blood glucose 0 0 0 0
b. Thyroid levels 0 0 0 0
3. Equipment and procedures
a . Blood glucose monitoring (1) Blood glucose measuring device type:
(2) Insulin administration-IV drip 0 0 0 0
(3) Visual blood glucose strips 0 0 0 0 4 . Care of the patient with:
a. Cushing's syndrome 0 0 0 0
b. Diabetes insipidus 0 0 0 0
c. Diabetes mellitus 0 0 0 0
d. Diabetic ketoacidosis 0 0 0 0
e. Disorders of adrenal gland (Addison's disease) 0 0 0 0
f. Drug overdose 0 0 0 0
g. Hyperthyroidism 0 0 0 0
h. Hypothyroidism 0 0 0 0
I. Pheochromocytoma 0 0 0 0
j . Post adrenalectomy 0 0 0 0
k. Post hypophysectomy 0 0 0 0
I. Post thyroidectomy 0 0 0 0
5. Medications
a. Hydrocortisone 0 0 0 0
b. IM vasopressin (Pitressin) 0 0 0 0
c. Insulin 0 0 0 0 d. Prednisone 0 0 0 0
e. Radioactive iodine 0 0 0 0
H. WOUND MANAGEMENT
1. Assessment
a. Skin for impending breakdown 0 0 0 0
b. Stasis ulcers 0 0 0 0
c. Surgical wound healing 0 0 0 0
2. Equipment and procedures a. Air flu idized, low airloss beds 0 0 0 0
b. Sterile dressing changes 0 0 0 0
c. Wound care/irrigations 0 0 0 0
d. Perform cast care 0 0 0 0
e. Maintain traction (skin/skeletal) 0 0 0 0
3. Care of the patient with:
a. Burns 0 0 0 0
b. Pressure sores 0 0 0 0
c. Staged decubitus ulders 0 0 0 0
FREEDOM MEDSTAFF INC.
d. Surgical wounds with draln(s) 0 0 0 0
e. Traumatic wounds 0 0 0 0
I. PHLEBOTOMY / IV THERAPY 1. Equipment and procedures
a. Drawing blood from central line 0 0 0 0
b. Drawing venous blood 0 0 0 0
C. Starting IVs
(1) Angiocath 0 0 0 0
(2) Butterfly 0 0 0 0
(3) Heparin lock 0 0 0 0
d. Administration of blood/blood products
(1) Albumin/plasma 0 0 0 0
(2) Cryoprecipitate 0 0 0 0
(3) Packed red blood cells 0 0 0 0
( 4) Whole blood 0 0 0 0
2. Care of the patient with:
a. Peripheral line/dressing 0 0 0 0
b. Central line/catheter/dressing
(1) Broviac 0 0 0 0
(2) Groshong 0 0 0 0
(3) Hickman 0 0 0 0
( 4) Portacath 0 0 0 0
(5) Quinton 0 0 0 0
J. PAI N MANAGEMENT
1. Assessment
2. Care of the patient with:
a. Anesthesia/analgesia 0 0 0 0
b. IV conscious sedation 0 0 0 0
c. Narcotic Analgesia 0 0 0 0
d. Patient control led analgesia 0 0 0 0
K. MISCELLANEOUS 1. Infectious diseases (HIV/AIDS) 0 0 0 0
2. Anitbiotice Resistance Infections 0 0 0 0
3. Chemotherapy 0 0 0 0
4. Patient education 0 0 0 0
5. Informed Consent 0 0 0 0
6. Computerized charting 0 0 0 0
7. Automated medication dispensing systems 0 0 0 0
8. AMA procedures yes 0 no 0
9. Suicide precautions yes 0 no 0
AGE SPECIFIC PRACTICE
A. Newborn/Neonate (birth - 30 days) D.Preschooler (3 - 5 years) I G.Young adults (18 - 39 years)
B.Infant (30 days - 1 year) E.School age children (5 - 12 years) H.Middle adults (39 - 64 years)
C.Toddler ( 1 - 3 years) F.Adolescents (12 - 18 years) I.Older adults (64+)
EXPERIENCE WITH AGE GROUPS A B C D E G H
FREEDOM MEDSTAFF INC.
Retyped name acts as signature, if submitting form by email.______________________________________________________________Signature:
Able to adapt care to incorporate normal growth 0 0 0 0 0 0 0 0
and development.
Able to adapt method and terminology of patient instructions to 0 0 0 0 0 0 0 0
their age, comprehension and maturity level.
Can ensure a safe environment reflecting specific needs of 0 0 0 0 0 0 0 0
various age groups.
My experience is primarily in: (Please Indicate number of years) O Medical year(s) 0 Cardiothoracic year(s) 0 Neuro year(s)
O Neurological year(s) O Cardiovascular year(s) 0 Burn year(s)
0 Trauma year(s) 0 Coronary care year(s) 0 PACC year(s)
0 Other (specify) year(s)
Signature Date